Doctor Billing / Medicare

Posted by Matthew Garretson and Mary Skinner

Question:
Matt, I'm a trial attorney in Miami getting ready to try a PI case. The Chicago treating doctor is claiming an outstanding bill of $47,000 even though he is a Medicare provider who previously billed Medicare and was paid by it and the supplemental insurance carrier. The defense is trying to limit me to only asking the jury for medicals in the amounts paid by Medicare as per Florida law. In other words, even though the doctor is billing for his full bill and says he expects to be paid, my client would not be able to recover his full bill at trial. I am aware of the law change in 2006 allowing providers to bill or lien the liability insurer. I saw your blog on it as well. It is my understanding that if the doctor does bill Medicare then he/she can't still pursue the liability lien. And, further, the doctor can't get clever and pay back Medicare and then take the full bill from the liability recovery. Am I correct?

-Florida Attorney

Answer:
Your understanding on this issue is consistent with mine. Mary Skinner, our Manager of Medicare Services may be able to offer further insight.

-Matt Garretson

You are correct in your understanding. The provider is not permitted to bill Medicare and then seek payment of actual charges, nor can he return the payment and seek actual charges. Doing so is a violation of his provider agreement with Medicare. For your convenience, here is some information that you can present to the provider to alert him to this fact: 40.2 Billing in MSP Liability Insurance Situations and Provider/Supplier Billing in MSP Liability Accident Situations. If you need further assistance please give me a call.

-Mary Skinner