Medicare and Lien Claims

Posted by Mary Skinner

Question:
I have a client that was injured in a 3rd party liability situation and seeks medical services from a provider. Client is a Medicare beneficiary. Provider files lien (in excess of 120 days from release of patient) instead of filing for Medicare and billing supplemental insurer. Provider argues that it did not know patient was a Medicare beneficiary at time of treatment. Provider will not reduce billing/lien by reduction of "procurement costs". It is our argument that "procurement costs" would be the reduction of the lien by a proportionate share of our attorney fee/costs for total settlement of liability claim. Is this a valid argument?

Oklahoma Attorney

Answer:
As of May 2006 providers do not have to bill Medicare. If they choose, they can recover from the settlement proceeds for actual charges; they do not have to bill Medicare. However, once they submit a claim to Medicare it negates their right to seek recovery for actual charges. With that said, because they are aware now that that your client is a Medicare beneficiary, they can bill Medicare but they must withdraw their lien. They cannot have a lien and submit a claim to Medicare.

Please feel free to contact me if you would like to discuss further.

Mary Skinner