Posted by Mary Skinner
We just settled a MVA case and are working on our demand letter request for Medicare. The beneficiary is now deceased. Medicare never filed a claim in the estate and we joined Medicare as a party to the suit and they did not file an answer. Can we default them on their lien or because they did not file a claim against the estate, is its lien still valid?
Medicare’s lien is still valid, they do not have to file a claim against the estate as they have a priority right of recovery. The death of a beneficiary does not materially change Medicare's interest in recovering it's benefits made on the behalf of the beneficiary while still alive.
Section 42 CFR 411.23 states that a beneficiary must cooperate in any action taken by the Centers for Medicare and Medicaid Services in recovering conditional payments. Failure to do so or not protecting the Medicare program during and after settlement negotiations may result in CMS taking action against the beneficiary to collect the mistaken payment.
In the event that reimbursement is not made to Medicare as required by 42 USC 1395y(b)(2)(B)(I), action may be brought against any entity responsible for payment (and may collect double damages from insurance companies), or any entity that has received a third-party settlement. Under 42 CFR 411.24(g), this includes attorneys whose fees are paid from settlement proceeds.
Additionally, if you have sent the MSPRC an authorization signed by the client prior to their death that authorization is no longer valid. In order to receive information from the MSPRC at this point you will need to send in a new authorization signed by the executor/administrator of the estate along with the Letter of Testimary from the court.