Post-settlement Payment to Medicare

Posted by Mary Skinner

Question:
Over three years ago we settled a Fen Phen claim for a client that was not eligible for Medicare yet. Even though they were not eligible, out of caution we submitted to CMS/Medicare a listing of all of our Fen Phen clients (including this client) to confirm that liens did not exist. Medicare did not respond in regard to this client's status.

The settlement included a future payment if the client had heart valve surgery before a specified date. The total value of the settlement, including the settlement guarantee, was less than $200,000.

The client has since then had heart valve surgery. We learned post-surgery that he started using Medicare in the last year or two and that Medicare paid for the surgery.
Given these facts, are we still obligated to hold this post-settlement payment from a client that was not Medicare eligible at the time of settlement and contact Medicare?

-Texas Attorney

Answer:
Although your client was not Medicare entitled at the time of settlement, he was entitled when he received the settlement for surgical guarantee. Having said that, you will need to open a record with Medicare, using the surgery date as the date of incident and reimburse Medicare for any injury related claims they may have paid.

Regards,
Mary Skinner