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Medicare Consul Liens
Lien Resolution Services
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MCS ORM Demand Resolution
Medicare Reimbursement Services
The MSPRC seeks recovery directly from the beneficiary with notice given to the beneficiary's representative. When Medicare recovers a payment made by a Primary Plan (e.g., workers' compensation carrier) from the beneficiary, it does not seek to recover more than the settlement amount. Medicare may demand up to the settlement amount minus any procurement costs if Medicare's conditional payment exceeds the settlement amount, but in practice Medicare tries to leave some of the settlement for the beneficiary.
Although there is no law requiring insurers (payers) to "Protect Medicare's Interest" by directly reimbursing Medicare, Medicare can seek recovery directly from the insurer if they are unable to recover from the beneficiary (See CFR 411.25). The two most common ways Insurer's have been using to protect Medicare's interest are:
- Two or three party check with the MSPRC as one of the payees
- Indemnification by plaintiff
Two Party Checks
Process -- Insurer issues a check that includes plaintiff and/or plaintiff attorney and MSPRC as a payees. Plaintiff countersigns the check and submits it to the MSPRC.
Advantage -- The funds cannot be spent before Medicare cashes the check
Disadvantage -- Discourages settlement, plaintiff and plaintiff attorney not paid timely
Plaintiff indemnification
Process -- Settlement documents include indemnification by plaintiff that Medicare will be reimbursed
Advantage -- Encourages settlement
Disadvantage -- If the plaintiff does not reimburse Medicare, Medicare may still demand reimbursement from the Insurer and recourse to plaintiff may be financially very limited
