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Why Does Medicare Get Paid Back from an Injury Settlement?


If you’ve been hurt in a car accident or slip and fall injury recently and you are a Medicare beneficiary, you might have received something in the mail from “CMS” or Center for Medicare and Medicaid Services. The letter may say something about the government’s right of reimbursement and your obligation to notify Medicare before accepting any settlement funds. But why would Medicare be allowed to take part of your money? After all, Medicare is something we all pay for through payroll deductions.

When working with an experienced Clearwater personal injury lawyer, the attorney should generally handle all communications with Medicare on your behalf. Here’s what you need to know about Medicare.

You Can’t Double Dip 

The law disfavors double recoveries. In other words, if you have been injured and recover compensation, you should only be allowed to recover once for your injuries. Because Medicare pays for medical care, you should not be allowed to keep money that was paid to you in order to compensate for medical expenses. Another way to look at it is this. Someone damages your property. A friendly neighbor gives you money to fix the damage for now, but you later recover money from the person who damaged the property. Wouldn’t it make sense that you should give the friendly neighbor back their money, now that you were compensated?

Medicare is Still a Good Deal

Medicare contracts with service providers to get better deals. This means a hospital that normally bills $5,000 for an ER visit might only receive $800. So, for someone who receives a personal injury settlement, it may be tough to part with that money and reimburse Medicare, but it’s a little less difficult when you realize that without Medicare, you would likely have to pay the full cost of care.

How Does Medicare Recover Funds?

Medicare collects reimbursement through a secondary payor program. There is an electronic online portal where attorneys can create an account to manage client accounts. A personal injury attorney will generally review the charges that Medicare claims are related to your injuries. Any unrelated charges will be disputed. Once the final amount is known, you and your attorney can take this amount into consideration when trying to negotiate a settlement with the negligent defendant in your case.

Final Thoughts on Medicare

In recent years, insurance companies have become particularly difficult when dealing with Medicare. Often, adjusters will refuse to turn over settlement funds until Medicare produces a “final demand” letter or a “closure letter.” Florida law does not necessarily require this, but insurance companies are often overly cautious in order to avoid being hit with penalties. Therefore, when you are settling your case, just keep in mind that even once the funds are received, it could be up to 60 days or more before you can actually receive the funds. This is because you must wait for Medicare to conclude its review and issue the requisite letters.

Call Roman & Roman, P.A.

It’s best to let the professionals handle Medicare. If you’ve been hurt and you’re a Medicare beneficiary, let the attorneys of Roman & Roman, P.A. represent you from start to finish. Call or visit us online to learn more.





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