Medicare Reporting Requirements

Following the event of an accident, Medicare beneficiaries can expect Medicare to cover the resulting health care costs. This coverage comes with strings attached, however, as Medicare recipients are subject to strict requirements for reporting accidents and any ensuing tort claims.

These requirements are designed to ensure that Medicare is reimbursed for coverage under any group health plan arrangements and in the event of a personal injury settlement, judgment or award related to the accident. Regardless of the payment source (tortfeasor; tortfeasor’s liability insurance, including self-insurance; no-fault insurance; workers’ compensation; or other), Medicare is entitled to tap into this money for full reimbursement. 

Client plaintiffs who are Medicare recipients should approach the reimbursement requirement with cautious diligence, for there is no gray area when it comes to this obligation. In fact, the current reporting requirement puts the onus directly on the Medicare client plaintiff by requiring prompt reporting of any such settlement, judgment or award within 60 days. Failure to do so can result in a fine up to $1,000.00 per day. That’s real money, and it adds up fast.

The strict standards for reporting are relatively new. According to the Centers for Medicare and Medicaid Services, Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added the mandatory reporting stipulations, which went into effect in 2010. The requirements include mandatory repayment criteria for all Medicare beneficiaries who receive settlements, judgments, awards or other payment from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation, collectively referred to as Non-Group Health Plan (NGHP) or NGHP insurance.

Medicare is determined to recover each and every dollar to which it is entitled. If a plaintiff neglects to report this information, there is a good chance that Medicare will find out anyway. Medicare scrutinizes payment reports provided by liability insurers. These reports leave a fresh trail leading to non-reported claims. Medicare also programs its computer software to flag payments for certain injury-related treatments. Thus, if a Medicare recipient breaks a bone in a car accident—and does not report the accident to Medicare—that person will probably receive a letter at some point inquiring about a possible personal injury claim, and, if one exists, asking for the details of the claim. A person who receives such a request must comply. Failure to respond could jeopardize that person’s Medicare eligibility and result in a possible criminal offense.

Considering these strict penalties, as well as Medicare’s formidable ability to seek out scofflaws, it doesn’t pay to neglect Section 111 reporting requirements. Plaintiffs who are Medicare recipients should approach their reporting responsibility with serious diligence. Complying with the reporting law not only preserves the Medicare program, it protects the plaintiff’s personal, familial and financial interests. If you have been considering a personal injury lawsuit, don’t forget to ask your attorney about your Medicare reporting obligations.

Amanda Narvaes

Amanda P. Narvaes, a Partner, joined Drew Cooper & Anding in 2011. Ms. Narvaes is a civil litigator in the areas of complex commercial litigation, lender liability, copyright litigation, and consumer protection. She graduated cum laude from Carleton College with a bachelor’s degree in history. She earned her law degree at WMU-Thomas M. Cooley Law School, graduating magna cum laude, and received Cooley’s Distinguished Student Award. Ms. Narvaes represents clients before Michigan trial courts across the state and in the Michigan Court of Appeals, and before the United States District Courts for the Western and Eastern District of Michigan. Ms. Narvaes has been a guest speaker in Ron Foster’s “Litigation for Paralegals” class. Ms. Narvaes discusses differences between Federal civil discovery rules and Michigan civil discovery rules.