Personal Injury Claims & Medicare Mandatory Reporting Requirements

If you are a Medicare beneficiary, or represent someone in that position, it is important to be knowledgeable about federal legislation that requires the reporting of any personal injury settlement, judgment, or award to the Centers for Medicare & Medicaid Services (CMS), and the mandatory reimbursement of any benefits paid by Medicare for an injured person. Under the law, Medicare is entitled to recover from insurers and other settling parties all benefits paid for treatment of a personal injury.

It is the plaintiff’s responsibility to identify and satisfy the Medicare conditional payment obligations from the date of injury to the date of settlement or judgment. To report, a plaintiff must submit information directly to CMS to determine what benefits have been paid related to their injury. Within 60 days after receiving a settlement, judgment, award, or other payment, Medicare beneficiaries have an obligation to refund conditional payments to CMS. Additionally, the plaintiff must also screen for future costs that may be shifted over to Medicare (i.e. Medicare Set Aside) from the date of settlement onward. Any attorney representing a Medicare beneficiary shares the responsibility of ensuring reimbursement to CMS.

Penalties can be brought against both the reporting entity and the personal injury plaintiff for failure to report and reimburse Medicare. If the injured person fails to reimburse Medicare, he or she may lose Medicare coverage and Social Security may offset benefits. Other penalties may also be assessed.

More information about mandatory reporting and reimbursing Medicare can be found at If you are unsure about your responsibilities as a personal injury plaintiff, seek the assistance of an experienced personal injury attorney.

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Adam Sturdivant

After earning his law degree from The Ohio State University and practicing in Columbus, Ohio, Adam returned to Michigan and joined Drew, Cooper & Anding in 2008. He was named Partner in 2011. Adam’s blend of litigation and transactional work concentrates in the areas of labor-employment, catastrophic injuries, and contract matters involving real estate and business transactions. A fierce competitor and strategist, Adam helped achieve multi-million dollar results across his disciplines since joining DCA in cases involving construction site injuries, sexual harassment in the workplace, and wrongful death. Adam has annually been recognized by Super Lawyers as a Rising Star since 2013 and by National Trial Lawyers as a Top 40 Under 40 attorney since 2014.