Have you ever wondered if your personal injury case could be impacted if you received Medicare and/or Medicaid payments? If so, the answer to this question is definitely, yes. Both attorneys and their clients have duties and obligations to Medicare under the Medicare Secondary Payer (MSP) law as well as to Medicaid. In Utah, Medicaid’s right to recover third-party lability payments is outlined in Utah Code. Consequently, if you are a Medicare and/or Medicaid recipient and either entity has paid for medical bills that were due to the fault of another, Medicare and Medicaid have a legal right to receive reimbursement of costs they have expended should you receive a settlement.
Moreover, both entities are precluded from paying medical costs if the expenses incurred should be covered under a third-party liability claim. This may be either Worker’s Compensation Benefits or PIP “no-fault” benefits available under your automobile insurance policy (until you can prove exhaustion of these benefits). After that, any benefits paid on your behalf which relate to your third-party liability claim will need to be reimbursed to Medicare and/or Medicaid at the conclusion of your case.
If you are a Medicare or Medicaid recipient, your attorney is required to notify Medicare and/or Medicaid and inform them they represent you in connection with a personal injury action. Of course, it is best that this occurs during the early stages of your case. You will need to sign an Authorization for Medicare allowing them to communicate with your attorney. Your attorney’s office will then work with Medicare and/or Medicaid to ensure they are informed of the progress of your case and to obtain an accurate and correct amount of the benefits they have paid relating to your personal injury case.
Medicare and Medicaid must be paid out of any settlement funds obtained prior to any other distributions being made. Medicare and Medicaid will pay their pro-rata share of attorney’s fees and costs, but their reimbursement will occur prior to you, or your attorney, receiving any of the settlement funds. Additionally, both entities require verification of the settlement amount, a copy of the Fee Agreement retaining your attorney, an itemization of case costs, and confirmation that any other available insurance was utilized. It is very important that the details of this part of your settlement are handled accurately and professionally.
