Medicare Extension Act

Written By:
Paulette Campbell RN-BC, BSN, MJ
Certified Legal Nurse Consultant

Section 111 of the Medicare, Medicaid and SCHIP Extension Act requires that liability insurers must report information about liability claimants who are entitled to Medicare. These requirements include; those insurers who are self-insured, no fault claims and continues to require worker’s compensation insurers. These Medicare requirements for liability insurers will affect the settlements of both personal injury and mass tort cases.

This law was enacted as an attempt for Medicare to cut down on the expenses that they are paying out to those whose medical expenses could or should be paid by other means. In 1980, Congress enacted the Medicare Secondary Payer status which requires insurers to pay for medical expenses and moves Medicare from primary to secondary payer.

If the reporting is not completed in a timely manner, the Department of Health and Human Services can enforce at $1000 penalty per day. Moreover, there is concern that legal malpractice claims can be made against attorneys by clients for not properly identifying the insurers or ensuring that monies were properly allocated through settlements for future medical expenses.

Medicare provides healthcare coverage to over 42 million individuals. Over 35 million of those individuals are age 65 or older, and 6 million are under the age of 65 and have permanent disabilities. At least thirty three percent of Medicare beneficiaries have disabilities or a chronic illness that limits their ability to care for themselves. Medicare is administered by the centers for Medicare and Medicaid Services which is a division of the U.S. Department of Health and Human Services.

If you have a medical chart that you would like us to screen, involving Medicare or other healthcare needs, contact our office at Medical Jurisprudence, Inc today at 630-551-0978 or e-mail us at info@medicaljurisprudence.com. Our medical legal consultants have solutions ready for your practice today.