CMS Files Suit Against Carriers

It’s happened!

On December 1, 2009, The United States through the Centers for Medicare and Medicaid Services (CMS) filed a lawsuit under the Medicare Secondary Payer Statute (42 U.S.C. § 1395y(b)(2)) in Federal District Court for the Northern District of Alabama.  Click here for a copy of the lawsuit.

The Medicare Secondary Payer Statute provides that when a Medicare beneficiary receives medical care and related services for which there is a “primary payer,” Medicare is entitled to reimbursement within 60 days.  The reimbursement is to come from either the “primary payer” or any person or entity who received payments from the “primary plan.”  The statute allows CMS to sue the “primary payer” or any entity or person who has received payment under the “primary plan”.  If reimbursement is not received, CMS may recover double damages (twice the amount actually paid).

The suit filed by CMS arises out of a $300Million settlement reached in a class action entitled Abernathy v. Monsanto Company in which CMS filed suit against:

1. The plaintiffs’ attorneys.
2. The defendants’ insurance companies.
3. The defendant companies themselves.

The suit seeks:

1. Reimbursement of all sums paid by CMS which should have been paid by the “primary payer.”
2. Double the amount of those payments.
3. Interest.
4. Declaratory relief.

How Does This Apply To California Workers’ Compensation?

California Workers’ Compensation carriers are “primary payers” under the Medicare Secondary Payer Statute.  Self-insured employers, self-insured groups and possibly even high retention employers are also “primary payers.”  As a result, all are potentially subject to liability the statute.

From a practical standpoint, the Medicare Secondary Payer Statute can result in a workers’ compensation defendant being liable for pre and post settlement medical treatment regardless of the terms of the settlement.

HSSP has extensive experience handling California workers’ compensation matters in ways which may minimize or even eliminate the risk to defendants created by Medicare Secondary Payer Statute.  There is no “one size fits all” solution to the unique problems arising out of each workers’ compensation matter.  All HSSP attorneys are expertly trained to spot and handle CMS related issues.  Let us help you navigate the difficult issues.

To learn more about how we can help you with your case, please contact us today!

Message

Heggeness, Sweet, Simington & Patrico, A P.C.
.........................................
Locations:

San Diego
7071 Convoy Court
Suite 200
San Diego, CA
92111-1023
Phone (858) 874-2100

Riverside
6180 Quail Valley Court
Suite 110
Riverside, CA
92507-0757
Phone (951) 656-1944

Santa Ana
600 West Santa Ana Boulevard
Suite 700
Santa Ana, CA
92701-4555
Phone (714) 550-1133

Bay Area
1633 Bayshore Highway
Suite 360
Burlingame, CA
94010-1537
Phone (650) 350-1908