| When we first speak to a potential client, or concerned | | | | Surgery $8000; Four day hospital Stay $7000; and |
| family member, we always ask: | | | | twenty days in the Nursing Home getting rehab, $4000. |
| - "Is your loved receiving Medicare or Medicaid | | | | Medicare will have paid at least $21,400.00 for Edna's |
| benefits?" | | | | care, and effectively can take almost every penny of |
| - "Is your health insurance provided by your | | | | her $25,000 settlement after attorneys' fees and |
| employer?" | | | | costs...so we warn clients, right away - THERE IS A |
| - "Were you injured on the job?" These may seem like | | | | POTENTIAL LIEN ON YOUR RECOVERY... AND WE |
| strange and somewhat irrelevant questions but they | | | | WON'T KNOW HOW LARGE OF A LIEN UNTIL THE |
| are essential for determining whether to file a lawsuit. | | | | END. Not only is this scary for many clients, it will often |
| Medicare | | | | be enough of a deterrent the family will decide not to |
| If you are sixty-five years old or older, then you are | | | | file suit. |
| entitled to Medicare insurance coverage through the | | | | And Medicare is not the only party who can claim a |
| federal government. If so, and often without your | | | | lien. |
| knowledge or notice, Medicare will be billed for and pay | | | | Medicaid |
| for a portion of your medical care and treatment. | | | | In Virginia, and most other states, programs exist to |
| Medicare may even pay for a portion of your nursing | | | | provide a level of healthcare for those who cannot |
| home stay. If so, any lawsuit you file where you seek | | | | afford it. There is no age limit to Medicaid, but rather an |
| repayment for medical care necessary as a result of | | | | income cap. Like Medicare, Medicaid has a right to |
| another's negligence, Medicare has a right to seek | | | | seek repayment for monies paid on behalf of a |
| repayment for the services they paid for on your | | | | beneficiary. If you file a lawsuit against a nursing home, |
| behalf. | | | | doctor, or even as a result of a car accident, if |
| For example - Edna, age 65, falls on an open can of | | | | Medicaid paid for a portion of your care, they will seek |
| soup at her local grocery store. The store manager | | | | repayment. And here is the real-kicker - both Medicaid |
| calls 911 when Edna is unable to walk and the | | | | and Medicare can seek repayment on the same |
| ambulance arrives. The rescue squad takes Edna to | | | | lawsuit.... So if Edna in the above example was on |
| Local Community Hospital where Edna is evaluated in | | | | disability or had an income qualifying her for Medicaid |
| the emergency room. She is admitted to the hospital | | | | benefits, Medicare could seek a lien for the $21,400 it |
| when her doctors realize she has fractured her right | | | | paid, and Medicaid could do the same if it paid any of |
| hip and requires surgery. Edna has surgery and two | | | | her related bills. |
| days after surgery she is discharged to a nursing | | | | Other possible liens |
| home for rehab after the hip surgery. | | | | If you receive health insurance benefits through your |
| If Edna files a lawsuit against the grocery store for | | | | employer as a result of a qualified ERISA plan, the plan |
| negligence and personal injury and recovers $25,000, | | | | will likely be entitled to reimbursement if you are |
| Medicare will seek repayment of any monies paid on | | | | successful in pursuing a claim against a negligent party. |
| her behalf for injuries related to the fall. Under Federal | | | | It is very important to discuss these issues with your |
| law, Medicare does not have to provide Edna notice | | | | attorney. |
| that they plan on seeking repayment. See 42 CFR | | | | Conclusion |
| §411.26. | | | | Our office staff spends weeks after a case has |
| But how much will Medicare seek in repayment? | | | | concluded, trying to work with Medicare and Medicaid |
| Sadly, we cannot answer that question for Edna or | | | | on liens. Sometimes they are more than we anticipate |
| her family. Each lien is determined on a case by case | | | | and on good days, they are less.... But the existence |
| basis... but by law, Medicare should reduce their | | | | and amount of liens is always a factor in our |
| demand, taking into consideration there were costs | | | | discussions on whether to take a case, settle a case, |
| with filing a lawsuit or seeking a settlement (including | | | | etc. If you know the lien could be overwhelming, |
| attorneys' fees, expert's fees, etc.). But what if the | | | | sometimes legal action is not the appropriate choice. |
| ambulance bill was $400; Emergency Room $2000; | | | | |