Those procedures are that the hospital must first submit charges to the “property and casualty insurer and primary medical payer of benefits available” to the injured person when that person is injured as a result of negligence or wrongful acts of another person, before filing a lien. The state appellate court clarified that neither Medicare nor Medicare are primary payers of medical benefits and because of this, held that Hospitals in Colorado do not need to bill Medicare and/or Medicaid before filing a lien.
Therefore, Colorado hospitals interested in collecting larger amounts of money than Medicare and/or Medicaid will pay will likely forego billing Medicare and/or Medicaid, and will put the at fault party on notice of its charges, will bill the liability carrier for the at fault party, and then proceed to file a lien against the injured party likely to receive a third party liability settlement.
Of course the charges must be related to the underlying third party liability injury and must be reasonable and necessary. So even if a Colorado hospital lien is perfected, the injured party has a right to dispute whether the charges are injury-related and to contest the reasonableness or necessity of the charges.
Call Medivest when your injured client is facing a hospital lien to allow our specialists to first determine if all of the requested charges are related to the underlying injury, and to negotiate with the lien holder or its recovery agent regarding the amount of reasonable and necessary charges. Don’t let your client pay unreasonable or unnecessary hospital bills even when a lien is filed!
*While this case has not been released for publication in permanent law reports and could be subject to a petition for rehearing in the Court of Appeals or for Certiori in the Supreme Court of Colorado, it is important to be aware of hospital practices in this regard.
Today marks yet another case where a plaintiff firm has entered into a settlement with Medicare over failure to consider Medicare’s interest with conditional payments. Like previous cases, the law firm will be required to pay a lump sum to the US government. In addition, they must:
1. Name a person responsible for paying Medicare secondary payer debts
2. Train the employee to ensure that the firm pays these debts on a timely basis
3. Review any additional outstanding debts to ensure compliance
4. Provide written certifications of compliance.
Over the past year, there has been a clear trend showing Medicare being very intentional about enforcing the MSP in liability cases. This case is just the latest to go along with several other recent cases:
We all know the MSP explicitly names liability insurance as a primary plan. In conjunction with the most recent round of notifications from the Office of Management and Budget (OMB) regarding the release of a NPRM clarifying methods of protecting Medicare’s interests post settlement for liability cases, these recent settlements with plaintiff firms highlight Medicare’s intent to have parties to liability settlements protect Medicare’s interests in compliance with the MSP just as is expected in Workers’ Compensation claims.
Partner with Medivest to help uncover public benefits, diagnose, and prepare preservation and legal compliance plans prior to settlement. MSP compliance is an exercise in protecting Medicare’s past interests via the investigation and resolution of payment obligations regarding past payments made by Medicare or Medicare Advantage Plans (liens) and its future interests regarding expected medical treatment in the injured party’s future (MSAs). Let our nursing staff perform a medical review to project the injury related future medicals broken down into both Medicare covered and non-Medicare covered medicals. For Medicare or any case involving recovery claims by any public or private source, allow our lien resolution department to use its proprietary software and experience to confirm amounts being requested are injury related and negotiate reductions beyond the ordinary procurement costs typically allowed. For Medicare cases, there is no charge for the portion of the reduction associated with those procurement cost reductions. Let us support you on your next case.