4. Medicare Right to Reimbursement


Where CMS makes a conditional payment, and a primary plan is determined to be responsible, the reimbursement of the Medicare Trust is mandatory. FN 1. Sounds simple enough, but below is the CMS description of the process:

Recovery Process

Determining the scope and limitations of the MSP right to reimbursement is where the action is, and we will explore this below. A word of caution, however. It is much more than a lien. FN 2. Medicare has been granted what has been called a “primary right of reimbursement”, which allows it to seek reimbursement from a wide range of persons involved with a personal injury claim, including the parties, the lawyers, the insurers and the medical providers. Almost everyone has a stake in complying with the MSP, and in this situation ignorance is the opposite of bliss.

FN 1.42 U.S.C. § 1395y(b)(2)(B)(ii); 42 C.F.R. § 411.22.

FN 2.Zinman v. Shalala, 835 F.Supp. 1163, 1171, 1993 WL 426075 (N.D.Cal. 1993).