Navigating Medicare Liens in Personal Injury Claims in New York State

Medicare card and fake cash with eyeglasses and a pen

For 35 years, Basch & Keegan, LLP has been dedicated to serving the Kingston, NY community with exceptional legal representation. When you're pursuing a personal injury claim in New York State (NYS), you may have encountered the term "Medicare lien." If you are injured in an accident and Medicare pays for some of your treatment, you will be obligated to reimburse Medicare for these payments if you bring a personal injury claim and get financial compensation for the accident.

Medicare liens are an essential aspect of personal injury law, and understanding how they work is crucial for both plaintiffs and personal injury attorneys. At Basch & Keegan, LLP, we're Here to Help guide you through this complex process. In this blog, we'll delve into what Medicare liens are, how they can impact your personal injury claim in NYS, and strategies to navigate them effectively.

What is a Medicare Lien?

A Medicare lien is a legal claim by the federal government against your personal injury settlement or judgment to recover the costs of medical treatment provided to you for injuries related to the accident. Medicare is a federal healthcare program available to individuals aged 65 and older, as well as certain younger individuals with disabilities. When Medicare covers medical expenses related to your personal injury, they have a right to recover those costs if you receive compensation from a liable party.

What Law Gives Medicare Reimbursement in Personal Injury Cases?

Under two federal statutes, 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)/Section and § 1862(b)(2)(A)(ii) of the Social Security Act, the Medicare program may not pay for medical expenses for a tort victim when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.”

This federal law also unambiguously gives the Medicare program subrogation rights if it does make payments. The law provides: “The United States shall be subrogated (to the extent of payment made under this subchapter for such an item or service) to any right under this subsection of an individual or any other entity to payment concerning such item or service under a primary plan.” 42 U.S.C. § 1395y(b)(2)(B)(iv).

How Medicare Liens Affect Your Personal Injury Claim

  1. Conditional Payment Notice (CPN): After Medicare pays for your medical bills related to your personal injury, they send you a Conditional Payment Notice (CPN). This notice outlines the medical expenses they covered and the amount they expect to recover from your settlement or judgment.
  2. Reporting to Medicare: As a plaintiff or personal injury attorney at Basch & Keegan, LLP, you are legally obligated to report your personal injury claim to Medicare. Failing to do so can result in penalties.
  3. Negotiating with Medicare: Medicare may be willing to negotiate the amount they claim from your settlement. Our experienced personal injury attorneys can help negotiate these liens to minimize their impact on your compensation.
  4. Protecting Your Settlement: It's essential to handle Medicare liens carefully, as failing to satisfy them can lead to the government withholding a portion of your settlement, leaving you with less compensation for your injuries.

Navigating Medicare Liens in NYS with Basch & Keegan, LLP

Navigating Medicare liens in NYS can be complex, but with the right strategies and Basch & Keegan, LLP on your side, you can protect your interests and maximize your compensation:

  1. Early Identification: Identify Medicare's involvement early in the personal injury claim process to ensure compliance with reporting requirements.
  2. Legal Assistance: Hire an experienced personal injury attorney at Basch & Keegan, LLP in NYS who is well-versed in Medicare lien resolution. They can help you navigate the intricacies of Medicare liens, negotiate effectively, and protect your settlement.
  3. Comprehensive Documentation: Maintain thorough records of all medical treatments and expenses related to your personal injury. This documentation will be crucial when negotiating with Medicare and ensuring accurate lien amounts.
  4. Timely Reporting: Promptly report your personal injury claim to Medicare to avoid potential penalties and streamline the lien resolution process.
  5. Negotiation Expertise: Our attorneys can negotiate with Medicare to reduce the lien amount, ensuring you receive the maximum compensation available.

Basch & Keegan, Here to Help

Medicare liens can significantly impact your personal injury claim in New York State, potentially reducing your compensation if not managed correctly. At Basch & Keegan, LLP, we are celebrating 35 years of legal excellence, and we remain dedicated to protecting your rights and securing the compensation you deserve. By following the appropriate steps and seeking legal guidance, you can navigate Medicare liens effectively and focus on your recovery and well-being.

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