A new law from Washington is expected to speed up the process of reaching a final payout for people who have a personal injury settlement and used Medicare to pay some of their related medical expenses.
"Bureaucratic inefficiency at the federal Centers for Medicare & Medicaid Services (CMS) can add months or even years to the process of getting a final payment for a claim," said Kennewick personal injury attorney Brian Anderson. "During this period, my client often has to wait until Medicare is reimbursed for its costs before he or she can receive any payment. The Medicare bureaucracy takes it time about getting the bills settled."
Mr. Anderson is a partner at Anderson Law in Kennewick, Washington.
When a person who has Medicare is hurt in an actionable matter, Medicare will cover medical bills just as it there was no actionable claim, Mr. Anderson said. The problem is Medicare is entitled to be reimbursed for what it paid out on an actionable claim that reaches a settlement, he said.
Determining the amounts paid by Medicare is not easy.
"CMS frequently doesn't make details available about the expenses it has incurred for several months after litigants inform the agency that a case is pending," he said. "Without that information, the case can stall. The plaintiff is left in the dark. That's just not fair."
Mr. Anderson has had clients who have reached a tentative settlement, but because CMS delayed, it took an additional year before the claim was resolved.
"Another problem we run into is not knowing how much to see in the settlement. If CMS won't tell the lawyer how much was spent on the matter, we can't file an appropriate claim," he said. "When the attorney walks in to mediation, it is impossible to settle unless he has solid numbers. Those numbers can only come from CMS."
The new law called Murphy's SMART Act, was brought to Congress by Pennsylvania represented Tim Murphy (R-PA).
"Four years ago, one of my constituents suffered severe injuries in a terrible car accident," the Congressman said.. "After coming to a settlement with the insurer, 73-year-old Lorraine Babich of Washington County was unable to get a straight answer from the Centers for Medicare and Medicaid Services about the amount of her medical bills, which had to be repaid to the Medicare Trust Fund. As a result of unnecessary bureaucratic hurdles, Lorraine waited years to get the proper settlement due to her. Unfortunately, Lorraine's heartbreaking story isn't an isolated case because there are thousands of senior citizens just like her who continue to await settlements, see their Social Security checks garnished, and Medicare coverage denied through no fault of their own. With the SMART Act now signed into law, Lorraine and thousands of other senior citizens will no longer needlessly suffer due to bureaucratic red tape."
Mr. Anderson applauds Rep. Murphy, Congress and the president for making this new law.
For more information on the law visit http://murphy.house.gov/latest-news/murphys-smart-act-signed-into-law/
For more information on how the law may affect you visit http://www.AndersonLawWa.com or call (509) 987-1777.
Brian Anderson, Partner