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Medicare to assess penalties for late eligibility filings beginning in summer 2009 for WC and liability cases

The attorneys at Burns White would like to bring to your attention an important Medicare issue that will be affecting liability and workers’ compensation cases as of July 1, 2009. If the below policies are not complied with, penalties can be assessed in the amount of $1,000 per day, per claim.

The legislation passed is the Medicare, Medicaid and Schipp Extension Act of 2007. In particular, Pages 15-22 illustrate the Medicare Secondary Payor responsibilities under Section 111, which, like the Medicare Modernization Act, serves to enforce existing statutory responsibilities. Specifically, Section 111 provides that filings will need to be made to Medicare providing information regarding an individual’s eligibility for Medicare benefits on dates to be specified by the Secretary of the Department of Health and Human Services.

When this policy takes effect in July 2009, a filing will have to be made to Medicare on every case that settles, or that has a judgment or award made. It is not established as of now when the filings are required, or exactly what information they should contain, but the filing will tell CMS whether a Claimant is Medicare-eligible. If the filings are not made on time, there is a $1,000 PER DAY fine, PER CLAIM.

Due to the fact that Medicare will not begin assessing penalties until at least July of 2009, Burns White will be available to assist you in your preparation, including development and implementation of a policy addressing this change before it takes place. In particular, we will make sure our plan provides for routine Social Security Verifications on open claims and those positioned to settle or reach trial.

As this matter progresses, Burns White will have updated information from the Secretary, so that we can best help protect client interests. If you have questions, please contact one of our Workers’ Compensation or Medicare Set-Aside attorneys at 412-995-3000.