What is the Medicare Secondary Payer (MSP) Recovery Program?

The federal health insurance program known as Medicare has a lien reimbursement interest on any California personal injury settlement - this means Medicare has the right to subrogate (or get paid back what it paid out) on an injured person's injury settlement. A good injury lawyer will know how to negotiate this lien interest low in order to increase an injured person's net recovery!

The Medicare statutes provide for Medicare to be the secondary payer whenever there is other insurance that covers health care for Medicare beneficiaries, but requires Medicare to make a conditional payment for the care when a primary insurer does not pay promptly. 42 U.S.C. § 1395y(b)(2). Medicare’s payment is conditioned on reimbursement before the expiration of 60 days after Medicare receives notice or other information that payment has been or should be made from another source, and the Secretary may charge interest until reimbursement is made. Id. She may waive (in whole or part) the reimbursement requirement, if she determines that waiver is in the best interests of the program. 42 U.S.C. § 1395y(b)(2)(B)(v).

The Medicare statute, 42 U.S.C. § 1395ff, also provides for administrative review and appeal rights to beneficiaries to resolve MSP claim disputes.

“[T]he nature of MSP monies reimbursable to Medicare, as opposed to non-MSP monies to which Medicare is not entitled, is not always discernible with pinpoint accuracy at the time a Medicare beneficiary becomes entitled to a settlement check . . . which in whole or in part is meant to encompass medical expenses previously “conditionally’ paid by Medicare.” Wall v. Leavitt, 2008 WL 4737164 *1 (E.D. Calif. 2008).