U.S. vs. Stricker Medicare Interests Secondary Payer Statute and Liability Settlements

USA v. STRICKER: CMS Asserts Recovery Rights And Gives Clues To Their Interpretation Of The MSP In Liability. In a continuing effort to help keep you up-to-date on happenings in Medicare we offer the following summary of important and timely information.

Gould & Lamb has been correctly advising its clients to protect Medicare’s interests both as to conditional payments and future Medicare covered expenses. They have foreseen and warned that any vagueness or doubts as to Medicare’s rights would be defined or clarified in future, imminent litigation. That time is now and will unquestionably continue.

The Stricker Complaint involves a class action claim which was settled without reimbursing Medicare for conditional payments and has resolved a question often posed; when a class action is settled with one lump sum and no specific amount is designated by the defendant/carrier for any plaintiff/claimant, must Medicare entitlement status and Medicare conditional payments be determined for each plaintiff to avoid future risks? The position of the government in the Stricker complaint gives clear indication of the aggressive position they will continue to pursue and portents the absolute need for liability claims handling and settlement practices to be compliant with the MSP.

In addition to seeking the conditional payments, interests and penalty, the government is requesting that “the defendants must give CMS notice of all future payments to Medicare beneficiaries pursuant to 42 C.F.R. § 411.25; and, that all Defendants must ensure before any future settlement payment is made to any claimant that appropriate payment is made to the United States.”

Clearly, the government claim appears to seek to establish a right to proceed against the liability carriers for pre and post-settlement Medicare expenses. This dramatic move from the traditional approach to the post-settlement exposure of liability carriers may be an omen of future actions. The final decision in this case may have far-reaching effects on liability carriers and their settlements, and as always, we will keep you advised of future developments in this case and other legal actions which may arise in the MSP arena.

News update provided by Gould and Lamb www.gouldandlamb.com

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