House Subcommittee Hears Testimony on Medicare SPS

Salam explained that in a liability case such as a slip and fall Medicare pays for the healthcare related to the injury until a settlement is reached. "But neither the beneficiary nor the settling party knows how much money Medicare will expect in reimbursement while negotiating the settlement."

The beneficiary is responsible for reimbursing Medicare but that responsibility falls to the settling party if the beneficiary reneges and doesn't repay the trust fund. Salam suggested that CMS be permitted to provide a conditional payment amount that could be used to negotiate the liability settlement so that the trust fund "will recover more money faster."

Jason Matzus, a Pittsburgh-based attorney who represents Medicare beneficiaries in claims against third parties, supported Salam's statements and added that "it is not uncommon for it to take six months to one year to resolve the MSPS portion of a claim. In the meantime settlement funds sit in an attorney escrow account instead of being placed in the Medicare Trust Fund."

In her testimony Ilene Stein, federal policy director at the Medicare Rights Center, said because there is no timeframe for when Medicare must provide its costs in a liability case there is "uncertainty in the settlement process." She noted that there is also no time limit for Medicare to recoup its costs and there have been cases where Medicare "reaches out to a beneficiary years after a case is settled."

Additional subcommittee hearings are planned on the Medicare Secondary Payer System but have not been scheduled.