Visitor Question

Fractured Hip and Shoulder from Fall at a Nursing Home…

Submitted By: Anonymous (Novi, Michigan)

My husband was admitted to a nursing home. He was considered a fall risk because of cardiac arrest after quadruple bypass surgery. Within two weeks he fell three times. On the third fall, he broke his hip and shoulder and was transferred to the hospital.

My question is: If I settle without a lawyer involved, do I still have to pay back Medicare and my Medigap insurance for expenses incurred? Thanks.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Anonymous,

Unfortunately, the answer is yes. If Medicare or Medicaid paid or supplemented any amounts of medical bills sustained as a result of an accident, you will have to reimburse them for those amounts. With or without an attorney the rule is the same.

The government retains a “Lien” on any settlement amounts. They will be the first ones paid at the time of settlement. Those liens must be paid within 60 days of the final settlement.

In 2007 the Medicare and Medicaid laws were amended. The amendments resulted in what is called the “SCHIP Extension Act of 2007”.

The Act requires insurance companies to report insurance settlements involving Medicare or Medicaid recipients. The insurance companies must report the settlement to the office of the Secretary of Health and Human Services.

The information from the insurance company must be sufficient to apprise them of the proposed settlement amounts and dates of settlement distributions.

The penalties for not reporting the information can be up to $1,000 dollars a day. Worse, in addition to the $1,000 dollars a day the government can assess double that amount and charge interest for every day the amount goes unpaid.

The good news is the liens can be negotiated to a lower amount. Doing so takes some legal sophistication and a substantial amount of experience with Medicare and Medicaid’s rules and regulations.

There are Personal Injury Attorneys who are skilled and experienced in Medicare and Medicaid claims. We suggest you seek one out. Most will not charge for an initial office consultation.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: August 26, 2011

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