Settlement and Alternative Dispute Resolution
Liens and Reimbursement
The Medicare Secondary Payer statute establishes that Medicare does not pay where another payer is primarily responsible. It gives the government recovery rights against primary payers, beneficiaries, and attorneys, and imposes mandatory reporting obligations on insurers and self-insured entities.
Compliance has two components: reimbursing past conditional payments and reasonably considering Medicare's interests in future injury-related care.
Alternative Names:
MSP, Medicare Secondary Payer Act
Why it Matters?
MSP compliance is a defendant-side obligation, not merely a plaintiff concern. Responsible reporting entities must report settlements involving Medicare beneficiaries, and failure carries civil money penalties. Because the government can pursue the defendant for amounts the plaintiff failed to reimburse, settlement agreements should require verification of Medicare status and confirmation of resolution.
Frequently Confused with
Related terms
Frequently asked questions
Who has reporting obligations under the MSP statute?
What happens if Medicare is not reimbursed?
