What is a Medicare or Medicaid lien?

Medical Lien on a Computer Screen With a Gavel and Scales of JusticeWhen you were first injured on the job, your primary concern was probably seeing a doctor for diagnosis and treatment. While you might have informed your doctor that your injury was work-related, the visit could still have been billed to Medicare or Medicaid if you receive those benefits. You might not be too concerned about who is covering your medical expenses—as long as it's not you!—but the government will be very concerned. If Medicare or Medicaid paid for treatment workers' compensation should cover, they must be paid back. To ensure they get this payment, the government could place a lien on your workers' comp claim.

What Is a Lien?

A lien is a legal claim on property or assets that gives the lienholder the right to seize what they are owed if they are not paid voluntarily. Because workers' comp claims can take time to be approved, it is not unusual for Medicaid and Medicare to be billed in the meantime. However, they need to be paid back and might issue a lien to ensure that they are reimbursed.

How Your Workers' Comp Attorney Will Help

One of the first questions a workers' comp attorney will probably ask you when discussing your claim is whether you are Medicare or Medicaid eligible. If you are, your attorney will likely notify the Centers for Medicare and Medicaid Services (CMS), which will open a file and communicate about payments that need to be made to them out of the workers' comp claim. These are known as conditional payments, and they should prevent a lien from being placed on your workers' comp claim.

While Medicaid and Medicare claims must be honored, you should continue to receive these benefits for medical expenses not related to the work injury. If a non-work-related medical issue is incorrectly submitted to Medicare or Medicaid by the doctor, CMS could assume that you are dishonest and issue a lien. As you can see, workers' comp claims involving Medicare or Medicaid can become complicated. Working with an experienced attorney can ensure that everything goes smoothly.

Medicare Set-Asides Are Not the Same as Liens

If you are on Medicare and settle your workers' comp claim, you will likely have to establish a Medicare Set-Aside (MSA) account, which is essentially a checking account funded by a portion of your workers' comp settlement proceeds. These funds would reimburse Medicare for future expenses they cover that workers' comp would have covered if you hadn't settled the claim. This differs from a lien, and your attorney will make sure you are within the law.

Monast Law Office Has You Covered

Our team has dealt with countless workers' comp claims involving Medicare and Medicaid, and we will help you meet your legal obligations while getting you the benefits you deserve. For more information, request a free copy of our book The Worker's Guide to Injury Compensation in Ohio and contact our office with any questions. We are standing by to take your call!

 

 

James Monast
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Fighting for Ohio’s Injured Workers and their Families