Insurance Companies and Self-Insureds that process claims for workers’ compensation, liability and no-fault claims (Primary Plans) involving Medicare beneficiary claimants need a better way to obtain information about Medicare Advantage and Part D Drug Plans that may have a claim for conditional payment reimbursement. Numerous lawsuits have been filed across the Country demanding double damages for failure to reimburse Medicare Advantage and Part D Drug Plans. These Private Medicare Plans advocate that they have the same recovery rights as traditional Medicare. Thus far, they have convinced two U.S. Court Circuits (3rd and 11th) that they are correct. For Alabama, George, Florida, Delaware, Pennsylvania and New Jersey, Primary Plans are challenged to find out the identity of Private Medicare Plans at time of settlement. There is no central database for this information that is available. Consequently, they must rely on Claimants and their attorneys for the information which prove unreliable leading to costly lawsuits.
The solution to all of this is a simple piece of legislation pending today in both houses of Congress (H.R. 1375/S. 1989). If passed, the Centers for Medicare & Medicaid Services (CMS) will be required to send Private Medicare Plan information as part of the Section 111 Query process that exists today that identifies for Primary Plans which claimants are Medicare beneficiaries. To pass this law this year, it is important we let Congress know of your support and there is an easy way to do this. Simply go to www.marccoalition.com and click on the Take Action Link. Once there you can send a message, Tweet or make a Facebook post to show your support, or do all three if you like. That’s it and with your support we can improve on the inequities of the current situation. To learn more about PAID, watch the following short video. Thank you!