MARC – Get On Board – Support H.R.#4796 Now!
Roy Franco
June 2, 2010

This is your time to stand up and be counted.  MARC needs you to write your Congressional Representatives today to support the Medicare Secondary Payer Enhancement Act.  Why?   Because its the right thing to do.

Our Medicare Trust Fund is bleeding red ink and it needs to be fixed.  That’s why Congress enacted the Medicare Secondary Payer Act way back on 12/5/1980 as a method for the Fund to be reimbursed any medical payments made caused by the negligence of others.  It made common sense, but unfortunately the law never worked as intended until very recently when the Medicare & Medicaid Schip Extension Act of 2007.  Congress gave Medicare the power to require negligent parties or their insurance carriers to electronically report all settlements, awards and judgments involving General Liabilty, Worker’s Compensation and No-Fault cases.  While well intended, the new law has created unintended consequences which adversely impact Medicare and the Medicare beneficiary; especially in the General Liabilty case.  Let me explain.

Medicare requires a Social Security Number or Health Identification Card Number before it can match up any reported information it receieves with its internal database.  That is  a problem because the Medicare beneficiary is not legally required to give this information up to a negligent party or their insurance carrier absent litigation.  Public policy favors settlements over litigation, consequently very few General Liability cases are filed in court which conserves our judicial resources.  The present status of the law drives the wrong outcome.  More so litigation does not equal victory.  In fact, in a recent study plaintiffs in a General Liabilty case were likely to receive less or nothing at all from pursuing a lawsuit.  H.R.#4796 will ban the use of Social Secufity Numbers and Health Identidication Card Numbers.  Better alternatives exist as proposed in my previous blog.

Next is getting a final number from Medicare.  If we do not pass H.R.#4796 the final amount Medicare wants to satisfy obligations owed to it under  the Medicare Secondary Payer Act is not available until after a case is settled.  Does this make any sense?  No.  The parties to a settlement today must take an educated guess at the final amount and with any luck after the case is resolved enough money was placed aside.  If not, the parties are left to fight over who pays any deficit.  The practical effect is that the process slows down which benefits no one.

When a negligent party or his insurance carrier wants to dispute an issue with Medicare it has no forum to do so.  Only the Medicare beneficiary has administrative appeal access.  There is no similar access for the paying party.  Consequently, when a Medicare issue arises after settlement the negligent party or his insurance carrier must locate the Medicare beneficiary and secure his or her cooperation in order to dispute it.  The Medicare beneficiary at this point is not properly incentivized if he or she has received the settlement funds.  H.R.#4796 creates these appeal rights for the paying party.

H.R.#4796 also adds two common sense rules for everyone to live and play by.  They are:  1) A clear period of time when Medicare can file a repayment claim after a case is resloved (3 years); and 2) Exemption of certain segment of cases (under $5K in total settlement, award or judgment) from any Medicare Secondary Payer Act requirements.  These sensible rules allow for the orderly disposition of claims and promotes reimbursement to Medicare.

HR #4796 enjoys a broad range of support.   There is no “side” to this issue which explains why stakeholder associations in Washington, DC – both the liberal and conservative groups  have come out to support it.   The present make-up of the law increases cost to business, but it also harms Medicare beneficiaries in delaying distribution of their settlement benefits.

This bill does not solve all of the Medicare reporting problems, but it moves us towards a reasonable process and also puts in place opportunities to help develop much needed reasonable regulations.

We have a brief window of opportunity to pass this legislation.  It is an election year and soon Congress will direct its attention to that effort.  Furthermore, the legislative session concludes at the end of this year, which means we will have to re-introduce this Bill next year if we are unsuccessful – something we would like to avoid, if at all possible.  There is no time like the present and with your help we can send a clear message to our Representatives to get this done.

If you have already provided a letter in response to our previous calls for action, thank you vwery much.

If you have not already done so, I would appreciate you taking the time to help us in our efforts.   Every letter counts, so if you have not submitted one on your own behalf, please take this time to do it now – time is of the essence.  To make it easier, MARC has upgraded its website to allow you to show your support electronically.  All you need to do is click the link below, fill-in the required information about yourself, hit the SUBMIT button and you are all done.

http://tinyurl.com/2bl6y7x

Your letters of support will have an important impact on the legislative process.  H.R. #4796 has sat in committee since March 9, 2010 and needs to be moved out before the full House can vote on it.  Your voice (in terms of letters) will make that happen and we will be one step closer to bringing responsible change to the Medicare Secondary Payer Act.

The time to act is now!  Turn your complaints into action, the more letters, the better!

Thank you for your help with this important initiative.