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Smart Act signed by President Obama. Update on changes to the conditional payment process and why this is great news.

obama_signs_smart_actToday I’d like to post a guest blog from Alex Berman. He is a Michigan workers compensation lawyer with over 35 years of experience. Here is what Alex has to say about changes to Medicare liens.

President Obama has now signed the Smart Act. This legislation is a victory for claimants, insurance companies, business interests, and the US taxpayer. It will go a long way towards fixing the current problem with Medicare liens.

CMS makes payments for medical treatment even when an insurance company may ultimately be responsible under workers compensation. This is important because it allows a person with a disputed claim to get needed medical care. These conditional payments must be paid back if an individual later receives a settlement or award.

CMS will not provide a “final demand” until after the workers compensation case is settled. This means that claimants and other stakeholders have to estimate the lien amount. Resolving a case became extremely difficult because nobody really knew how much needed to be paid back. The process was slow and inaccurate.

Everyone agrees that Medicare should be paid back for conditional payments. The problem has always been how CMS implemented its recovery program. The Smart Act goes a long way to fix these problems.

CMS will now have to provide the amount of conditional payments before settlement. This information will be provided through a website and can be relied upon as the final demand. A right of appeal is also established so that parties can challenge an unfair determination.

CMS will be bound by a 3 year statute of limitations to enforce reimbursement.Unfortunately, there is no provision that requires CMS to take a lesser amount in a disputed case. CMS needs to take an active role in compromising its lien when the facts of the case show an unlikelihood of recovery at trial.

 

– Alex Berman is the founder of Michigan Workers Comp Lawyers. He’s been representing injured and disabled workers exclusively for more than 35 years. Alex has helped countless people obtain workers compensation benefits and never charges a fee to evaluate a case. He can be reached at (855) 221-COMP.

About the Author:

The Injured Workers Law Firm is a Richmond, Virginia based firm solely focused on serving clients with workers' compensation claims in Virginia. If you have questions about your benefits or if you would like more information on the Virginia workers’ compensation system, order our book, “The Ultimate Guide to Workers’ Compensation in Virginia” , or call our office today (804) 755-7755.