Many factors can influence the amount of a recovery in a nursing home negligence suit including how the plaintiff paid for his or her care. Specifically, a plaintiff’s award is an award that may be subject to a Medicare Lien that allows Medicare to take a portion of any judgment as reimbursement.
Medicare Liens are a result of federal law. Put simply, when a nursing home negligence case is settled or tried to verdict then Medicare is entitled to be reimbursed for what it has paid. This can affect plaintiffs in multiple ways. First, it lessens the amount the plaintiff will actually receive for his or her injuries. Second, Medicare liens effect how much a plaintiff should demand to settle a lawsuit prior to verdict. For example, a plaintiff should demand a larger settlement if Medicare has paid a large portion of his or her bills because the final settlement will be off-set by Medicare liens.
The first step in resolving a Medicare lien is to contact the Coordination of Benefits office (“COB”). During this call, the attorney must give correct information regarding the injuries sustained by the plaintiff. After this initial call, the COB will send a Rights and Responsibilities letter and the attorney must respond with a Proof of Representation letter to the Medicare Secondary Payer Recovery Contractor (MSPRC). Within 65 days, the MSPRC will issue a Conditional Payment letter (“CPL”). At this time, the attorney must compare the claims listed in this letter with those in his or her file. If you believe that Medicare is listing unrelated medical bills, the attorney can dispute the CPL. This process is repeated until the CPL is correct.
As the attorney is negotiating the final CPL, the underlying litigation is continuing. Once the case is settled or is tried to verdict, the attorney requests a Final Settlement Detail Document. The request requires: the total amount of the settlement, the amount of any other insurance liens on the case, the amount of attorney fees, the other expenses incurred that will come out of the settlement amount and the date that the case was settled. Once the attorney receives the Final Demand Letter, payment must be issued within 60 days.
If you suspect your loved one is the victim of nursing home abuse please contact us. Nursing home negligence claims involve many complex legal and medical issues such as Medicare liens. Having the right attorney is essential to recovering what you deserve.
Our Kansas City nursing home abuse law firm will do everything possible to assist you in obtaining the maximum compensation you deserve. More importantly, our Kansas City nursing home abuse law firm will serve as an ally that will give you and your family the respect and compassion it needs. Contact us for your free consultation today.