If you receive Medicare benefits and are injured in an accident, federal law provides the Centers for Medicare and Medicare Services (CMS) with extensive authority to ensure that Medicare does not cover expenses for which it should not be liable. Commonly referred to in legal circles as a Medicare “super lien,” the power held by CMS is not actually a lien, but instead the right to recover any payment made for expenses that should have been the responsibility of another insurance company or liable party.
Conditional Payment
Under law, Medicare will not pay for items or services if payment “has been made or can reasonably expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (included a self-insured plan or under no-fault insurance.” When payment is not made by the expected primary payer, however, Medicare may provide coverage on a conditional basis, which must be reimbursed if and when the primary payer does make payment. This includes payments made directly to a medical provider, as well as payments intended for the Medicare beneficiary in the form of a settlement, judgment or other award.
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