Gives a Whole New Meaning to the Term “Bureaucracy”

Medicare, in almost every instance, is the primary payer for medical services for people 65 and older and some of the disabled. But in some cases, such as auto accidents, on-the-job injuries or slip-and-fall accidents, Medicare becomes the secondary payer. It may be billed first and pay for the immediate care — but the medical costs are really somebody else’s primary responsibility. So Medicare has the right to recoup them from the responsible party.

For instance, if a senior is injured in a car accident, the hospital bills Medicare. But if there’s a settlement, or if the case goes to court and a person is awarded damages, Medicare has a right to recoup at least some of what it paid. The settlement also must take into account future Medicare costs that could arise from the condition or injury.

And it’s at this point, Farber and others say, that the process breaks down, leaving attorneys, Medicare beneficiaries and businesses in the lurch. Legal settlements stall.

More from Matt Dobias in POLITICO.

Comments (5)

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  1. Devon Herrick says:

    If you have any type of coverage along side Medicare, Medicare generally become the secondary payer.

  2. Brian says:

    “The Congressional Budget Office estimates that Medicare loses around $1.1 billion every decade largely because of the lax or complicated reporting procedures.”

    That’s a lot.

  3. Greg says:

    Sounds like a nightmare.

  4. Tom H. says:

    Sounds like a Rube Goldberg system.

  5. Greg Scandlen says:

    This is absurd. Only in a political system is this a problem. EVERY private insurer has a subrogation department that collects payment from workers comp and auto insurers for health claims that should be their responsibility. It is not complicated. It is standard business practice. And the loss is almost certainly far more that $1 billion over ten years.