U.S.. v. Weinberg., U.S.. District Court for the Eastern District of Pennsylvania, (July 01, 2002)


Medicare: Medicare as Secondary Payer

Attorney's liability to reimburse Medicare for payments made on client's behalf.-

Pursuant to the Medicare Secondary Payer (MSP) statute, an attorney who received settlement funds from a third party on behalf of a Medicare beneficiary is liable for reimbursement of payments that the Medicare program made in connection with the beneficiary's injuries. A Medicare beneficiary was severely injured in an automobile accident, and two months after that accident, she suffered a stroke. Medicare paid approximately $189,000 in medical bills in connection with the beneficiary's injuries, including costs related to the stroke. The beneficiary's attorney brought a personal injury lawsuit against a third party on behalf of the beneficiary and obtained a $750,000 settlement. The attorney sent a check for approximately $6,200 to the Medicare contractor, stating on the back of the check that endorsement or deposit of the check would constitute full and final settlement of Medicare's claim. Nearly six years after Medicare first made payment in connection with the beneficiary's injuries, the federal government filed suit against the attorney under the MSP Act seeking reimbursement for payments Medicare had made on the beneficiary's behalf. The beneficiary's attorney argued that the government's MSP lawsuit fell under a three-year statute of limitations, which would render Medicare's claim untimely. The government's MSP claim, however, was most analogous to a suit for restitution, which is subject to a six-year statute of limitations. Therefore, even if the statute of limitations began to run in April 1996, when Medicare first made payment in connection with the beneficiary's injuries, the government's MSP lawsuit was still timely. Further, although the Medicare contractor deposited the attorney's check, this did not mean that the government had accepted the amount of that check in full satisfaction of Medicare's claim. In addition, a trial was necessary to determine whether the beneficiary's stroke was causally related to the automobile accident, because if the two injuries were unconnected, Medicare could not seek reimbursement from the beneficiary's attorney for payments related to the stroke.


Jay J. Sangerman, PLLC
171 East 84th Street, Unit 21B
New York, New York 10028
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