Medicare Secondary Payer

[J2D2]

Client is being pursued by Medicare for liability under the Medicare Secondary Payer rules. We believe we have meritorious defenses to the claim. We also are considering whether we can present a statute of limitations defense because of Medicare's delay in asserting its claim, but I haven't been able to find any statute of limitations or similar provisions in the Medicare statutes.

Has anyone looked at this issue? Any cites to statutes, regs, cases, etc. are most welcome.

Thanks.

[Mary C]

In August of 97 or 98, I believe, the government amended the secondary payer rules so that CMS (formerly HCFA) has a 3 year look back for claims reimbursement REGARDLESS of any timely filing limits. And the 3 years is measured form the date they became aware of the outstanding claims and first mailed a notice to you.

We are experiencing receipt of a large number of unpaid "demand" letters for reimbursement - cases they say they originally sent anywhere from 1 to 7 years ago that they claim have not been responded to. They are getting quite aggressive with collecting these and are employing several collection agencies which use typical strong arm collection agency tactics.

While you don't mention what your defence is, in my experience, the only valid defenses they have recognized are 1) the Medicare beneficiary had no coverage from us 2) the Medicare beneficiary is not/was not every employed by us 3) claims were previously submitted to carrier at time of service and carrier paid them. Even the fact that the beneficiary was covered by a fully insured plan is not a recognizable defence.