Under federal law and Massachusetts state law, MassHealth and Medicare are automatically entitled to be reimbursed for any medical costs covered by them for related treatment to your injuries.

How do I know if MassHealth is Asserting a Lien?

Medicare and MassHealth Insurance Claim Form

If you have a MassHealth plan or did at any point during your treatment for your injuries, you should tell your attorney as soon as possible. They will then contact MassHealth to inquire if there is a lien. To do this, your attorney will request that you sign a MassHealth Permission to Share Information form (“PSI form”). They will then send this form with a letter requesting an itemization of the lien that MassHealth claims is for related treatment.

Sometimes, unrelated charges can inadvertently be included in a lien. For example, if you broke an arm in a car accident and treatment for your arm is on the lien, that will be “related treatment” and validly included on the lien. However, treatment for an unrelated illness during your treatment would be “unrelated” and should not be included in the lien. Your attorney will review the itemized lien from MassHealth to ensure only related charges are included and contact MassHealth to remove any unrelated charges.

How do I know if Medicare is Asserting a Lien?

The process to determine if Medicare is asserting a lien is similar to MassHealth. If you are Medicare eligible or Medicare covered your related treatment, you and your attorney are responsible for contacting Medicare to inquire about a lien. To do this, your attorney will ask you to sign a Proof of Representation form that will allow Medicare to communicate directly with your attorneys on your behalf.

Medicare has an online portal where your attorney can report your case, upload the proof of representation form, request updated lien amounts, and dispute any unrelated charges. An itemized lien will be sent to your attorney by Medicare, which will be reviewed like a lien from MassHealth. Medicare is only entitled to recover for related treatment, so unrelated charges will need to be disputed. Medicare will then review the charges being disputed and the explanation for why they are unrelated and make a determination.

It is important to ensure that liens from MassHealth and Medicare are promptly requested and thoroughly analyzed for accuracy.

What if the Lien Asserted is Greater than my Recovery?

In some cases, the lien asserted may be greater than the actual settlement amount – whether that is due to inadequate insurance coverage or other circumstances. When this occurs, your attorney can request a lien reduction. You are not required to pay a lien that is greater than your total recovery. Your attorney will send a settlement breakdown to Medicare and recommend a fair amount to pay in satisfaction of the lien. While MassHealth and Medicare have the right to be reimbursed, liens can be negotiated in certain situations.

There is a Medicare and/or MassHealth Lien on my Settlement – Now What?

If you have determined that MassHealth or Medicare is asserting a lien on your personal injury case settlement, you must contact them once your case is settled to obtain a final lien amount. For MassHealth, your attorney may simply send a letter to MassHealth asking for a final lien amount. For Medicare, your attorney must provide them with the details of your settlement, including the total amount it settled for, the date the case settled, and your attorney’s fees and expenses. Upon receipt of that information, Medicare will issue a demand reflecting their final lien amount which must be paid within 60 days.

After you have received the final lien amounts from Medicare and/or MassHealth (if applicable), and your attorney has received the settlement funds, they will pay the liens from the settlement funds. Once the payment for the liens has been processed, your attorney will receive written confirmation (“Release of Lien”) from both MassHealth and Medicare that the lien has been paid in full.

SUGARMAN attorneys have decades of experience advocating for injured persons to ensure they recover maximum damages. If you or a loved one has suffered injury as the result of an accident, you may be entitled to compensation. To learn more, speak to one of our principals today by calling 617-542-1000 or email us at info@sugarman.com.