We highly recommend that claimants refrain from direct outreach to lienholders, as LitPRO’s dedicated contacts are typically situated in a distinct department, separate from general call center operations. Engaging directly with the call center may result in the receipt of inaccurate information. It is essential to inform your clients that they may indeed receive correspondence from these agencies. However, it is imperative to emphasize that LitPRO is concurrently receiving and diligently addressing all relevant correspondence. For seamless coordination and resolution, we encourage the forwarding of any received correspondence to LitPRO for management.

The process can take anywhere from two to nine months, depending on what agencies are involved.

When a person covered by Medicare receives a settlement or judgment related to a wrongful death claim, Medicare may have a right to recover any conditional payments it made for medical expenses related to the injury that led to the wrongful death.

Medicare will typically follow the state statutes to determine if medical payments are recoverable in wrongful death actions. It’s important to review the state statutes regarding wrongful death and understand that Medicare requires documentation showing what was pleaded, claimed, and released in the settlement in addition to the state recovery rules. If allocations to wrongful death are not made based on the merits of the case and approved by a Judge, Medicare may not reduce their recovery even in states where medical payments aren’t recoverable for wrongful death actions.

Estimated timelines depend on LitPRO’s receipt of complete, accurate information, settlement allocations, and appropriate authorizations. LitPRO updates timelines and manages expectations as our work proceeds.

In cases involving exposure, ingestion, or implantation, we are required to report the date of loss or injury as the initial date of claimant exposure. Medicare is entitled to recover from the date of exposure (or the first date of entitlement if it occurred after the date of exposure) up to the settlement date.

If exposure ended before December 5, 1980, Medicare does not have the right to recover. In such instances, a “No Interest” letter is issued promptly on receipt of the complaint or other documentation validating the final date of exposure.

LitPRO is well-prepared to leverage the three levels of appeal at our disposal. The first level of appeal is managed internally by the team responsible for issuing the Final Demand, and it frequently confirms the initial decision. The subsequent two levels of appeal involve external contractors; the third level involves an Administrative Law Judge (ALJ) hearing. Both levels of appeal beyond the initial stage have demonstrated higher rates of success.

Before initiating each level of appeal, LitPRO consults with the firm to deliberate on a strategic approach and determine whether additional information is required.

Medicare and Medicaid serve as mandatory notice agencies; as a best practice, LitPRO strongly advises verifying this information. Submitting the necessary documentation to Medicare/Medicaid ensures compliance with the notification obligation, and these agencies issue clearance if the claimant is not entitled to their benefits.

Your health insurance may have paid for the injury-related care that is part of your lawsuit. Some health insurers have a right to be reimbursed for those payments, with the reimbursement coming out of your personal injury settlement. This right to reimbursement can be based in either statute or the contractual language in your policy.

When your health insurance pays for medical bills caused by a third party, it suffers an economic loss. As a result, your health insurance may claim a “lien” against the third party, just like you do. However, that claim shifts to you once you receive money from the third party, because you received compensation for the medical bills your insurer paid.

In complex litigation, it is common for law firms to engage the expertise of a thirty-party company that specializes in healthcare lien resolution. This company, referred to as the Lien Resolution Administrator (LRA), is tasked with reporting cases to the relevant lienholders, auditing claims listings, and finalizing liens to ensure compliance with statutory and contractual law. LitPRO is the company your attorney has engaged to perform this work in this litigation.

Medicare-entitled claimants receive a copy of a Medicare Rights & Responsibilities letter, stating that CMS was notified that you filed a liability insurance claim on their behalf. The letter confirms that a Medicare Secondary Payer (MSP) recovery case has been established, and it goes on to explain the concept of conditional payments made toward the injury-related care. Medicare benefits will not be affected as we work through this process. After the Rights & Responsibilities letter, claimants receive copies of all Conditional Payment Letters and any correspondence that the LRA has requested. You should keep these letters but you do not need to act on them. The LRA handles all lien correspondence.

Depending on the type of healthcare lien, failure to resolve reimbursement obligations could result in the suspension of your healthcare coverage, financial penalties, and/or a potential lawsuit against you.