Under the Medicare Secondary Payer Act, there are many complicated laws associated with self-insured employers’ responsibilities. This makes it hard to stay on top of ever-changing regulations. The Centers for Medicare and Medicaid Services (CMS) is going after recovery of payments they have made from a variety of sources—including self-insured employers.

There is a risk involved when an employee who is injured is a Medicare or Medicaid beneficiary. Expenses for workers compensation-related medical care that is paid by the CMS can be recovered from self-insured employers. This even applies when a claim has been settled and closed.
In regular workers’ comp claims, the employees go to a medical provider to receive treatment and the provider then turns the medical bills in to the claims office where they are processed and paid. Self-insured employers can encounter problems when workers are treated by more than one medical provider for both work and non-work related medical problems. At some point, the employee will most likely give a Medicare or Medicaid card to the workers’ comp medical professional. This will result in CMS paying for the services.

Workers’ compensation medical bills should directly be paid to the medical provider. If you are settling a claim with a worker who has Medicare or Medicaid, do an inquiry with CMS as part of your pre-settlement process. Please note it is not enough to just use an employee statement claiming he or she will either reimburse their Medicare benefits or they have not used them.

Visit https://www.cms.gov/MandatoryInsRep/Downloads/NGHPUserGuideV3.1.pdf to learn more about the guidelines for submitting a query as part of the CMS Secondary Payer Act.

CMS is not part of any agreement between you and an injured employee. They can and will enforce their monetary recovery rights.

An honest mistake or misrepresentation by an employer won’t let you off the hook and won’t stop you from having to pay back CMS for any medical care costs they have paid. CMS believes that all companies should know what is required through the Secondary Payer Act.

Modern Business Associates is an HR company that focuses on payroll and HR outsourcing. We routinely work with clients on the Medicare Secondary Payer Act. As a Professional Payroll and HR outsource organization, our clients rely on us to help them effectively deal with these kinds of topics.