July 02, 2011

Congress and Medicare

July 02, 2011

In June, 2011, congressional hearings were held in Washington D.C. to examine systems under the Medicare Secondary Payer Law.  Objectives included whether the systems adequately protect the interests of Medicare beneficiaries, businesses, taxpayers, and other interested parties.

Particular focus has been on the conditional payment aspect of the MSP.

The MARC Coalition’s H.R. 1063; “Strengthening Medicare and Repaying Taxpayers Act,” was the impetus for the hearings.

The MARC-proposed bill seeks to improve the current Medicare procedure for conditional payment recovery, among other objectives.

In its current form, the conditional payment recovery process acts as a serious barrier to prompt and efficient resolution of workers’ compensation claims (especially minor claims) involving Medicare beneficiaries.  Because the existing system does not allow parties to have complete information during the settlement decision making process, parties often fail to settle or determine late in the process that a review threshold on a settlement has unwittingly been reached because of conditional payments.

The recent hearings drew into sharp contrast the needs of business as compared to the “state of CMS”.  The Director of Financial Management for CMS testified, as well as a representative of the Government’s Accountability Office (GAO).

The members of the congressional subcommittee were reportedly dissatisfied with the CMS presentations.  It was clear from comments made by the chairman of the subcommittee that he viewed the system as “broken.” Additional hearings are anticipated.  It is expected, also, that H.R. 1063 will continue to gain momentum.  All are encouraged to make contact with congressional representatives.