When Medicare liens are involved in personal injury settlements, Medicare has been likened to an “800-pound gorilla” at the negotiations table. Any significant Medicare lien can dominate settlement negotiations because the Medicare Secondary Payer (MSP) statute grants Medicare a firstpriority right to prompt reimbursement for all pre-settlement conditional payments and wields the threat of double-damages for failing to fully consider Medicare’s interests. If the Center for Medicare and Medicaid Services (CMS) continues the trend of extending the MSP statute’s reach, Medicareeligible recipients of personal injury settlements risk losing much more of their settlement proceeds, not only to satisfy existing Medicare liens, but also to pay for future medical expenses that would otherwise be covered by Medicare. With such an expansion, the great “gorilla at the table” could start to take on the mythic proportions of Carl Denham’s “Eighth Wonder of the World.”
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