Medicare Rights Center Testifies Before Congress on Problems with Medicare Secondary Payer

The Medicare Rights Center’s federal policy director, Ilene Stein, testified this week before the Energy and Commerce Committee’s Subcommittee on Oversight and Investigations about problems people with Medicare face under the current Medicare Secondary Payer program. The policy allows Medicare to recoup payments for a patient’s health care when another entity is responsible for paying for such treatments, such as when a patient is in a car accident and the auto insurance should pay for health services to treat injuries related to the accident. Ms. Stein’s testimony supports the premise that Medicare should not pay when another party is responsible for payment, but also highlights the various flaws in the system, including delays in seeking repayment, the lack of a statute of limitations in which Medicare may seek repayment, and the failure of Medicare to differentiate between care stemming from the original incident and unrelated treatments.

Medicare Rights Center often receives calls on its helpline from consumers who receive letters from Medicare demanding repayment for coverage provided for services that are unrelated to past accidents, and that should thus be covered by Medicare. In some cases, Medicare will prospectively refuse payment for all services if a secondary payer case is improperly closed, even when these services do not relate to treatment for an injury for which another party is responsible for payment. To address these shortcomings, Medicare Rights proposes a statute of limitations on Medicare’s right to seek recovery, as well as increased scrutiny of Medicare claims to ensure that the recovery attempt applies only to care related to claims against a separate payer.

Also testifying before the committee were Deborah Taylor, the director of financial management at the Centers for Medicare & Medicaid Services (CMS), who spoke about the current operation and oversight of the Medicare Secondary Payer system, and James Cosgrove, director of health care at the Government Accountability Office (GAO), who spoke about ongoing studies of the failures and successes of Medicare Secondary Payer policies. The panel on which Ms. Stein testified included representatives from the business, insurance and legal sectors, all of whom cited multiple, overlapping defects in the program.

Read Ms. Stein’s testimony on the impact of the Medicare Secondary Payer policy on people with Medicare.