How Medicare Secondary Payer Law Works

The Medicare Secondary Payer law essentially allows the U.S. government to recover reimbursement from insurers and self-insured plans that are legally required to the primary source of payment of medical care for individuals eligible for Medicare who settle a liability claim

According to the Code of Federal Regulations, 42 CFR 411.25, the parties also are required to notify the federal Centers for Medicare & Medicaid Services in writing when they become aware of any liability claim settlement, award or “other payment” tied to the release of a medical injury claim by a Medicare-eligible beneficiary.

A recent lawsuit filed by the U.S. Department of Justice reveals a lot about how CMS will enforce those laws, observers say.

Observers had thought CMS might seek reimbursement only from future liability claims settlements. However, the lawsuit shows that CMS is looking to past cases. In this instance, the government is suing for reimbursement related to a 2003 settlement of a pollution liability case.


Featured News

  • Medicare Advocacy Recovery Coalition (MARC) Urges Beneficiaries to Support Legislative Reforms to Improve Medicare Secondary Payer (MSP) Program

    WASHINGTON, DC – February 22, 2023 – Established in 2008 with a mission to improve the Medicare Secondary Payer (MSP) program, the Medicare Advocacy Recovery Coalition (MARC) has unveiled a new website aimed at improving their critically important work.

    Read Article
  • The PAID Act is Now the Law

    The Medicare Advocacy Recovery Coalition (MARC) thanks the Congress for passing the PAID Act (H.R. 1375, Section 1301 of H.R. 8900) on December 11, 2020.  The bill was brought to the House Floor and passed by voice vote on December 8, 2020. 

    Read Article
  • Growing Number of Organizations Urge Congressional Support for the Paid Act

    In a letter addressed to Senators Tim Scott (R-SC) and Ben Cardin (D-MD), seventeen organizations and companies representing the Medicare Secondary Payer-regulated community urged Congress to pass the bipartisan Provide Accurate Information Directly (PAID) Act (S.1989/H.R.1375).

    Read Article