Healthcare Law

Medicare Secondary Payer

Despite the longstanding prohibition against such activity, Group Health Plan’s (GHPs) continue to search for ways to take Medicare into account, denying plan member’s benefits to which they are entitled and leaving the federal government to pay for treatment cost the GHPs are required to cover.
The Gibson Firm has encountered two main trends in this area. First, GHPs often drastically reduce benefits to Medicare beneficiaries, knowing that the beneficiary cannot be balanced billed because of federal laws protecting Medicare beneficiaries from financial liability. GHPs often reduce reimbursement only upon Medicare entitlement, paying at a different rate until then. Second, rather than terminating GHP coverage upon Medicare entitlement—a practice The Gibson Firm helps to prevent—many GHPs are now converting enrollees from GHP coverage to Medicare Advantage coverage upon Medicare entitlement. While many of these conversions are legal, many are not. The result is that the provider often receives less reimbursement, the GHPs incur less cost, and the federal government pays despite laws in place to prevent these occurrences.