Securing a $140,000 Medicare Refund: How Our Strategic Appeals Cut a Lien in Half
Medicare lien resolution is rarely straightforward in personal injury settlements, but even less so in cases with complex injuries and facts. One recent case highlights how quick, informed action by one of Precision Resolution’s lien resolution specialists, Ajka Kudic, reduced a Medicare Conditional Payment Amount (CPA), ultimately saving the client over $140,000.
The Case: A Life-Altering Burn Injury
The plaintiff was severely burned while cooking in his apartment. After catching fire, he removed his sweater, felt no immediate pain, and fell asleep. The plaintiff awoke eight hours later in agony. It would later come to light that the building’s fire alarm had been disconnected.
Simply by chance, police responding to an unrelated call discovered the plaintiff and called an ambulance. Having gone untreated for over 12 hours, the plaintiff was hospitalized with serious burns across multiple areas of his body.
Medicare’s Increasing Conditional Payment Amount
Initially, Precision Resolution disputed unrelated claims contained within Medicare’s conditional payment summary form. The Benefits Coordination & Recovery Center (BCRC) agreed only in part with this dispute, removing a small number of claims while adding over $100,000 in additional, unrelated charges. The conditional payment amount jumped to $596,081.49.
Director of Lien Operations, Ajka Kudic then immediately submitted a second dispute, which lowered the amount to $500,592.67. Our third dispute brought Medicare’s claim down to $455,357.38.
At this point, the carrier reported settlement to Medicare, triggering the issuance of a Conditional Payment Notice (CPN) and, soon after, a Final Demand Letter (FDL) in the amount of $269,421.30. Precision Resolution recommended that the attorney pay this debt to avoid interest accrual. The carrier’s reporting of the settlement to Medicare put the pressure on Ajka to get the lien amount reduced quickly.
Appealing for Justice: Three Rounds to Victory
Our first-level appeal reduced the FDL by only $237. Ajka then escalated to a second-level appeal (reconsideration request) submitted to Medicare’s Qualified Independent Contractor (QIC).
Finally, two months later, Ajka received confirmation from the Medicare contractor that the appeal was fully successful.
The result of the successful appeal reduced the final lien amount from $455,119.83 to $128,779.61.
The Result: A $140,641.69 Refund Check
Yes, Medicare will issue refund checks for ‘overpayment’ of lien amounts.
Here, thanks to strategic disputes and persistent appeals, Medicare issued a refund in the amount of $140,641.69—a powerful reminder of the importance of early lien resolution involvement and expereinced advocacy.
For support navigating Medicare or other health insurance lien in personal injury cases, contact Precision Resolution’s Director of Lien Operations, Ajka Kudic, today.