One of the most common scenarios I see in plaintiff personal injury practice is a Medicare-eligible client with a single motor vehicle accident that has generated three separate open Medicare files. The attorney is usually focused on the liability claim…” to “The attorney is usually focused on the liability claim, because that is the file that drove the case, and assumes Medicare lien resolution will be straightforward.
That is when the problems start. Because in this scenario, the liability claim is not the only file Medicare has open. There is also a pending UIM claim with the client’s own auto carrier, and a separate no-fault file from the same accident. Three files, all tied to the same incident, none of them reconciled with each other.
If the firm only resolves the liability file, the client and the firm both walk away with exposure they do not know they have.
Why Medicare lien resolution often involves multiple open files
Medicare does not maintain one master ledger per beneficiary or one ledger per accident. It maintains a separate file for each instance of insurer reporting under Section 111 of the Medicare Secondary Payer Act. Every time a primary payer reports a claim with potential responsibility, Medicare opens a corresponding file on its end.
In a typical auto case, that often means:
- The at-fault driver’s liability carrier reports the bodily injury claim, which generates one file
- The client’s own auto carrier reports the UIM claim once it is tendered or pending, which generates a second file
- The client’s no-fault or PIP carrier reports Ongoing Responsibility for Medicals (ORM) the moment treatment starts, which generates a third file
All three files relate to the same accident. All three are tracked independently by Medicare. And conditional payments can be sitting on any of them.
What goes wrong when you only resolve one
I see the same three problems whenever a firm tries to close out Medicare on only the liability file.
The other files keep accruing. The no-fault file in particular is dangerous, because the client’s own carrier often continues paying ORM benefits long after the liability claim has settled. Medicare keeps logging conditional payments on that file, and the firm has no visibility into it.
Charges end up on the wrong file. Treatment for the same accident can show up on the liability file, the UIM file, or the no-fault file, depending on which carrier got billed first. An audit that only covers the liability itemization will not catch the duplicates sitting on the others.
The pending UIM claim becomes a trap. Once UIM resolves, Medicare will issue a Final Demand on that file as well. If the firm settled UIM without coordinating the Medicare side, the demand can come in higher than expected, and there is no negotiating leverage left because settlement has already occurred. The firm is left explaining to the client why the net is lower than promised.
This is the core mistake. The liability file gets closed cleanly. The UIM file resolves later with a surprise demand. The no-fault file keeps quietly accruing until somebody, usually Medicare, forces the issue.
The correct approach to multi-file Medicare lien resolution
Three steps, and the order matters.
Run a full BCRC query at the start. Before negotiating anything, identify every open Medicare file associated with the beneficiary. The MSPRP and BCRC will both produce a complete picture, including files the firm did not know existed. This is non-negotiable. If you do not know what is open, you cannot resolve it.
Audit each file independently. Every open file gets its own line-by-line review of the Conditional Payment Summary. Treatment that does not belong on a particular file gets challenged off. Duplicates across files get identified and addressed. This is where most of the real reduction happens, and it cannot be done by looking at one file in isolation.
Coordinate the timing. Do not pay the Final Demand on the liability file before the UIM and no-fault sides are reconciled. Final Demands paid prematurely cannot be unwound. The right sequence is to know what is on every file, audit every file, and resolve the demands in a coordinated way that accounts for which carrier is actually responsible for which charges under primary payer rules.
A clean multi-file resolution looks like this: one combined audit, one coordinated negotiation, and closure letters on every file when the work is done. The client gets the maximum net recovery. The firm carries no residual exposure. Medicare’s records reflect that every primary payer obligation has been satisfied.
The takeaway
The reason I push every plaintiff firm to treat Medicare lien resolution as a multi-file question from intake is that the scenario above is the rule, not the exception, in any case with UIM exposure or no fault coverage. Treating Medicare as a single-file problem is what creates surprise demands, lower client nets, and post-settlement headaches that should never have happened.
If your firm is working a case with multiple open Medicare files, or wants help coordinating liability, UIM, and no-fault resolution together, I handle Medicare resolution nationwide. Contact me at office@merschbrocklaw.com.