C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT › Subpart C—Limitations on Medicare Payment for Services Covered Under Workers' Compensation

42 C.F.R. § 411.45

Basis for conditional Medicare payment in workers' compensation cases

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(a) A conditional Medicare payment may be made under either of the following circumstances:

(1) The beneficiary has filed a proper claim for workers' compensation benefits, but the intermediary or carrier determines that the workers' compensation carrier will not pay promptly. This includes cases in which a workers' compensation carrier has denied a claim.

(2) The beneficiary, because of physical or mental incapacity, failed to file a proper claim.

(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.

[71 FR 9470, Feb. 24, 2006, as amended at 73 FR 9685, Feb. 22, 2008]
Notes of Decisions
Cited in 2 cases, 2008–2012 · leading case: Su Hoang v. Workers' Comp. Appeal Bd., 51 A.3d 905 (Pa. Commw. Ct. 2012).
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Su Hoang v. Workers' Comp. Appeal Bd., 51 A.3d 905 (Pa. Commw. Ct. 2012). “” To the extent that Medicare has, in the past, made any "conditional payments,” Medicare will recover those payments pursuant to 42 C.F.R. § 411.45 and § 411.47. Whenever future medical expenses are a component of a compromise and release agreement, as in this case, Medicare's…”
Miller v. Workers' Comp. Appeal Bd., 940 A.2d 603 (Pa. Commw. Ct. 2008). “” To the extent that Medicare has, in the past, made any “conditional payments,” Medicare will recover those payments pursuant to 42 C.F.R. § 411.45 and § 411.47. Whenever future medical expenses are a component of a compromise and release agreement, as in this case, Medicare’s…”
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