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Sep 29, 2014 by |

Medicare Conditional Payments Claimants Can Now File Private Cause of Action Lawsuits


If you are a victim of non-payment of a primary payment or reimbursement by a primary plan employer or carrier, you can file a private action against them for damages. Not only do they have to pay, they have to pay twice that amount.  On August 28, 2014, the US District Court for the Western District of Kentucky decided in a case that a defendant must pay damages to both Medicare and to any individual who filed a civil lawsuit for non-payment according to the Medicare Secondary Payer Act.

A private individual can file a civil action for non-payment by a primary plan to enforce Medicare rights under The Medicare Secondary Payer Act. The individual will be allowed twice the amount of damages in order to (1) pay back the government and (2) still have money left over for him or herself.  The employer or carrier defendant in that action cannot avoid paying the double damages by claiming they already paid Medicare.  Defendants will have to pay back both Medicare and the individual harmed.  With this provision so clearly enforced, hopefully there will be enough incentive to convince employers and carriers to pay Medicare’s conditional payments, immediately.

The Evans Law Firm, Inc. handles insurance fraud, banking fraud, consumer fraud class actions, qui tam (whistleblower/false claims) litigation, personal injury, and elder abuse cases. If you think you have been a victim of insurance fraud, contact the Evans Law Firm for a free and confidential consultation at 415-441-8669 or via email at

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