NGHP Notice Of Settlement (NOS)

Once a case has been settled, the beneficiary, or their authorized representative, must submit a Notice Of Settlement (NOS) that documents the result of the litigation to the MSPRC to the appropriatemail box.

In general, Medicare policy requires recovering payments from liability awards or settlements, whether the settlement arises from a personal injury action or a survivor action, without regard to how the settlement agreement stipulates disbursement should be made. That includes situations in which the settlements do not expressly include damages for medical expenses. Since liability payments are usually based on the injured or deceased person’s medical expenses, liability payments are considered to have been made “with respect to” medical services related to the injury even when the settlement does not expressly include an amount for medical expenses. To the extent that Medicare has paid for such services, the law obligates Medicare to seek recovery of its payments.

The only situation in which Medicare recognizes allocations of liability payments to nonmedical losses is when payment is based on a Federal court order from a court of competent jurisdication on the merits of the case. If the court specifically designates amounts that are for payment of pain and suffering or other amounts not related to medical services, Medicare will accept the Court’s designation. Otherwise, Medicare will seek recovery based on entire court award.

A beneficiary’s death does not materially change Medicare’s interest in recovering its payments made on behalf of the beneficiary while alive. Upon death, the estate of the beneficiary comes into existence by operation of law. An executor or administrator whose sole purpose is to conclude all business and financial matters that still remained at death manages it. Medicare’s interest in the outcome of a third party liability claim is one of these matters. Therefore, Medicare’s claim is properly asserted against the estate. Ordinarily, the estate should not have possession of any settlement proceeds that are due Medicare, since Medicare’s claim should have been satisfied before distribution to the estate (i.e., while the attorney was still in possession of the proceeds)

If the case was not favorable to the Medicare beneificiary, the MSPRC still needs to be alerted. If the beneficiary, or their representative does not inform the MSPRC, then the beneficiary may have claims related to the incident denied. The MSPRC is the only government contractor with the authority to remove the lead from the Common Working File.

expoint The MSPRC will demand the recovery amount, upon receipt of the NOS. It is best to submit the NOS after receiving the funds from the settlement.