A vast amount of misinformation and confusion exists about what constitutes 100% compliance for P&C insurers.
The following is a brief explanation of obligations:
Compliance obligations exist for insurers when the following three conditions are present in a claim:
- Personal injury claim
- Claimant is a Medicare beneficiary
- Money has or will change hands
"Distinguishable but Inseparable" Duties
The primary sources of P&C industry confusion comes from not understanding there are two independent obligations an insurer has to Medicare:
- Section 111 Reporting
- MSP Recovery/Reimbursement
These two obligations have completely different sets of rules, dates, threshold amounts, etc.
Even though the rules governing Reporting and Recovery are different, they are inseparably related. The only reason Medicare introduced Reporting was to facilitate its Recovery efforts. In other words, compliance with Reporting obligations does not equate to compliance with Recovery obligations, and vice versa.
The chart below shows the “distinguishable but inseparable” nature of P&C insurer’s Medicare obligations.
Distinguishable but Inseparable