Liability Claim Also Involved

30.2.1.2 - Liability Claim Also Involved (Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23) If the individual files a claim against a third party for injuries suffered in an accident, the provider may bill Medicare conditionally for otherwise covered expenses to the extent that payment has not been made, or cannot be made promptly by a no-fault insurer or liability insurer. For example, a Medicare beneficiary incurs $20,000 in medical expenses due to an automobile accident. The individual receives $5,000 in no-fault insurance benefits and also has a liability claim pending against the driver of the other car. Medicare does not pay benefits for the $5,000 in expenses paid for by the no-fault insurer but does pay benefits based on the additional $15,000 in expenses. Medicare recovers from the liability insurer or the beneficiary when the liability claim is settled.