Medicare Secondary Payer Program

HEHS-95-101R: Published: Mar 6, 1995. Publicly Released: Mar 6, 1995.

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GAO provided information on and suggested language for proposed legislation regarding the recovery of health care costs from private insurers where Medicare is the secondary payer. GAO noted that the: (1) proposed legislation would give a clearer statutory basis for existing Medicare regulations on cost recovery from private insurers, which were recently invalidated by a court ruling; (2) Department of Health and Human Services is also preparing a legislative proposal to address this issue and other Medicare issues; (3) government may have to refund millions of dollars in past recoveries and forego future recoveries because of the court ruling; and (4) court ruling barred recoveries from third party administrators and claims filed past the insurers' filing deadlines and before 1989.

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