Article V.B. of the Guidant Master Settlement Agreement requires the appointment of a Medicare / Medicaid Lien Administrator to address the Medicare and Medicaid liens / obligations arising under the settlement.  The Medicare / Medicaid Lien Administrator (MLA) is tasked with affirmatively verifying which Participating Claimants are past or present Medicare and / or Medicaid beneficiaries and resolving all such Medicare and Medicaid interests.  The MLA is NOT appointed to handle healthcare liens outside Medicare and Medicaid, such as private insurance, healthcare coverage offered through employers (i.e. “ERISA”), or health benefits provided through Veterans Affairs (the “VA”) or other military programs, but can provide some assistance to you, as outlined below.  This FAQ is designed to answer the more common questions regarding Medicare and Medicaid obligations in the Guidant settlement.  Further questions can be directed to the MLA, using the contact information at the end of the FAQ

Q:  Who is the Medicare/Medicaid Lien Administrator?

A: The Garretson Law Firm has been appointed as the MLA in the Guidant Settlement.  The Garretson Law Firm has served in similar capacities in many other mass tort settlements and has the experience and resources to satisfy and discharge these liens / obligations as efficiently as possible (www.garretsonfirm.com and www.lienresolution.com ).

Q:  Under the settlement terms, what liens/obligations are being addressed by the Medicare/Medicaid Lien Administrator and what are the responsibilites of plaintiff counsel?

A:  The Master Settlement Agreement tasks the MLA with resolving all Medicare and Medicaid liens and obligations arising out of the Guidant settlement.  These are traditional Medicare (Parts A and B) and Medicaid liens and obligations, which the MLA will address and resolve affirmatively (meaning the MLA will facilitate resolution by working directly with Medicare and Medicaid on behalf of all Participating Claimants as a condition of the Claimants’ participation in the Guidant settlement program).  Also included in the category of “Medicare and Medicaid liens and obligations” are those asserted by Medicare Part C plans, which the MLA also will address on a case-by-case basis upon claimant-specific notice provided by plaintiff counsel.

Under the Master Settlement Agreement, the MLA does not have the task of addressing other healthcare liens and obligations, such as those arising under private insurance, ERISA and other employee health plans, military coverage, or other programs.  It is the responsibility of plaintiff counsel and your clients to address all other liens and third-party claims.  However, plaintiff counsel may contact The Garretson Law Firm to address these other healthcare liens and obligations separate and independent from the MLA engagement.

Q:  Should I contact Medicare of Medicaid if my client is entitled to these benefits, or for any other reason? 

A:   No.  The MLA will identify, address, and resolve all Medicare and Medicaid liens and obligations in the Guidant settlement.  The MLA is equipped with information which allows it to identify all Participating Claimants who have an obligation to either traditional Medicare (Parts A and B) or Medicaid, and facilitate resolution of those obligations.  Neither you nor your clients need to do anything to address these Medicare or Medicaid obligations.  Any agency contact by someone outside the MLA will result in duplicate files being created at the respective agency and delay resolution.  However, if you have contacted or been contacted by Medicare or Medicaid, please see the next question.

Q:  What if I already have contacted or have been contacted by Medicare or Medicaid?

A: If you or your client has received notice and / or placed the Medicare and / or Medicaid government agencies on notice (“notice claimants”), your immediate cooperation is required.  Notify the MLA of this contact immediately.  Also notify the MLA of any claimant-specific contact by a Medicare Part C plan. Please provide a spreadsheet listing these “notice claimants”. In addition, separately scan (in PDF form) all inbound and outbound correspondence with the Medicare and / or Medicaid government agencies and / or Medicare Part C plan, and title each claimant-specific file with the claimant’s 9-digit social security number.  Burn this information onto a CD-ROM and send to the MLA at the address listed at the end of this FAQ.  In the alternative, properly-labeled hard copies may be sent if more convenient.  ALL OF THIS MUST BE DONE BEFORE FEBRUARY 29, 2008.  (Also, please send to the MLA any other claimant-specific notice received after the February 29, 2008, deadline from the Medicare and / or Medicaid government agencies or any Medicare Part C plan).

Upon collection of these materials from the various plaintiff firms, the MLA will contact each firm to validate the “notice claimant” listing and provide a template letter that your firm will place on its letterhead and send to the interested agency re-directing all future activity to the MLA.

Q:  How will Medicare and Medicaid liens/obligations be addressed?

A:  With respect to traditional Medicare (Parts A and B) the MLA will: (i) verify the Participating Claimants in the Settlement Program who are (or have been) entitled to traditional Medicare and who may have potential Medicare obligations related to the Guidant settlement, and  (ii) facilitate a “global” resolution to satisfy Medicare’s interest for all Medicare-entitled (Parts A and B) Participating Claimants.  The MLA will work with the Claims Administrator and Special Masters to ensure that the allocation system recognizes the application of the Medicare global resolution in the settlements of those entitled Claimants.  Regardless of the extent to which any Medicare-entitled (Parts A and B) Participating Claimant has relied on his/her Medicare coverage in the past, this formalized process ensures that no future injury-related care will be denied as a result of this tort recovery.

With respect to Medicaid, the MLA will verify which Participating Claimants currently are or have been Medicaid beneficiaries in each state and territory between the dates of interrogation of recalled device through the date of settlement.  The MLA will then secure claims histories from the appropriate Medicaid agency and audit each claim to help ensure that only those medical expenses associated with Guidant Cardiac Medical Device injuries are included in the final reimbursement or “lien” amount.  The perfected lien will be deducted from the entitled plaintiff’s settlement payment. 

Q:  Who do I contact with questions regarding the satisfaction of Medicare or Medicaid interests?

A:  Should plaintiff counsel need to contact the MLA, please use the information at the end of this FAQ.  Furthermore, the MLA’s verification of entitlement, any lien-related “hold backs” and final resolution efforts will be incorporated and available through the Claim Administrator’s data base.

Q:  What about ERISA, private insurance and other healthcare liens?

A: The MLA engagement does NOT include the task of addressing healthcare liens other than those Medicare and Medicaid obligations specifically outlined above.  Other healthcare liens and obligations are to be resolved by plaintiff counsel and your clients, including those asserted under ERISA, FEHBA, or other employee health plans, private health insurance, military and veterans healthcare programs, and others. 

Plaintiff counsel may contact The Garretson Law Firm to address private healthcare liens separate and independent from the MLA engagement.