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If you were injured in a Georgia automobile accident and receive Medicare or Medicaid, your case is more complicated than most people realize.
These programs do not simply “pay the bills and move on.” Under federal and Georgia law, both Medicare and Medicaid have powerful reimbursement rights that can significantly affect your settlement.
Failing to handle these claims correctly can delay your case, reduce your recovery, or even expose you to penalties.
Here’s what you need to know.
When someone else causes your crash, Georgia law allows you to pursue compensation for:
Medical expenses
Lost wages
Pain and suffering
Future medical treatment
Permanent disability
(O.C.G.A. § 51-12-4 allows recovery for necessary medical expenses resulting from injury.)
However, if Medicare or Medicaid paid for your accident-related treatment, they have a right to be reimbursed from your settlement.
This is not optional.
Under the Medicare Secondary Payer Act (42 U.S.C. § 1395y(b)), Medicare does not want to be the primary payer when another party is responsible.
If Medicare pays for your accident-related treatment, it makes what is called a “conditional payment.” That means:
Medicare expects to be paid back once you recover money from the at-fault driver.
If you settle your case:
Medicare must be notified of the claim.
Medicare issues a conditional payment summary listing accident-related medical bills.
Medicare asserts a reimbursement claim (often called a “Medicare lien,” though technically it’s a statutory recovery right).
The final settlement cannot be properly closed until Medicare’s interest is resolved.
Failing to repay Medicare can result in:
Collection actions
Interest penalties
Potential double damages under federal law
If your injury requires future medical treatment, Medicare may require a portion of the settlement to be allocated for future accident-related care before Medicare will resume paying.
While MSAs are most common in workers’ compensation cases, they may arise in serious liability cases involving permanent injuries.
Georgia Medicaid is administered through the Georgia Department of Community Health (DCH).
Unlike Medicare (federal), Medicaid reimbursement is governed by both federal law and Georgia statutes.
Under O.C.G.A. § 49-4-149 and related statutes, Georgia Medicaid has a statutory right to recover funds it paid for accident-related medical care.
However, Medicaid recovery is more limited than Medicare’s.
Thanks to U.S. Supreme Court decisions (including Arkansas Dept. of Health v. Ahlborn), Medicaid generally may only recover from the portion of a settlement allocated to medical expenses, not pain and suffering or lost wages.
This can make a significant difference in maximizing your net recovery.
Let’s say:
Your settlement: $100,000
Medicare paid: $25,000
Attorney’s fees and costs apply
Medicare typically reduces its recovery proportionally to account for attorney’s fees under federal regulations. This is called a procurement cost reduction.
Medicaid may also reduce its claim depending on how the settlement is allocated.
Without proper handling, however, these reimbursement claims can dramatically shrink your final check.
Medicare requires reporting through the Benefits Coordination & Recovery Center (BCRC).
You cannot simply “ignore” Medicare or Medicaid and keep the full settlement.
Failing to properly allocate damages between medical expenses and other categories can cost you thousands.
Medicare can pursue recovery directly from beneficiaries.
Many Georgians have Medicare Advantage (Part C) plans.
These are private insurers administering Medicare benefits. Courts have increasingly allowed these plans to assert strong reimbursement rights similar to traditional Medicare.
They must be addressed carefully during settlement negotiations.
Georgia follows a modified comparative negligence rule (O.C.G.A. § 51-12-33). If you are 50% or more at fault, you recover nothing. If less than 50%, your recovery is reduced proportionally.
Because lien repayment comes out of your settlement, reduced liability findings can dramatically impact how much you ultimately receive after Medicare or Medicaid reimbursement.
This makes strategic case valuation critical.
No — but it can feel that way in smaller cases.
If:
Medical bills are high
Insurance policy limits are low
Liability is disputed
Reimbursement claims may consume a large portion of the settlement.
In some cases, hardship reductions or compromise requests may be appropriate.
Handling Medicare and Medicaid reimbursement is not just paperwork.
It involves:
Identifying all accident-related payments
Challenging unrelated charges
Negotiating reductions
Structuring settlement allocations correctly
Ensuring compliance with federal and Georgia law
Failure to do this correctly can delay disbursement or expose you to future claims.
If you are on Medicare or Medicaid and injured in a crash in Georgia, your case requires careful coordination between:
Liability insurance claims
Medical billing
Federal reporting requirements
Georgia statutory reimbursement rights
At Kevin Patrick Law, we regularly handle automobile accident cases involving Medicare and Georgia Medicaid recipients. Protecting our clients means not only fighting for maximum compensation — but also ensuring that government reimbursement claims are handled correctly so clients keep as much of their recovery as possible.
Medicare and Medicaid are essential safety nets — but when you are injured due to someone else’s negligence, they become part of a complex legal and financial equation.
Understanding:
The Medicare Secondary Payer Act
Georgia Medicaid recovery statutes
Settlement allocation rules
Lien negotiation strategies
can make the difference between a frustrating outcome and a fully protected recovery.
If you’ve been injured in a Georgia automobile accident and receive Medicare or Medicaid benefits, getting experienced legal guidance early can protect both your case and your future medical coverage.
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