PAID Act Implemented

The PAID Act was implemented on December 11, 2021. As such, RREs can now receive the last three years of Medicare Advantage Plan and Medicare Prescription Drug Plan enrollment information through the query process, provided that RREs are using the most recent version of the HEW software (version 5.0). Query response files will return the Contract Number, Contract Name, Plan Number, Coordination of Benefits (COB) Address, and Entitlement Dates for the last three years (up to 12 instances) of Medicare Advantage Plan and Medicare Prescription Drug Plan coverage, as well as the most recent Part A and Part B entitlement dates. RREs, including DDE submitters, are also able to obtain this information using the beneficiary lookup function.

Please let us know if you have any questions regarding the implementation of the PAID Act. The ability to confirm Medicare Advantage Plan and Medicare Prescription Drug Plan enrollment data is tremendously helpful to ensure that Medicare Advantage Plan and Medicare Prescription Drug Plan liens are addressed, as a number of courts have recognized that such plans can assert a private cause of action against primary payers and seek double damages if their liens are not resolved. We encourage defendants and insurers to ensure such liens are resolved to avoid the potential for future litigation. There have been an increasing number of lawsuits over the years involving Medicare Advantage Plan liens, including a recent False Claims Act lawsuit by MSP Recovery against 315 insurers.

Because the PAID Act provides that RREs will be able to obtain the last three years of Medicare Advantage Plan and Medicare Prescription Drug Plan enrollment information, it is important to keep in mind that a claimant could have been enrolled in other plans when the date of injury and Medicare entitlement date are more than three years ago. If so, such plans could seek reimbursement as well.