List Medicare secondary-payer facts already in the file
Key facts
- Human involvement
- RedLawyer-led
- How AI is used
- Columns are whether the file says the person has Medicare, the primary plan named, the settlement or judgment date printed, and any conditional-payment figure printed. Write no sentence of a notice to the Secretary. Do not calculate a reimbursement.
- What the lawyer must review
- 42 U.S.C. § 1395y(b)(2) makes Medicare secondary where payment has been made or can reasonably be expected under a primary plan. A primary plan includes a group health plan to the extent clause (i) applies, and a workers' compensation law or plan, an automobile or liability policy or plan, including a self-insured plan, or no-fault insurance, to the extent clause (ii) applies. An entity that carries its own risk is deemed to have a self-insured plan. A conditional payment is conditioned on reimbursement of the Trust Fund. A primary plan, and an entity that receives its payment, must reimburse if responsibility is demonstrated by a judgment or by a payment conditioned on a compromise, waiver, or release, whether or not liability is admitted. If reimbursement is not made before the end of the 60-day period that begins when notice of that responsibility is received, the Secretary may charge interest. The claimant or applicable plan may notify the Secretary beginning 120 days before the reasonably expected date of settlement. You write any notice. Do not compute a protected period.
- Written for / version
- United States versionUS
Who does what
| Role | What they do |
|---|---|
| Assistance | Supporting preparation only. Potential support includes assembling provisional schedules. Confirm the tool’s capability and permitted scope. The tool writes nothing into the document. Substantive advice, judgement and any restricted content remain with the responsible human. |
| Lawyer | Perform the substantive analysis and decisions. Independently check any permitted supporting work and approve the exact output for its intended use. |
Checklist
- Trace every relied-on figure to its source, confirm dates and assumptions, and independently recalculate totals or derived amounts.
- Review operative clauses in the complete document, including definitions, cross-references, schedules and inconsistencies with the instructions.
- Confirm that the wording reflects the client’s instructions and contains no unintended admission, concession or commitment. Check the recipient and tone.
- Confirm the output against the client’s instructions and the complete relevant source material, including omissions or contradictions.
- Resolve exceptions and record the responsible lawyer’s approval of the exact output and intended use.