MEDICARE LIEN RESOLUTION AND REPORTING Sample Clauses

MEDICARE LIEN RESOLUTION AND REPORTING. A. The PSC agrees that Class Members are responsible for payment of any liens asserted against them for any payments made to them or on their behalf related in any way to the Incident which is the subject of this Settlement. B. Procedures for Lien Resolution i. Per Section IV.C.i., all Claims must be submitted on a Proof of Claim Form signed by the Class Member and attested to under penalty of perjury. The Proof of Claim Form must include a section which addresses liens. Each Class Member asserting a personal injury claim must complete this section. This will be considered a mutually agreeable indemnity agreement from all personal injury Class Members in favor of IP. 1. Each Class Member must identify any potential Governmental Authority Third Party Payer/Providers. Failure to provide this information or otherwise cooperate with the procedures set forth in this Section and as separately established by the Special Master shall be a basis for the Special Master to deny a Class Member's Claim. 2. Class Members must represent and warrant that none of his or her claims or rights arising out of the Incident have been assigned, subrogated, and/or transferred in any way, and that no liens or privileges exist in connection with this matter, other than a Medicare claim for conditional payments that Medicare made for medical expenses allegedly resulting from the Incident. Class Members must acknowledge Medicare’s right, pursuant to 42 U.S.C. § 1395y(b), as amended, and the statute’s implementing regulations, to recover certain conditional payments of medical expenses incurred in treatment of Class Members’ alleged injuries. Specifically, the Special Master must confirm that no Medicare lien exists. 3. Class Members must acknowledge that IP’s payment of the settlement proceeds terminates any responsibility that IP has or may have for Class Members’ past, present, or future medical expenses. Class Members must agree to provide the Special Master with written documentation evidencing satisfaction or waiver of any claim or lien related to treatment, services, and/or supplies provided in connection with the Incident, including evidence of satisfaction of the Medicare claims should the Class member claim such liens have been satisfied. Otherwise, the Special Master will complete all necessary reporting and obtain any documentation of the satisfaction of lien or a determination by CMS that no lien exists. The Special Master is required to provide any such documentation to t...