Short Answer

If neither Medicare nor North Carolina Medicaid paid any of your accident-related medical bills, you generally do not owe them reimbursement from your settlement. Federal law requires repayment only when Medicare (including Medicare Advantage or Part D) made conditional payments, and state law creates a lien only when NC Medicaid paid for your injury care. Still, many release forms include Medicare indemnity language; confirm your coverage and payments before you sign and disburse funds.

Understanding the Problem

In North Carolina personal injury settlements, can you safely ignore Medicare or Medicaid repayment if you had only employer-provided private insurance? You are the injured person resolving a boating-injury claim, and the release includes an indemnification for Medicare liens. You want to know whether you have any duty to reimburse a government program before disbursing your settlement.

Apply the Law

Under North Carolina law and federal Medicare rules, reimbursement is required only if the relevant program actually paid accident-related medical expenses. Medicare’s right of recovery applies to beneficiaries when Medicare made conditional payments tied to a liability settlement. North Carolina Medicaid has a statutory lien that attaches to a personal injury recovery when it paid for injury-related care, and the lien must be resolved before funds are disbursed. If neither program paid, there is typically no reimbursement owed. The practical forum is administrative: Medicare recovery is handled through CMS’s recovery contractor; Medicaid liens are handled by NC DHHS (Division of Health Benefits) Third Party Recovery. Medicare final demands must be paid promptly (generally within 60 days) once issued.

Key Requirements

• Program involvement: Repayment is triggered only if Medicare (including Medicare Advantage or Part D) or NC Medicaid actually paid for your accident-related care.
• Beneficiary/recipient status: Verify whether you were a Medicare beneficiary or a NC Medicaid recipient at the time of treatment; if not, government repayment usually does not apply.
• Lien resolution before disbursement: If applicable, obtain lien/conditional payment amounts, finalize them, and pay them before distributing settlement proceeds.
• Medicare timing: After settlement, pay Medicare’s final demand within the required timeframe to avoid interest.

What the Statutes Say

• Medicare Secondary Payer rule (42 C.F.R. § 411.24) - Medicare may recover conditional payments from a liability settlement.
• N.C. Gen. Stat. § 108A-57 (Medicaid lien on PI recoveries) - State Medicaid lien attaches when Medicaid paid accident-related expenses; allocation rules apply.
• N.C. Gen. Stat. § 135-48.37 (State Health Plan subrogation) - The NC State Health Plan has statutory recovery rights separate from Medicaid.

Analysis

Apply the Rule to the Facts: You report only employer-based private insurance and no Medicare or Medicaid involvement. If that is accurate and neither Medicare nor NC Medicaid paid any injury-related bills, you generally have no government reimbursement to pay. The indemnity for Medicare liens in your release is a risk-shifting term; it does not create a lien, but it can make you responsible if a Medicare claim later surfaces. Confirm your coverage status and obtain written confirmation of any $0 balance before disbursing funds.

Process & Timing

1. Who files: Injured party or counsel. Where: For Medicare, coordinate with CMS’s recovery contractor; for NC Medicaid, contact the NC Department of Health and Human Services, Division of Health Benefits, Third Party Recovery. What: Request a conditional payment/lien statement; after settlement, request a final demand (Medicare) or final lien amount (Medicaid). When: Do this before distributing settlement funds; pay any Medicare final demand within the required window (typically 60 days of the demand).
2. If a statement shows $0 for Medicare/Medicaid, retain that confirmation in your file and proceed with disbursement consistent with the release.
3. Obtain written satisfaction/closure letters for any resolved lien and keep them with the settlement file.

Exceptions & Pitfalls

• Medicare Advantage/Part D counts: If you had a Medicare Advantage plan or Part D drug plan, those plans can assert Medicare-based recovery rights even if you didn’t use traditional Medicare.
• NC State Health Plan isn’t “private”: If your employer coverage is the NC State Health Plan, it has statutory reimbursement rights different from typical private insurance.
• Indemnity clauses: A broad Medicare indemnity in the release can shift liability to you if a later Medicare claim appears; consider limiting it to known, verified liens.
• Future medicals language: Avoid statements implying Medicare will pay future injury care; while set-asides aren’t mandated in liability cases, you must not shift known future costs to Medicare.

Talk to a Personal Injury Attorney

If you’re finalizing a settlement and want to be sure no Medicare or Medicaid reimbursement is owed, our firm has experienced attorneys who can help you understand your options and timelines. Call us today.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.