1

SYLLABUS

This syllabus is not part of the Court’s opinion. It has been prepared by the Office of the 

Clerk for the convenience of the reader. It has been neither reviewed nor approved by the 

Court. In the interest of brevity, portions of an opinion may not have been summarized.

Cooper Hospital University Medical Center v. Selective Insurance Company of 

America (A-46-20) (085211)

Argued September 13, 2021 -- Decided December 22, 2021

ALBIN, J., writing for a unanimous Court.

In this appeal, the Court considers who bears the primary responsibility for the 

payment of Dale Mecouch’s medical bills arising from an automobile accident that took 

place before December 5, 1980 -- the issuer of an automobile insurance policy or 

Medicare.

In 2016, Mecouch was hospitalized for approximately two months at Cooper 

Hospital University Medical Center (Cooper) due to complications arising from a 1977 

automobile accident that left him paralyzed from the waist down. At the time of his 

accident, Mecouch had a no-fault automobile insurance policy with Selective Insurance 

Company of America (Selective), which provided Mecouch with unlimited personalinjury-protection (PIP) benefits.

Sometime after 1979 but before 2016, Mecouch was enrolled in Medicare. 

Selective continued to pay Mecouch’s medical expenses related to the 1977 accident until 

December 11, 2015, when it notified Mecouch by letter that, going forward, “Medicare is 

the appropriate primary payer for any treatment related to” the 1977 accident.

After Mecouch’s 2016 hospital stay, Cooper forwarded to Selective a bill in the 

amount of over $850,000 for medical services rendered to Mecouch. Instead of paying 

that bill, Selective directed Cooper to seek reimbursement from Medicare. Cooper was a 

participating Medicare provider, and, at that time, Mecouch was a Medicare enrollee. 

Cooper then billed Medicare, which issued a payment of under $85,000. Selective

eventually agreed to reimburse Cooper for Mecouch’s co-payments and deductibles.

Cooper filed a complaint against Selective, seeking the total cost of Mecouch’s 

care. The trial court granted summary judgment in favor of Cooper, awarding Cooper the 

cost of Mecouch’s care minus the amount covered by Medicare. The Appellate Division 

reversed, concluding Medicare is the “primary payer” of medical bills for healthcare 

costs incurred by Mecouch at Cooper. The Court granted certification. 245 N.J. 470 

(2021).
2

HELD: Because Mecouch was a Medicare enrollee in 2016, Cooper -- a Medicare 

provider -- was required to bill and accept payment from Medicare, which promptly 

covered Mecouch’s medical expenses in accordance with its fee schedule. Cooper could 

not seek payment from Selective other than for reimbursement of the Medicare copayments and deductibles.

1. Whether Selective or Medicare has primary responsibility for the payment of 

Mecouch’s hospital bills turns on the interpretation of two statutory schemes: the New 

Jersey Automobile Reparation Reform Act (the No Fault Act) and Title XVIII of the 

Social Security Act (Medicare). In 1972, the Legislature passed the No Fault Act. Two 

of the principal aims of the Act were providing prompt care to automobile accident 

victims, regardless of fault, and constraining the spiraling cost of automobile insurance. 

The No Fault Act required car owners to have automobile insurance and, in return, 

required automobile insurers to provide PIP coverage for reasonable medical expenses 

incurred as a result of personal injury sustained in an automobile accident. To ensure the 

financial soundness of the no-fault system and to make automobile insurance premiums 

affordable, the Legislature also adopted a provision to shift the costs of medical care 

arising from automobile accidents to collateral sources, such as workers’ compensation 

insurance and Medicare. Benefits collectible from a collateral source are typically 

deducted from benefits collected under PIP under N.J.S.A. 39:6A-6, “the collateral 

source rule.” Under that rule, workers’ compensation insurance and Medicare are the 

primary payers and the PIP carrier the secondary payer. And because, in the case of a 

work-related automobile accident, a workers’ compensation insurance carrier is the 

primary payer, the Court recognized that a PIP carrier that pays benefits under a no-fault 

policy could “seek reimbursement from the workers’ compensation provider.” N.J. Mfrs. 

Ins. Co. v. Hardy, 178 N.J. 327, 339 (2004). (pp. 2-3, 17-21)

2. The primacy of Medicare, however, presents a scenario distinct from the workers’ 

compensation setting in Hardy because of the statutory and regulatory requirements of 

federal law. Congress enacted Medicare to provide healthcare benefits to persons over 

the age of sixty-five, and expanded benefits in 1972 to persons under the age of sixty-five 

who suffer from severe disabilities. In the Medicare system, healthcare providers, such 

as Cooper, may contract with the Department of Health and Human Services (DHHS) to 

receive compensation for treating Medicare enrollees. Hospitals that contract with 

DHHS -- known as participating Medicare providers -- agree to accept reimbursement of 

medical expenses incurred by Medicare enrollees according to a schedule set by the 

Centers for Medicare and Medicaid Services (CMS), a division of DHHS. In contracting 

with DHHS, Cooper and other healthcare providers agree “not to charge . . . any 

individual or any other person” -- which includes corporations, like Selective, under 

federal law -- “for items or services for which such individual is entitled to have payment 

made under” Medicare. 42 U.S.C. § 1395cc(a)(1)(A) (emphasis added). Healthcare 

providers, however, may collect a patient’s co-payments and deductibles, as determined 

by CMS, among other select costs. 42 U.S.C. § 1395cc(a)(2)(A). (pp. 21-24)
3

3. In 1980, to ensure the financial viability of Medicare, Congress passed the Medicare 

Secondary Payer Act to expand the collateral sources that would have primary 

responsibility for paying the medical expenses of a Medicare enrollee. Before December 

5, 1980, Medicare was willingly the primary payer, even when automobile insurance was 

available to pay for an enrollee’s medical expenses. In the Secondary Payer Act, 

Congress prohibited Medicare from paying an enrollee’s medical expenses “to the extent 

that payment has been made, or can reasonably be expected to be made” under a policy 

of workers’ compensation insurance, “automobile or liability insurance . . . or . . . no fault 

insurance.” See 42 U.S.C. § 1395y(b) (1976 & Supp. IV 1980). Requiring that no-fault 

automobile insurance carriers pay their insureds’ medical expenses spared Medicare from 

shouldering those costs. Congress granted DHHS authority to craft regulations to 

implement Medicare, and DHHS promulgated a regulation stating that the Secondary 

Payer Act does “not apply to any services required because of accidents that occurred 

before December 5, 1980.” The Secondary Payer Act, in effect, preempted the No Fault 

Act’s collateral source rule as it pertained to Medicare. (pp. 24-27)

4. In this pre-December 5, 1980, automobile injury case, the objectives of the No Fault 

Act and Medicare are aligned. The No Fault Act shifted to Medicare the primary 

responsibility for the payment of medical expenses arising from an automobile accident 

to reduce the financial costs borne by the automobile insurance system -- costs eventually 

passed on to the consumer. Medicare, in turn, was a program designed to provide 

affordable medical insurance for the aged and disabled, and federal law prohibited 

healthcare providers from seeking additional compensation from Medicare enrollees or 

other insurers -- except to recoup such costs as co-payments and deductibles. Thus, at the 

time of Mecouch’s automobile accident in 1977, the No Fault Act designated Medicare as 

having primary responsibility for the payment of the medical costs of Medicare enrollees, 

and Medicare willingly accepted primary responsibility for the healthcare of its enrollees. 

Congress later expanded Medicare’s collateral source doctrine to include automobile 

insurance carriers and no-fault insurance in the Secondary Payer Act. Under current 

federal law, the automobile insurance carrier has primary responsibility for the costs of a 

person’s medical care for injuries suffered in automobile accidents arising after 

December 5, 1980. (pp. 27-30)

5. Mecouch, however, falls in a limited class of approximately 150 current New Jersey 

Medicare enrollees who were injured in automobile accidents before December 5, 1980, 

and whose medical care continues to be covered by Medicare as the primary payer. The 

No Fault Act designated Medicare as the primary payer for Mecouch’s medical expenses, 

and Medicare authorized the payment of those expenses. The No Fault Act shifts the 

financial burden of an insured’s medical expenses onto Medicare if that insured is a 

Medicare enrollee. See N.J.S.A. 39:6A-6 (1977). In line with its broad remedial 

purpose, Medicare will directly pay for an enrollee’s medical expenses related to a preDecember 5, 1980 automobile accident. Because the enrollee is entitled to have medical 

expenses covered by Medicare, the healthcare provider is barred from seeking 
4

reimbursement from the enrollee or the enrollee’s PIP carrier, except for the co-payment 

and deductible amounts. Healthcare providers that contract with Medicare -- such as 

Cooper -- know that they are barred from seeking further satisfaction “for items or 

services for which such individual is entitled to have payment made” by Medicare. 

42 U.S.C. § 1395cc(a)(1)(A). If a healthcare provider seeks satisfaction from a PIP 

carrier instead of Medicare when treating a Medicare-enrolled patient, the healthcare 

provider must refund the money to the carrier after receiving reimbursement from 

Medicare. See 42 U.S.C. § 1395cc(a)(1)(C). (pp. 30-31)

6. The Court notes that here, Cooper has no reason to bill Selective first and should 

instead directly bill Medicare. In cases when a healthcare provider is not certain whether 

an insured is enrolled in Medicare, however, billing the PIP carrier first would further a 

core purpose of the No Fault Act, which is to provide automobile accident victims with 

the funds necessary for prompt medical care. If the insured in fact is a Medicare enrollee, 

then the healthcare provider must refund the monies received upon payment from 

Medicare. See 42 U.S.C. § 1395cc(a)(1)(C). (pp. 31-32)

7. This case is about legislative policies that set the order for the utilization of resources. 

Today, in accordance with the Secondary Payer Act, if Mecouch suffered serious injuries 

in an automobile accident and were treated in a Medicare participating hospital, such as 

Cooper, then his automobile insurance carrier would be responsible for payment of the 

hospital’s bill. The hospital would receive a much higher billing return for its medical 

services because payment is coming from the carrier. But Congress’s Medicare policy 

today is different from the policy in effect in 1977. Federal law in 1977 did not preempt 

the No Fault Act’s designation of Medicare as a collateral source, and the Court must 

give effect to the federal and state statutory schemes that apply to Mecouch’s 2016 

hospital treatment and care arising from injuries that he suffered in a 1977 automobile 

accident. Applying those schemes, Cooper -- upon notice from Selective -- was required 

to bill Medicare for the hospital care rendered to Mecouch, a Medicare enrollee, and 

Selective is responsible for the co-payments and deductibles owed by Mecouch to 

Cooper. (pp. 32-34)

AFFIRMED. REMANDED to the trial court.

CHIEF JUSTICE RABNER and JUSTICES LaVECCHIA, PATTERSON, 

SOLOMON, and PIERRE-LOUIS join in JUSTICE ALBIN’s opinion. JUSTICE 

FERNANDEZ-VINA did not participate.
1

SUPREME COURT OF NEW JERSEY

A-46 September Term 2020

085211

Cooper Hospital University Medical Center

on assignment by Dale Mecouch,

Plaintiff-Appellant,

v.

Selective Insurance Company of America,

Defendant-Respondent.

On certification to the Superior Court, 

Appellate Division.

Argued

September 13, 2021

Decided

December 22, 2021

Stanley G. Wojculewski argued the cause for appellant 

(Costello Law Firm, attorneys; Stanley G. Wojculewski, 

on the brief).

Laura A. Brady argued the cause for respondent

(Coughlin Midlige & Garland, attorneys; Laura A. Brady, 

of counsel and on the brief, and Christa P. McLeod, on 

the brief).

Robert B. Hille argued the cause for amicus curiae New 

Jersey Hospital Association (Greenbaum, Rowe, Smith & 

Davis, attorneys; Robert B. Hille, of counsel and on the 

brief, and John W. Kaveney and Neil Sullivan, on the 

brief).
2

Susan Stryker argued the cause for amicus curiae

Insurance Council of New Jersey (Bressler, Amery & 

Ross, attorneys; Susan Stryker, of counsel and on the 

brief).

JUSTICE ALBIN delivered the opinion of the Court.

In 2016, Dale Mecouch was hospitalized for approximately two months

at Cooper Hospital University Medical Center (Cooper or Cooper Hospital)

due to complications arising from a 1977 automobile accident that left him 

paralyzed from the waist down. By the time of his 2016 hospitalization, 

Mecouch had become enrolled in Medicare.1 We must determine who bears 

the primary responsibility for the payment of the medical bills arising from his

hospital treatment and care -- Selective Insurance Company of America 

(Selective), which issued the no-fault automobile insurance policy that

provided Mecouch with unlimited personal-injury-protection (PIP) benefits, or 

Medicare. The parties agree that Mecouch has no responsibility to pay those

bills. 

Whether Selective or Medicare has primary responsibility for the 

payment of Mecouch’s hospital bills turns on the interpretation of two 

statutory schemes: the New Jersey Automobile Reparation Reform Act (the 

1 He was not eligible for Medicare at the time of his accident.
3

No Fault Act), N.J.S.A. 39:6A-1 to -18 (1977); and Title XVIII of the Social 

Security Act (Medicare), 42 U.S.C. §§ 1395 to 1395lll.

In 1977, the No Fault Act mandated that every automobile insurance 

policy contain a provision requiring the insurer to pay “all reasonable medical 

expenses” -- PIP benefits -- to the insured and insured’s family in the event 

they were injured in an automobile accident, regardless of who was at fault in 

causing the accident. N.J.S.A. 39:6A-4(a) (1977). The Act imposed on the 

automobile insurance carrier the responsibility of paying PIP benefits “as loss 

accrues,” but provided that medical expenses payable from collateral sources, 

such as workers’ compensation insurance and Medicare, were to be deducted 

from the PIP benefits. N.J.S.A. 39:6A-6 (1977) (the collateral source rule).

Under the collateral source rule, the automobile carrier typically was expected 

to make prompt PIP payments first, but ultimately the collateral source had

primary responsibility for the payment of the medical bills. N.J. Mfrs. Ins. Co. 

v. Hardy, 178 N.J. 327, 339 (2004).

In 1972, Congress expanded Medicare to provide healthcare benefits not 

only to the aged, but also to persons of any age who suffer from severe 

disabilities. Social Security Amendments of 1972, Pub. L. No. 92-603, 

§ 201(a)(2), 86 Stat. 1329, 1371. At that time, Medicare was authorized to 

provide coverage for payment of an enrollee’s medical expenses -- except for 
4

those expenses covered by workers’ compensation insurance. See 42 U.S.C. 

§ 1395y(b) (1976); Fanning v. United States, 346 F.3d 386, 388 (3d Cir. 2003).

In 1980, Congress passed the Medicare Secondary Payer Act to expand 

the field of collateral sources bearing primary responsibility for the payment of

medical expenses of a Medicare enrollee. See 42 U.S.C. § 1395y(b) (1976 & 

Supp. IV 1980).

2

 The Secondary Payer Act prohibited Medicare from paying 

an enrollee’s medical expenses if an automobile insurance carrier could 

reasonably be expected to cover those costs. Ibid. The Act, however, operates 

prospectively. The Department of Health and Human Services (DHHS) 

interpreted the Secondary Payer Act to apply only to automobile accidents 

occurring on or after December 5, 1980. See 42 C.F.R. § 411.50; Colonial 

Penn Ins. Co. v. Heckler, 721 F.2d 431, 440 (3d Cir. 1983). Given DHHS’s 

interpretation of the Act, Medicare was responsible for paying such medical 

expenses as Mecouch’s 2016 hospitalization, which related to injuries he

suffered in his 1977 automobile accident. 

Relying on its interpretation of the No Fault Act, Cooper filed an action 

in Superior Court to compel Selective to pay the entirety of Mecouch’s 2016 

medical bills in the amount of $853,663, including interest. Selective replied 

2

 What is commonly known as the “Secondary Payer Act” was a part of the 

Omnibus Reconciliation Act of 1980, Pub. L. 96-499, § 953, 96 Stat. 2599, 

2647. 
5

that, pursuant to the No Fault Act’s collateral source rule, Cooper, as a 

participating Medicare provider, was required to accept reimbursement solely

from Medicare. The Medicare fee schedule limited payment to Cooper in the 

amount of $84,339.94; Selective eventually conceded its responsibility to pay 

$12,236 in Medicare co-payments and deductibles that Mecouch owed to 

Cooper.

Ultimately, the trial court granted judgment in favor of Cooper, ordering 

Selective to pay Cooper $769,323.06 (the full hospital bill minus the 

$84,339.94 Medicare was willing to pay). The court construed N.J.S.A.

39:6A-6 as placing on the automobile insurance carrier the primary obligation

to pay medical expenses when billed, regardless of available collateral sources

such as Medicare.

The Appellate Division reversed, finding that for automobile-accident

injuries that occurred in 1977, under the No Fault Act and federal law,

Medicare had primary responsibility. According to the Appellate Division,

Cooper was required to bill Medicare -- the collateral source under N.J.S.A.

39:6A-6 -- not Selective, for Mecouch’s 2016 medical expenses; however,

Cooper could bill Selective for the Medicare co-payments and deductibles

owed by Mecouch.
6

We substantially agree with the Appellate Division. As of 1977, two of 

the paramount goals of the No Fault Act were to provide prompt payment of 

medical expenses arising from an automobile accident, regardless of fault, and 

to contain the rising cost of automobile insurance premiums. See Caviglia v. 

Royal Tours of Am., 178 N.J. 460, 467 (2004) (citing Gambino v. Royal Globe 

Ins. Cos., 86 N.J. 100, 105-06 (1981)). The Legislature understood that the 

affordability of insurance premiums depended on stabilizing the costs borne by 

automobile insurance carriers. See Haines v. Taft, 237 N.J. 271, 284-85

(2019). To achieve that objective, the Legislature, in passing the No Fault Act

in 1972, placed restrictions on the right of accident victims to sue for noneconomic injuries, Caviglia, 178 N.J. at 466-67 (citing Sotomayor v. Vasquez, 

109 N.J. 258, 261-62 (1988)), and shifted the primary responsibility for 

payment of medical expenses from automobile insurance carriers to certain 

collateral sources, such as workers’ compensation insurance and Medicare, see

N.J.S.A. 39:6A-6 (1977). Under the No Fault Act’s collateral source rule,

Medicare had primary responsibility and the PIP carrier secondary 

responsibility for paying medical bills arising from automobile accidents.3 See

ibid. 

3

 The terms “PIP carrier” and “automobile insurance carrier” are used 

interchangeably.
7

At the same time, in 1977, for those enrolled in Medicare, federal law

authorized Medicare to pay for an enrollee’s medical expenses, including 

expenses arising from automobile accidents, with one notable exception: 

expenses covered by workers’ compensation. See 42 U.S.C. §§ 1395d(a), 

1395y(b) (1977). Thus, the No Fault Act’s shifting of medical costs from the 

automobile insurance carrier to Medicare, pursuant to the collateral source 

rule, N.J.S.A. 39:6A-6 (1977), furthered the objective of both state and federal 

law at the time of Mecouch’s accident in 1977.

For that reason, because Mecouch was a Medicare enrollee in 2016,

Cooper -- a Medicare provider -- was required to bill and accept payment from 

Medicare, which promptly covered Mecouch’s medical expenses in accordance 

with its fee schedule. Cooper could not seek payment from Selective other 

than for reimbursement of the Medicare co-payments and deductibles. 

As explained in more detail in this opinion, we therefore affirm the 

judgment of the Appellate Division.

I.

A.

The facts are largely undisputed and based on the summary judgment 

record developed before the trial court.
8

In July 1977, Dale Mecouch, then twenty-three years old, was seriously 

injured in an automobile accident in California that rendered him a paraplegic 

in need of life-long medical care. At the time, Mecouch was a New Jersey 

resident stationed in San Diego as a member of the Marine Corps. Mecouch’s 

driver’s license listed his residence as his parents’ home in Pitman, New 

Jersey.

In a declaratory judgment action brought by Mecouch, the Superior 

Court, Chancery Division, determined that Mecouch was covered by his 

father’s automobile insurance policy issued by Selective. Accordingly, the 

court ordered Selective to provide Mecouch with PIP benefits for all medical 

expenses arising from the 1977 automobile accident, as required by N.J.S.A. 

39:6A-4 (1977).

4

 

Sometime after 1979 but before 2016, Mecouch was enrolled in 

Medicare. Selective continued to pay Mecouch’s medical expenses related to 

the 1977 automobile accident until December 11, 2015, when it notified 

Mecouch by letter that, going forward, “Medicare is the appropriate primary 

payer for any treatment related to” the 1977 accident. 

4

 The court’s order did not suggest in any way that the collateral source rule,

N.J.S.A. 39:6A-6 (1977), was inoperative. 
9

From February 15 to May 17, 2016, Mecouch was admitted to Cooper 

Hospital for the treatment of medical complications related to the 1977 

accident. Cooper forwarded to Selective a bill in the amount of $853,663 for 

medical services rendered to Mecouch. Instead of paying that bill, Selective

directed Cooper to seek reimbursement from Medicare. Cooper was a

participating Medicare provider, and, at that time, Mecouch was a Medicare 

enrollee.

Cooper then billed Medicare, which issued a payment of $84,339.94 in 

satisfaction of the medical services that Cooper provided to Mecouch.

Selective ultimately agreed to reimburse Cooper for Mecouch’s co-payments 

and deductibles totaling $12,236.

B.

Cooper filed a complaint against Selective in the Superior Court, Law 

Division, seeking payment of the $853,663 it initially billed Selective.5 While 

pursuing the action against Selective, Cooper refunded the $84,339.94 it 

received from Medicare. In answering Cooper’s complaint, Selective claimed 

that Medicare was primarily responsible for the payment of Cooper’s bill.

5

 Mecouch assigned his rights to Cooper for purposes of Cooper’s coverage 

dispute with Selective.
10

After Cooper and Selective engaged in discovery and a failed mediation, 

both parties moved for summary judgment.

The trial court granted summary judgment in favor of Cooper. The court 

held that Selective was required to pay the entirety of the medical bill of 

$853,663 submitted by Cooper, minus the $84,339.94 Cooper received from

and returned to Medicare. The court also awarded Cooper $33,340 in 

attorney’s fees for Selective’s improper denial of the PIP claim, pursuant to

Rule 4:42-9(a)(6) and Cirelli v. Ohio Casualty Insurance Co., 72 N.J. 380, 

384-85 (1977). In all, Selective owed Cooper a total of $802,663.06. 

The court reasoned that, under N.J.S.A. 39:6A-6, Selective, as the PIP 

carrier, had to pay Cooper’s bill when submitted -- even if Selective was “not 

ultimately the primary source obligated to make the payment.” According to 

the court, because the No Fault Act “make[s] PIP benefits the immediate and 

primary source of medical expense payment,” Selective “did not have the right 

in the first instance to simply deny the claim,” even if Selective had a later 

right to seek reimbursement or deduct amounts received from collateral 

sources, such as Medicare. In its ruling, the court acknowledged that, under 

federal law, Medicare potentially has primary responsibility for providing

benefits to automobile accident victims injured before December 5, 1980.
11

C.

In an unpublished opinion, the Appellate Division reversed and 

remanded. 

In construing the federal statutes governing Medicare, including the 

Medicare Secondary Payer Act, the Appellate Division concluded that 

Medicare is the “primary payer” of medical bills for healthcare costs incurred 

by Mecouch at Cooper Hospital as a result of the 1977 automobile accident. 

The Appellate Division’s interpretation of federal law accorded with its 

interpretation of the No Fault Act’s collateral source rule, N.J.S.A. 39:6A-6,

which, in this case, shifted the burden of paying medical bills from the PIP 

carrier to Medicare.

While acknowledging that, under the No Fault Act, PIP is the primary 

payer under most circumstances, the court emphasized that N.J.S.A. 39:6A-6 

provides that payments from collateral sources “shall be deducted” from PIP

payments. The “shall be deducted” language, in the court’s view, is “most 

clearly understood as shifting the insurance coverage from automobile 

insurance to” collateral sources, such as workers’ compensation insurance and 

Medicare, quoting Lambert v. Travelers Indem. Co. of Am., 447 N.J. Super. 

61, 74 (App. Div. 2016).
12

That interpretation of the collateral source rule, the Appellate Division 

declared, “is logical and efficient, and comports with and does not present a 

conflict or obstacle to the federal Medicare method of payment.” Because 

Cooper was a Medicare participating hospital, it agreed to accept Medicare’s 

fee schedule and to forego any further payment for the costs of Mecouch’s 

medical care, other than co-payments and deductibles, for which Selective was 

responsible. In that light, the Appellate Division determined that Medicare’s 

payment of $84,339.94 to Cooper for Mecouch’s medical care extinguished 

Mecouch’s debt. In addition, the court ordered Selective to pay Cooper the 

$12,236 in co-payments and deductibles, plus interest, owed by Mecouch. 

Going forward, the Appellate Division noted that if Mecouch was not 

covered under Medicare, Selective would be liable for the billed amounts in 

accordance with New Jersey’s no-fault insurance scheme. On remand, the trial 

court was directed to determine the appropriate legal fees and costs.

We granted Cooper’s petition for certification. 245 N.J. 470 (2021). We 

also granted the motions of the New Jersey Hospital Association and the 

Insurance Council of New Jersey to participate as amici curiae. 
13

II.

A.

Cooper argues that the availability of a collateral source under N.J.S.A. 

39:6A-6 does not preclude an insured -- or its assignee in this case -- from first 

seeking reimbursement of medical expenses from the PIP carrier, citing Hardy, 

178 N.J. at 339. Cooper contends that the Appellate Division erred in 

construing N.J.S.A. 39:6A-6 as allowing Medicare’s payment to entirely 

extinguish Selective’s obligation to pay the balance of Mecouch’s hospital bill.

In Cooper’s view, even before the Medicare Secondary Payer Act, 

Congress could not have intended for Medicare to serve as the primary payer 

for the medical expenses incurred by automobile injury victims, given that 

state no-fault laws were not on the books at the time of Medicare’s enactment 

in 1965. Although Cooper stresses that “nothing in the Medicare law itself 

states that Medicare is ‘primary’ to any other form of insurance in general,” it 

concedes that before enactment of the Secondary Payer Act in 1980, Medicare 

generally issued payment even if there was another potential source of 

coverage. 

In short, Cooper submits that Selective, as the PIP carrier, had to pay 

Cooper’s bill, once tendered, even if Selective later sought reimbursement 

from Medicare. 
14

The New Jersey Hospital Association generally echoes Cooper’s 

arguments that Congress never intended Medicare to act as the primary payer

in cases where automobile insurers were already contractually responsible to 

cover medical costs for their insureds. In that regard, the Association 

emphasizes that in 1977, the No Fault Act required PIP carriers to provide 

unlimited medical expense coverage to insureds. The Association expresses 

concern that, if the Appellate Division is affirmed, “PIP carriers will receive a 

windfall by receiving premiums for care that they are relieved from 

reimbursing” and overburdened hospitals “will face significant additional 

annual losses.” 

B.

Selective states that the only issue is whether it or Medicare will bear the 

costs of a patient’s medical care in the limited number of automobile injury

extended-care cases that occurred before passage of the Medicare Secondary 

Payer Act. Selective makes clear that “[e]ither way, the patient receives the 

necessary medical services and is assigned no financial responsibility.” 

Selective argues “that the original Medicare statute enacted a ‘primacy 

structure’ that excepted only workers’ compensation benefits.” It agrees with 

the Appellate Division’s pronouncement that “should Medicare find Mecouch 
15

is not covered under its program, [Selective] is liable for the amounts” 

pursuant to the no-fault scheme. 

Selective submits that the “proposed PIP-goes-first-offset” scheme is

barred on federal preemption grounds. Additionally, it contends that Cooper’s 

interpretation of N.J.S.A. 39:6A-6 essentially writes out of the collateral 

source rule the provision allowing Medicare benefits to be deducted from PIP 

benefits. According to Selective, had it paid Cooper’s invoice, Mecouch’s 

financial obligation would have been extinguished and federal law would have 

precluded a Medicare reimbursement. In its view, Medicare stands in the 

primary payer position, and Selective is responsible only for the co-payment

and deductible amounts not paid by Medicare. 

The Insurance Council of New Jersey urges that we affirm the Appellate 

Division, mostly for the reasons expressed by Selective. It underscores that 

the purpose of the collateral source rule is “to shift costs from the no-fault 

system to other responsible payers in order to reduce automobile insurance 

premiums.” Shifting the costs to Medicare, the Council contends, is consistent 

with federal law at the time of Mecouch’s 1977 accident when “Medicare 

served as primary insurance for all covered individuals . . . with the exception 

of workers’ compensation insurance.” 
16

III.

A.

The question before the Court is straightforward: does Selective or 

Medicare have primary responsibility for the payment of Mecouch’s 2016 

medical expenses at Cooper Hospital? If Selective is primarily responsible, 

then Cooper receives the full payment of its bill with the cost borne by the 

automobile insurance system. If Medicare is primarily responsible, then 

Cooper is bound by the Medicare fee schedule to which Cooper agreed. 

The answer to the question depends on the policy choices made by the 

Legislature in passing the No Fault Act and Congress in passing Medicare. To 

understand the policies adopted by the Legislature and Congress, we must look 

to the statutory schemes they enacted. Our ultimate goal in this interpretive 

analysis is to determine what the Legislature and Congress intended. The best 

indicator of legislative intent typically is found in the statutory language itself. 

DiProspero v. Penn, 183 N.J. 477, 492 (2005) (citing Frugis v. Bracigliano, 

177 N.J. 250, 280 (2003)). In reviewing that language, we must give “the 

statutory words their ordinary meaning and significance.” Ibid. (citing Lane v. 

Holderman, 23 N.J. 304, 313 (1957)). In addition, we must read related 

statutes and provisions in context with one another “to give sense to the 

legislation as a whole.” Ibid. (citing Chasin v. Montclair State Univ., 159 N.J. 
17

418, 426-27 (1999)). An understanding of the “legislative plan” may also be 

gleaned by reading the statutory scheme “in full light of its history, purpose, 

and context.” Chasin, 159 N.J. at 427 (quoting State v. Haliski, 140 N.J. 1, 9 

(1995)). Last, when construing federal and state statutes that relate to the 

same subject matter, we must view them together to see whether they have 

common or conflicting objectives. See Hedgebeth v. Medford, 74 N.J. 360, 

365-66 (1977).

With those familiar canons of statutory interpretation in mind, we now 

proceed to review the New Jersey No Fault Act and the federal law enacting

Medicare.

B.

In 1972, the Legislature passed the No Fault Act, L. 1972, c. 70, §§ 1 to 

18, to replace the traditional tort “fault” system in which automobile accident 

victims waited years for their medical bills to be paid “while their lawsuits 

lumbered through an overburdened court system.” Caviglia, 178 N.J. at 467 

(citing Roig v. Kelsey, 135 N.J. 500, 502-03 (1994)). One of the principal 

aims of the No Fault Act was to constrain the spiraling cost of automobile 

insurance. DiProspero, 183 N.J. at 485. 

The No Fault Act required the owner of an “automobile registered or 

principally garaged in this State” to have automobile insurance. N.J.S.A. 
18

39:6A-3 (1977). In return, the Act required automobile insurers to include in 

every automobile insurance policy a form of self-insurance -- “[p]ersonal 

injury protection [PIP] coverage, regardless of fault.” N.J.S.A. 39:6A-4 

(1977). PIP coverage guaranteed the insured, the insured’s family and 

passengers, as well as pedestrians, the “[p]ayment of all reasonable medical 

expenses incurred as a result of personal injury sustained in an automobile 

accident.” N.J.S.A. 39:6A-4(a) (1977). The No Fault Act placed restrictions 

on the “unlimited right to sue in exchange for the benefit of ‘lower premiums 

and prompt payment of medical expenses.’” DiProspero, 183 N.J. at 485 

(quoting Caviglia, 178 N.J. at 467).

To ensure the financial soundness of the no-fault system and to make 

automobile insurance premiums affordable, the Legislature also adopted a 

provision to shift the costs of medical care arising from automobile accidents 

to collateral sources, such as workers’ compensation insurance and Medicare. 

N.J.S.A. 39:6A-6 (1977); see Lefkin v. Venturini, 229 N.J. Super. 1, 12 (App. 

Div. 1988). Under the collateral source rule, medical expenses, incomecontinuation expenses, essential-service expenses, survivor expenses, and 

funeral expenses provided in the PIP statute, N.J.S.A. 39:6A-4, 

shall be payable as loss accrues, . . . except that benefits 

collectible under workmen’s compensation insurance, 

employees temporary disability benefit statutes and 

[M]edicare provided under Federal law, shall be 
19

deducted from the benefits collectible under [the PIP

statute].6

[N.J.S.A. 39:6A-6 (1977).]

Accordingly, benefits collectible from a collateral source are typically

deducted from benefits collected under PIP. Ibid. Thus, if the collateral 

source satisfied the entirety of the medical expenses arising from an 

automobile injury, the PIP carrier would be relieved of making any payment. 

Under the collateral source rule, workers’ compensation insurance and

Medicare are the primary payers and the PIP carrier the secondary payer. Ibid. 

Recently, we examined the collateral source rule in a case that dealt with 

the intersection of the Workers’ Compensation Act, N.J.S.A. 34:15-1 to -147, 

and the Auto Insurance Cost Reduction Act (AICRA), N.J.S.A. 39:6A-1.1 to -

35, the successor to the No Fault Act.7 N.J. Transit Corp. v. Sanchez, 242 N.J. 

78 (2020) (Patterson, J., concurring). An equally divided Court in Sanchez

affirmed the Appellate Division, which concluded that New Jersey Transit, 

6

 N.J.S.A. 39:6A-10 (1977) required PIP carriers to offer insureds additional 

PIP coverage, the details of which are not relevant here. It bears noting, 

however, that in the years that followed, the Legislature passed measures to 

limit PIP benefits to make automobile insurance premiums more affordable. 

Compare N.J.S.A. 39:6A-4(a) (1977), with N.J.S.A. 39:6A-4(a) (2021). See 

also DiProspero, 183 N.J. at 485-86 (describing the Legislature’s evolving 

efforts to contain costs within the No Fault Act’s framework).

7

 AICRA incorporates many of the No Fault Act’s provisions, including the 

collateral source rule provisions at issue in this case. See N.J.S.A. 39:6A-6.
20

which had paid workers’ compensation benefits to an employee injured in a 

work-related motor vehicle accident, could bring a subrogation claim against 

the alleged tortfeasor. Id. at 79 (Patterson, J., concurring). 

Despite the different views held on that issue, both the concurrence and 

the dissent agreed that, when medical expenses are covered by both no-fault 

automobile insurance and workers’ compensation insurance, workers’ 

compensation has primary responsibility for the payment of medical expenses 

pursuant to the collateral source rule. See Sanchez, 242 N.J. at 90-91

(Patterson, J., concurring) (“From its inception, the No-Fault Law made clear 

that the burden to provide benefits to employees injured in work-related 

automobile accidents remained on the workers’ compensation system.” (citing 

L. 1972, c. 70, § 6)); id. at 109-10 (Albin, J., dissenting) (“Since its inception, 

and in its present iteration, our no-fault law makes the workers’ compensation 

system the primary source of reimbursement for economic damages suffered 

by a driver injured in a work-related automobile accident.” (citing L. 1972, c.

70, § 6)).

8

Because, in the case of a work-related automobile accident, a workers’ 

compensation insurance carrier is the primary payer under the collateral source 

8

 In Sanchez, the injured worker did not seek or receive PIP benefits. 242 N.J. 

at 81. 
21

rule, we recognized that a PIP carrier that pays benefits under a no-fault policy 

could “seek reimbursement from the workers’ compensation provider.” Hardy, 

178 N.J. at 339. We noted in Hardy that the injured worker, despite the 

availability of workers’ compensation, could have sought PIP benefits first, 

although, in the end, workers’ compensation still had primary responsibility 

for the medical costs related to the accident. See ibid.

The primacy of Medicare, however, presents a scenario distinct from the 

workers’ compensation setting in Hardy because of the statutory and 

regulatory requirements of federal law. We therefore now turn to Medicare.

C.

Congress enacted Medicare to provide healthcare benefits to persons

over the age of sixty-five and to persons under the age of sixty-five who suffer 

from severe disabilities. See 42 U.S.C. § 1395c.

9

 Significantly, for purposes

of the facts before us, Medicare coverage is available to persons of any age 

who are entitled to receive disability insurance benefits for at least twenty-four 

months under the Social Security Act. Ibid. Among other benefits, Medicare

“shall consist of entitlement to have payment made on [a person’s] behalf . . . 

for . . . inpatient hospital services . . . for up to 150 days during any spell of 

9

 Congress later amended Medicare to also include persons who suffer from 

end-stage renal disease. 42 U.S.C. § 1395(c).
22

illness . . . .” 42 U.S.C. § 1395d(a)(1).

10

 No one disputes that Mecouch was 

entitled to payment by Medicare for the “inpatient hospital services” provided 

by Cooper. Ibid.

In the Medicare system, healthcare providers, such as Cooper, may 

contract with DHHS to receive compensation for treating Medicare enrollees. 

42 U.S.C. § 1395cc(a)(1)(A). Hospitals that contract with DHHS -- known as 

participating Medicare providers -- agree to accept payment for reimbursement 

of medical expenses incurred by Medicare enrollees according to a schedule 

set by the Centers for Medicare and Medicaid Services (CMS), a division of 

DHHS. See 42 U.S.C. §§ 1395f(b), 1395ww; 42 C.F.R. §§ 412.1, 412.8. 

Federal regulations dictate that “Medicare pays hospital insurance benefits 

only to a participating provider,” 42 C.F.R. § 409.100(a)(1), and define 

“participating” as “a hospital or other facility that meets the conditions of 

10

 We note that DHHS allows “[a] patient on admission to a hospital or skilled 

nursing facility [to] refuse to request Medicare payment and agree to pay for 

the services out of their own funds or from other insurance.” Medicare Claims 

Processing Manual ch. 1, § 50.1.5 (2021). No one claims that Mecouch 

waived payment from Medicare. Because the issue of waiver is not present in 

this case, we need not address whether a patient’s waiver of Medicare 

payments, in a case such as this, would run afoul of the collateral source rule, 

N.J.S.A. 39:6A-6.
23

participation and has in effect a Medicare provider agreement,” 42 C.F.R. 

§ 409.3.11 As indicated earlier, Cooper is a participating Medicare provider. 

In contracting with DHHS, Cooper and other healthcare providers agree 

“not to charge . . . any individual or any other person for items or services for 

which such individual is entitled to have payment made under” Medicare. 42 

U.S.C. § 1395cc(a)(1)(A) (emphasis added). Under federal law, Selective, as a 

corporation, is a person. See 1 U.S.C. § 1 (“[T]he words ‘person’ and 

‘whoever’ include corporations, companies, associations, firms, partnerships 

. . . as well as individuals.”). Healthcare providers, however, may collect a 

patient’s co-payments and deductibles, as determined by CMS, among other 

select costs, from an “individual or other person.” 42 U.S.C. 

§ 1395cc(a)(2)(A). 

In 1977, at the time of Mecouch’s automobile accident, Medicare was 

generally providing primary coverage for payment of an enrollee’s medical 

expenses, except for those expenses covered by workers’ compensation 

insurance. See 42 U.S.C. § 1395y(b) (1977); see also Fanning, 346 F.3d at

388 (“Prior to 1980, Medicare generally paid for medical services whether or 

11

 Medicare will also pay hospital insurance benefits to nonparticipating 

providers “[f]or emergency services furnished by a nonparticipating hospital” 

and “[f]or services furnished by a Canadian or Mexican hospital,” subject to 

federal regulations. 42 C.F.R. § 409.100(b). 
24

not the recipient was also covered by another health plan.” (citing Social 

Security Amendments of 1965, Pub. L. No. 89-97, § 1862(b), 79 Stat. 286)); 

Bio-Med. Applications of Tenn., Inc. v. Cent. States Se. & Sw. Areas Health & 

Welfare Fund, 656 F.3d 277, 278 (6th Cir. 2011) (stating that before 1980, 

“Medicare paid for all medical treatment within its scope and left private 

insurers merely to pick up whatever expenses remained”).

In 1980, to ensure the financial viability of Medicare due to skyrocketing 

health costs, Congress passed the Medicare Secondary Payer Act to expand the 

collateral sources that would have primary responsibility for paying the 

medical expenses of a Medicare enrollee. See Omnibus Reconciliation Act of 

1980, Pub. L. 96-499, § 953, 96 Stat. 2599, 2647. The legislative history of 

the Secondary Payer Act makes clear that Congress understood that Medicare 

had been the “primary payor” of medical costs related to injuries suffered by 

Medicare enrollees in automobile accidents, generally relieving private 

automobile insurance carriers of that financial burden. That view is reflected 

in a report issued by the House Ways and Means Committee that endorsed 

passage of the Secondary Payer Act. The report stated:

Under present law, Medicare is the primary payor 

(except where a workmen’s compensation program is 

determined to be responsible for payment for needed 

medical services) for hospital and medical services 

received by beneficiaries. This is true even in cases in 

which a beneficiary’s need for services is related to an 
25

injury or illness sustained in an auto accident and the 

services could have been paid for by a private insurance 

carrier under the terms of an automobile insurance 

policy. As a result, Medicare has served to relieve 

private insurers of obligations to pay the costs of 

medical care in cases where there would otherwise be 

liability under the private insurance contract. 

[H.R. Rep. 96-1167, at 389, reprinted in 1980 

U.S.C.C.A.N. 5526, 5752 (1980) (emphasis added).]

Importantly, the report indicates that, before December 5, 1980, 

Medicare was the primary payer, even when automobile insurance was 

available to pay for an enrollee’s medical expenses. Ibid. Federal 

jurisprudence also recognizes that “[u]ntil 1980, Medicare ‘paid for services 

without regard to whether they were also covered by an employer group health 

plan.’” N.Y. Life Ins. Co. v. United States, 190 F.3d 1372, 1373 (Fed. Cir. 

1999) (emphasis added) (quoting Health Ins. Ass’n of Am. v. Shalala, 23 F.3d 

412, 414 (D.C. Cir. 1994)).

In the Secondary Payer Act, Congress prohibited Medicare from paying 

an enrollee’s medical expenses “to the extent that payment has been made, or 

can reasonably be expected to be made” under a policy of workers’ 

compensation insurance, “automobile or liability insurance . . . or . . . no fault 

insurance.” See 42 U.S.C. § 1395y(b) (1976 & Supp. IV 1980).

12

 Requiring 

12

 Congress allowed Medicare to pay for an enrollee’s care if it was uncertain 

whether the enrollee’s workers’ compensation, automobile, or no-fault 
26

that no-fault automobile insurance carriers pay their insureds’ medical 

expenses spared Medicare from shouldering those costs. 

Congress granted DHHS authority to craft regulations to implement 

Medicare. See 42 U.S.C. §§ 1302, 1395hh. DHHS then promulgated a 

regulation stating that the Secondary Payer Act does “not apply to any services 

required because of accidents that occurred before December 5, 1980.” See 42 

C.F.R. § 411.50(a); Medicare Program, Services Covered Under Automobile 

Medical, No-Fault, or Liability Insurance; Services Furnished to ESRD 

Beneficiaries Who Are Covered Under Employer Group Health Insurance, 48 

Fed. Reg. 14802-01 (Apr. 5, 1983).

The Secondary Payer Act, in effect, preempted the No Fault Act’s 

collateral source rule as it pertained to Medicare. See U.S. v. Rhode Island 

Ins. Insolvency Fund, 80 F.3d 616, 622-23 (1st Cir. 1996). After December 5, 

1980, Medicare became the secondary payer to a PIP carrier. See Abrams v. 

Heckler, 582 F. Supp. 1155, 1164-65 (S.D.N.Y. 1984).

In sum, the No Fault Act’s collateral source rule of shifting the costs of 

medical expenses from PIP carriers to Medicare came to an end on December 

insurance carrier would cover the enrollee’s medical costs. See 42 U.S.C. 

§ 1395y(b) (1976 & Supp. IV 1980). Once such insurers make payment to the 

provider, however, the provider must reimburse CMS for the amount that CMS 

paid. See ibid.; 42 C.F.R. §§ 411.22, 411.24. 
27

5, 1980, given the supremacy of federal law. See Colonial Penn Ins. Co., 721 

F.2d at 440; Abrams, 582 F. Supp. at 1164-65. Until that date, Medicare was 

authorized to pay an enrollee’s medical expenses related to an automobile 

accident even if a PIP carrier would otherwise cover those expenses. See

Humana Med. Plan, Inc. v. W. Heritage Ins. Co., 832 F.3d 1229, 1234 (11th 

Cir. 2016).

IV.

A.

In this pre-December 5, 1980 automobile injury case, the objectives of 

the No Fault Act and Medicare are aligned. The No Fault Act shifted to 

Medicare -- and other collateral sources -- the primary responsibility for the 

payment of medical expenses arising from an automobile accident. See

N.J.S.A. 39:6A-6 (1977) (“[B]enefits collectible under . . . [M]edicare . . . 

shall be deducted from the benefits collectible under [the PIP statutes].”). The 

purpose of the collateral source rule was to reduce the financial costs borne by 

the automobile insurance system -- costs eventually passed on to the consumer. 

See Lefkin, 229 N.J. at 12. From the Legislature’s perspective, the logic of 

passing along costs to collateral sources is easy to discern. The larger the total 

payout of PIP benefits, the greater the need for insurance carriers to increase 

premiums to ensure their financial viability; increasing premiums to insure 
28

vehicles decreases the number of middle- and lower-income residents able to 

afford automobile insurance; and decreasing the number of insured motor 

vehicles leads to greater instability in the automobile insurance market. See

Auto. Ins. Study Comm’n, Reparation Reform for New Jersey Motorists 9-11

(Dec. 1971). 

Medicare, in turn, was a program designed “to provide affordable 

medical insurance for the aged and disabled.” See Furlong v. Shalala, 156 

F.3d 384, 392 (2d Cir. 1998) (citing Garelick v. Sullivan, 987 F.2d 913, 914 

(2d Cir.1993)). Medicare ensured that enrollees would not face the prospect of 

forgoing necessary healthcare because of lack of financial means. Cf.

Rodriguez v. Celebrezze, 349 F.2d 494, 496 (5th Cir. 1965) (“[T]he Social 

Security Act is to be construed liberally to effectuate its general purpose of 

easing the insecurity of life. . . .” (citing Page v. Celebrezze, 311 F.2d 757, 

762 (5th Cir. 1963))). As part of the overall Medicare scheme, federal law

prohibited healthcare providers from seeking additional compensation from 

Medicare enrollees or other insurers -- except to recoup such costs as copayments and deductibles. See 42 U.S.C. § 1395cc(a)(1)(A); Rybicki v. 

Hartley, 792 F.2d 260, 262-63 (1st Cir. 1986). Before December 5, 1980, 

Medicare had its own collateral source rule that exempted Medicare from 
29

paying healthcare costs covered by a workers’ compensation plan. See 42 

U.S.C. § 1395y(b) (1972).

Thus, at the time of Mecouch’s automobile accident in 1977, the No 

Fault Act designated Medicare as having primary responsibility for the 

payment of the medical costs of Medicare enrollees, and Medicare willingly

accepted primary responsibility for the healthcare of its enrollees. At that 

point, state and federal law worked in tandem with each other. Additionally,

the No Fault Act and Medicare had common goals -- the prompt and efficient 

payment of medical expenses borne by individuals covered under those 

legislative schemes. See Caviglia, 178 N.J. at 467 (citing Gambino, 86 N.J. at 

105-06); United States v. Pisani, 646 F.2d 83, 86 (3d Cir. 1981) (noting that 

one of the objectives of Medicare is to provide “prompt reimbursements to 

providers” for the purpose of encouraging providers “to treat Medicare 

patients”).

Congress expanded Medicare’s collateral source doctrine to include 

automobile insurance carriers and no-fault insurance in the Secondary Payer 

Act. Under current federal law, the automobile insurance carrier has primary 

responsibility for the costs of a person’s medical care for injuries suffered in 

automobile accidents arising after December 5, 1980. In the Secondary Payer 

Act, like our Legislature in the No Fault Act, Congress pursued the goal of 
30

securing the financial viability of Medicare by further shifting costs to 

collateral sources. 

Mecouch, however, falls in a limited class of approximately 150 current

New Jersey Medicare enrollees who were injured in automobile accidents

before December 5, 1980, and whose medical care continues to be covered by 

Medicare as the primary payer. In this case, the No Fault Act and Medicare

are not in conflict. The No Fault Act designated Medicare as the primary 

payer for Mecouch’s medical expenses, and Medicare authorized the payment 

of those expenses. The No Fault Act shifts the financial burden of an insured’s 

medical expenses onto Medicare if that insured is a Medicare enrollee. See

N.J.S.A. 39:6A-6 (1977). 

In line with its broad remedial purpose, Medicare will directly pay for an

enrollee’s medical expenses related to a pre-December 5, 1980 automobile 

accident. See Pisani, 646 F.2d at 86; Fanning, 346 F.3d at 388; Bio-Med., 656 

F.3d at 278; Health Ins. Ass’n, 23 F.3d at 414. Because the enrollee is entitled 

to have medical expenses covered by Medicare, the healthcare provider is 

barred from seeking reimbursement from the enrollee or the enrollee’s PIP 

carrier, except for the co-payment and deductible amounts. See Holle v. 

Moline Pub. Hosp., 598 F. Supp. 1017, 1021 (C.D. Ill. 1984). That 

accomplishes the Legislature’s goal of ensuring payment of medical costs for
31

automobile accident victims and reducing costs to the automobile insurance 

system, while also advancing Congress’s goal of providing affordable, prompt 

healthcare to Medicare enrollees. See Emmer v. Merin, 233 N.J. Super. 568, 

572 (App. Div. 1989) (citing Mario A. Iavicoli, No Fault & Comparative 

Negligence in New Jersey 20 (1973)); Pisani, 646 F.2d at 86.

As earlier discussed, healthcare providers that contract with Medicare --

such as Cooper -- know that they are barred from seeking further satisfaction 

“for items or services for which such individual is entitled to have payment 

made” by Medicare. 42 U.S.C. § 1395cc(a)(1)(A). If a healthcare provider 

seeks satisfaction from a PIP carrier instead of Medicare when treating a 

Medicare-enrolled patient, the healthcare provider must refund the money to 

the carrier after receiving reimbursement from Medicare. See 42 U.S.C. 

§ 1395cc(a)(1)(C) (requiring healthcare providers “to make adequate provision 

for return . . . of any moneys incorrectly collected from such individual or 

other person”). 

In light of Medicare’s primary responsibility to pay the medical 

expenses of Mecouch’s hospital care, and its willingness to do so promptly, 

Cooper has no reason to bill Selective first. Instead, Cooper should directly 

bill Medicare. That approach will avoid needless waste and duplication of 

effort and fulfill Medicare’s promise of prompt care and the No Fault Act’s 
32

goal of shifting costs to collateral sources when possible. See Talmadge v. 

Burn, 446 N.J. Super. 413, 418 (App. Div. 2016) (citing Lefkin, 229 N.J. 

Super. at 7). 

However, we recognize that there may be cases when a healthcare 

provider is not certain whether an insured is enrolled in Medicare. In such an 

instance, billing the PIP carrier first would further a core purpose of the No 

Fault Act, which is to provide automobile accident victims with the funds 

necessary for prompt medical care. See Caviglia, 178 N.J. at 467. If the 

insured in fact is a Medicare enrollee, then the healthcare provider must refund 

the monies received upon payment from Medicare. See 42 U.S.C. 

§ 1395cc(a)(1)(C).

B.

In the end, this case is about legislative policies that set the order for the

utilization of resources.

Had Mecouch suffered serious injuries from an accident in the home or 

been stricken with a severe illness, then a Medicare provider, such as Cooper, 

would accept reimbursement from Medicare, according to the fee schedule set 

by DHHS. See 42 U.S.C. §§ 1395f(b), 1395ww; 42 C.F.R. §§ 412.1, 412.8. 

That fee schedule clearly does not permit a dollar-for-dollar return on the 

value of medical services. See generally Eric Lopez et al., How Much More 
33

Than Medicare Do Private Insurers Pay? A Review of the Literature (Apr. 15, 

2020), Kaiser Fam. Found., https://www.kff.org/medicare/issue-brief/howmuch-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/

(last visited Dec. 8, 2021) (highlighting differences in payment between 

Medicare and private insurers). As with many hospital systems in our State, 

Cooper has accepted its role in the Medicare system -- a role that affords a 

great benefit to the people of this State who are dependent on the critical 

medical services provided by hospitals and physicians participating in 

Medicare. The allocation of resources pursuant to Medicare is a product of 

Congressional policy and the willingness of hospitals and physicians to 

participate in the Medicare program.

Today, in accordance with the Secondary Payer Act, if Mecouch 

suffered serious injuries in an automobile accident and were treated in a 

Medicare participating hospital, such as Cooper, then his automobile insurance 

carrier would be responsible for payment of the hospital’s bill. The hospital 

would receive a much higher billing return for its medical services because 

payment is coming from the carrier. See 42 C.F.R. § 411.31(b) (“With respect 

to . . . no-fault insurers, . . . a provider or supplier may bill its full charges and 

expect those charges to be paid unless there are limits imposed by laws other 

than [T]itle XVIII of the Act or by agreements with the primary payer.”). The 
34

Secondary Payer Act is a product of Congressional policy, which places the 

automobile insurance carrier as the primary payer, thereby preempting the No 

Fault Act’s collateral source rule. See 42 U.S.C. § 1395y(b)(2)(A).

Congress’s Medicare policy today is different from the policy in effect

in 1977. Federal law in 1977 did not preempt the No Fault Act’s designation 

of Medicare as a collateral source. Our role is to give effect to the federal and 

state statutory schemes that apply to Mecouch’s 2016 hospital treatment and 

care arising from injuries that he suffered in a 1977 automobile accident. We 

have no commission to “interfere with the policy choices made by the 

Legislature” in deciding how to achieve cost savings through the No Fault Act. 

DiProspero, 183 N.J. at 506.

We conclude that Cooper -- upon notice from Selective -- was required 

to bill Medicare for the hospital care rendered to Mecouch, a Medicare 

enrollee. That Selective may have unwittingly paid for services in the past 

covered by Medicare -- to the benefit of Cooper -- is not relevant to the issue 

before us. Selective, however, is responsible for the co-payments and 

deductibles owed by Mecouch to Cooper.
35

V.

For the reasons expressed, we affirm the judgment of the Appellate 

Division and remand to the trial court for proceedings consistent with this 

opinion.

CHIEF JUSTICE RABNER and JUSTICES LaVECCHIA, PATTERSON, 

SOLOMON, and PIERRE-LOUIS join in JUSTICE ALBIN’s opinion. JUSTICE 

FERNANDEZ-VINA did not participate.