Medicare Compensation Recovery Notice of Judgment or Settlement form (MO022)

Use this form to tell us about a judgment or settlement for Medicare Compensation Recovery.

Download and complete the Medicare Compensation Recovery Notice of Judgment or Settlement form.

The compensation payer or their nominated representative must send us this completed form within 28 days of the date the amount of compensation was fixed.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use business online services or contact us. We can help you access, complete and submit them.

Page last updated: 29 October 2024.
QC 19031