Monsanto Settles the Cancer Claim. Medicare May Still Be Holding the Bill.

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The Medicare Insider Blog

By Jamie Sarno


By Jamie Sarno

    
    
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A proposed $7.25 billion Roundup settlement promises closure. Humana says it could instead leave cancer patients responsible for medical liens, protect Monsanto from Medicare claims and limit what Medicare Advantage plans can recover. Imagine being 78 years old and living with non Hodgkin lymphoma. You are told that a company has agreed to pay billions of dollars to settle claims that its product caused your cancer. You submit your records, surrender your right to sue and accept an award that is supposed to compensate you for what happened. Under the proposed Roundup settlement, your average award could be $10,000. Now imagine that Medicare or your Medicare Advantage plan has already paid far more than that for your cancer treatment. The settlement money arrives. Your lawsuit is over. Monsanto receives its release. The attorneys are paid. Then the medical reimbursement claims arrive. Who pays them? According to Humana, the answer built into the proposed settlement may ultimately be the cancer patient. That is the hidden Medicare story buried inside one of the largest product liability settlements in American history. Humana filed a 44 page federal lawsuit against Monsanto Company and its parent, Bayer AG, on September 3, 2026. The insurer alleges that Monsanto has resolved or is preparing to resolve thousands of Roundup cancer claims without creating an adequate system to reimburse the Medicare Advantage plans that paid for the patients’ medical care. Humana is seeking reimbursement, double damages and a federal declaration that a private settlement cannot reduce rights created by the Medicare Secondary Payer Act. This is not simply an insurance company trying to collect another check. It is a fight over whether a corporation can settle an injury claim, obtain a release from the person who was injured and leave Medicare, a Medicare Advantage plan or the patient responsible for the medical consequences. Monsanto may be settling the cancer lawsuits. Humana says it is not settling the cancer bills. The Medicare Secondary Payer Act is based on a straightforward principle. When another party is responsible for an injury, Medicare should not be the first and final payer for the resulting medical care. Medicare or a Medicare Advantage plan may initially pay the bills while liability is unresolved. Those payments are considered conditional. If a lawsuit later produces a judgment or settlement, the party responsible for that payment may be required to reimburse the Medicare payer. The law does not require the company to admit wrongdoing before these recovery obligations can arise. Responsibility can be demonstrated when money is paid in exchange for a compromise, waiver or release of an injury claim. That distinction matters here. Monsanto continues to deny that Roundup causes cancer. Bayer says regulators, including the Environmental Protection Agency, have concluded that glyphosate can be used safely. The proposed settlement contains no admission of liability. But Monsanto is offering money in exchange for releases covering Roundup related non Hodgkin lymphoma claims. Humana argues that those settlement payments trigger Monsanto’s responsibility as a primary payer under federal Medicare law. The proposed national settlement would provide as much as $7.25 billion through payments extending for as long as 21 years. It would cover people exposed to Roundup before February 17, 2026, who already have non Hodgkin lymphoma or receive a diagnosis during the 16 years following final approval. The headline number sounds enormous. The individual numbers tell a different story. According to the settlement schedule, an occupational claimant younger than 60 with aggressive lymphoma could receive an average award of $165,000. A residential claimant between 60 and 77 with aggressive lymphoma could receive $30,000. A residential claimant in the same age range with indolent lymphoma could receive $20,000. Any qualifying claimant diagnosed at 78 or older would fall into a category with an average award of $10,000. Some quick payment awards would be as low as $6,000. Certain people who establish exposure but fail to satisfy the settlement’s principal exposure documentation standards could receive only $150 while still being required to sign the applicable release. These amounts must be considered against the potential cost of diagnosing and treating lymphoma. Hospital care, specialist visits, imaging, chemotherapy, immunotherapy, prescription drugs and continuing monitoring can quickly dwarf an individual settlement award. This is where the promise of compensation collides with the reality of Medicare recovery. CMS recognized this problem years ago. In January 2023, the agency issued a memorandum specifically addressing Medicare Secondary Payer obligations in settlements involving alleged Roundup exposure. CMS issued an update that June. That history is critical. The Medicare problem was not discovered after the proposed $7.25 billion agreement had been written. Federal officials had already identified Roundup settlements as requiring special Medicare recovery attention. An earlier Roundup lien resolution program reportedly allowed Original Medicare to compromise its recovery so that its claim would not exceed 30 percent of a beneficiary’s gross settlement. According to the settlement administrator Epiq, CMS later indicated that the compromise might no longer be available. Lien resolution and claimant payments were temporarily suspended while the issue was reviewed. The reason was painfully simple. Cancer treatment costs could consume a claimant’s entire settlement. Original Medicare at least has a centralized recovery structure through CMS. Medicare Advantage does not operate that way. Every Medicare Advantage organization maintains its own medical claims, member records and reimbursement rights. A person may have changed plans several times while undergoing treatment. Monsanto may know that a claimant received a settlement, but the insurer that paid the medical bills may not know that the settlement exists. The plan cannot recover money from a settlement it cannot identify. Humana says that is precisely what happened. The insurer alleges that Monsanto and Bayer resolved more than 100,000 Roundup injury claims through earlier settlements reportedly exceeding $10 billion. Humana says additional agreements involving individual law firms covered approximately 77,000 claims. Earlier settlements used private lien resolution programs, and Humana participated in them. But participation by individual claimants was voluntary. If a claimant or attorney did not submit the necessary information, the Medicare Advantage plan might never learn that its member had settled. Humana alleges that Monsanto did not independently provide complete claimant information to the affected plans or ensure that every Medicare Advantage lien was resolved before distributing settlement money. Its initial investigation identified at least 12 Humana members connected with earlier Roundup litigation whose unresolved liens allegedly exceed $800,000. Humana identified at least 14 additional members apparently connected with the proposed 2026 settlement and says it has already paid more than $157,000 toward their lymphoma related care. The complaint ultimately references at least 28 identified Humana members. Given Humana’s size and the tens of thousands of Roundup claims, the company believes many more remain unidentified. These are allegations. Monsanto and Bayer have not yet presented their complete defense, and no court has ruled that they violated Medicare law. But the actual settlement language raises questions that go well beyond Humana’s financial interests. The 233 page agreement requires settlement members to identify every government payer or insurer that may have paid their lymphoma related medical expenses. They must certify that they used their best efforts to identify those payers. The Healthcare Compliance Administrator must take reasonable steps to verify the information. But the principal process for obtaining written agreements with government payers specifically treats Medicare Advantage and Part D plans differently. For those private Medicare plans, the administrator is directed to seek a mechanism for resolving liens on an individual basis. The mechanism is subject to Monsanto’s approval. The agreement then states that settlement members are solely responsible for resolving the liens and that Monsanto and related parties have no responsibility for them under the settlement’s allocation of responsibility. That is not a minor technical provision. It determines who could be left exposed when a Medicare claim remains unpaid. The agreement goes further. A settlement recipient must acknowledge that all current and future medical expenses, liens, subrogation claims and related demands connected with the Roundup claim are the recipient’s responsibility. If Medicare or another payer pursues Monsanto because a lien was not satisfied, the settlement member may be required to indemnify Monsanto up to the amount of the award received. The agreement specifically references reimbursement demands from CMS, Medicare, the federal government and their agents or assignees. It also includes attorneys’ fees and statutory penalties. In plain language, Monsanto could pay a cancer patient, obtain a release and then look back to that patient for protection if Medicare later demands reimbursement. The settlement also acknowledges that accepting an award could affect a recipient’s right to future Medicare benefits. Medicare could potentially refuse to pay future medical claims connected with the injury that has already been settled. Settlement members waive certain claims against Monsanto arising from those consequences. That produces a disturbing possibility. A beneficiary could accept a relatively modest award, surrender the right to sue, remain responsible for existing medical liens and face questions about who will pay for future related treatment. The company receives closure. The patient may not. A settlement is not complete if the legal claim disappears but the medical liability follows the patient home. Humana is also challenging what it calls a “super cap” on insurer recoveries. The settlement allows a court, special master or administrator to allocate an award between medical and nonmedical damages. Reimbursement claims cannot exceed the portion assigned to medical expenses. Consider a hypothetical example. A patient receives a $20,000 settlement. The settlement process allocates $5,000 to medical expenses. The patient’s Medicare Advantage plan paid $100,000 for lymphoma treatment. Under the settlement process, the insurer’s recovery might be limited to $5,000. Humana argues that a private allocation cannot override its independent rights under federal Medicare law. Monsanto will have serious arguments of its own. A settlement compensates people for more than medical bills. It may cover pain, suffering, lost income and other injuries. The fact that an insurer paid for lymphoma treatment does not prove that every medical service was attributable to Roundup. Humana must connect specific members, diagnoses, treatments and payments to claims Monsanto actually settled. Monsanto may also argue that its compliance administrator provides a sufficient process, that some liens were already resolved, that Humana’s requests involving unidentified future members are too broad and that patients remain legally responsible for satisfying reimbursement claims from their awards. Bayer may separately challenge whether the parent company itself qualifies as the primary payer responsible for Monsanto’s settlements. Those issues deserve a full hearing. But Humana is not entering that hearing empty handed. Federal appellate courts have already recognized the right of Medicare Advantage organizations to pursue reimbursement and, in appropriate circumstances, double damages under the Medicare Secondary Payer Act. The Third Circuit, whose rulings govern the New Jersey federal court hearing Humana’s case, held in the Avandia litigation that Medicare Advantage organizations can use the law’s private cause of action against primary payers. Humana also prevailed in a separate case against Western Heritage Insurance in which a federal appellate court upheld double damages after a settlement was paid without proper reimbursement. Humana is therefore not asking the court to invent a new Medicare right. It is asking the court to apply an established right to one of the largest mass settlements ever proposed. The potential consequences extend far beyond Roundup. Mass settlements involving prescription drugs, medical devices, toxic exposure and defective products routinely include people covered by Medicare Advantage. If defendants can place the burden entirely on patients and their lawyers, insurers may never receive the information needed to identify their members. If Humana prevails, companies negotiating mass settlements may have to establish mandatory Medicare Advantage lien resolution programs before money is distributed. They may have to disclose claimant information, match members with plans, audit related medical expenses, reserve money for reimbursement and obtain final lien resolutions before receiving complete legal releases. That could make settlements slower and more expensive. It could also make them more honest. There is another truth that should not be ignored. Humana is a private insurance company protecting its own money. A recovery paid to Humana would not automatically be deposited dollar for dollar into the Medicare Trust Fund. But Medicare Advantage plans operate largely on federal payments and assume responsibility for members’ medical costs. When another legally responsible party fails to pay, those costs remain inside the Medicare financing system. Recoveries can affect plan costs, bids, benefits, premiums and future federal payments. The public therefore has a legitimate interest in who ultimately absorbs these expenses. Humana’s lawsuit exposes a weakness created by the growing scale of Medicare Advantage. More than half of Medicare beneficiaries now receive their coverage through private plans, but the system for recovering medical costs from mass settlements remains fragmented among dozens of insurers. A settlement defendant may obtain a nationwide release. The Medicare recovery system remains divided plan by plan, claim by claim and patient by patient. That imbalance creates an opportunity for medical costs to disappear from the settlement calculation without ever disappearing from the Medicare system. The September 14 fairness hearing in Missouri will determine whether the proposed Roundup settlement is fair, reasonable and adequate for the affected class. Humana’s separate federal lawsuit raises a different question: whether that settlement can alter reimbursement rights belonging to an insurer that never agreed to surrender them. The answer could determine whether billions of dollars represent true accountability or merely a carefully structured transfer of liability. There is nothing inherently wrong with a company settling disputed claims while denying wrongdoing. Settlements exist because litigation