U.S. Attorney Again Takes on Plaintiff’s Attorney for Failure to Reimburse Medicare

March 25, 2019

close up of judge's gavel with the scales of justice in the background

On March 18, 2019 the U.S. Attorney for the District of Maryland announced a $250,000 settlement agreement (See Press Release) with the law firm of Meyers, Rodbell & Rosenbaum, P.A., as a result of allegations the firm failed to reimburse the United States for Medicare payments made to medical providers on behalf of a firm client.

This is the second such action taken by a U.S. Attorney’s office in the past year, with the first being the U.S. Attorney for the Eastern District of Pennsylvania who announced an agreement with a Philadelphia law firm to repay $28,000 in June 2018 (See Tower article: U.S. Attorney Recovers Against Plaintiff Attorney for Failure to Reimburse Medicare).

According to the release from the Maryland U.S. Attorney, “in and prior to 2012 Medicare made conditional payments to healthcare providers to satisfy medical bills for a client of the firm.” In December 2015 the law firm obtained a $1,150,000 medical malpractice settlement on behalf of their client. Medicare was notified of the settlement and demanded repayment of conditional payments made. The U.S. Attorney indicates that the firm refused to pay the debt in full, even when the debt became administratively final.

The U.S. Attorney pursued the law firm for the debt and reached the following settlement agreement:

The firm agreed to pay the United States $250,000 to resolve the Government’s claims.

The firm also agreed to (1) designate a person at the firm responsible for paying Medicare secondary payer debts; (2) train the designated employee to ensure that the firm pays these debts on a timely basis; and (3) review any outstanding debts with the designated employee at least every six months to ensure compliance.

 

Practical Implications

U.S. Attorney Robert K. Hur put it best, saying:

“Attorneys typically receive settlement proceeds for and disburse settlement proceeds to their clients, so they are often in the best position to ensure that Medicare’s conditional payments are repaid. We intend to hold attorneys accountable for failing to make good on their obligations to repay Medicare for its conditional payments.”

Since 2010, insurers and self-insurers have been required to electronically report most liability settlements involving Medicare beneficiary claimants to the Centers for Medicare and Medicaid Services (CMS) as part of the Section 111 Mandatory Insurer Reporting process. Consequently, the days of Medicare not being made aware of a settlement have long since passed. Medicare conditional payments should be investigated prior to settlement and demands for repayment addressed prior to the settlement amount being paid to the plaintiff attorney’s client.

There is an implication in the press release where it indicates “the firm refused to pay the debt in full, even when the debt became administratively final,” that the firm appealed the debt. While we do not know if that is the case here, it is nonetheless an important reminder that there is a five step Medicare conditional payment appeal process with four steps at the administrative level and the fifth step allowing for filing suit in federal court. Each step has a deadline attached to it that must be adhered to or one loses their right to appeal.

Tower MSA Partners has a complete solution to Medicare conditional payment resolution in liability cases, which includes investigation of conditional payments and properly disputing or appealing conditional payment charges determined to be unrelated to the injury. For further consultation on Medicare conditional payment best practices in liability settlements, please contact Dan Anders, Chief Compliance Officer, at 888.331.4941 or daniel.anders@towermsa.com

Coming Soon: CMS Portal for Full or Partial Demand Payments

March 20, 2019

hands at a laptop keyboard with screen showing lock icon and words "secure payment"

Our Chief Compliance Officer Dan Anders discusses how the Medicare Secondary Payment Recovery Portal’s e-payment option works and its potential benefits and drawbacks in this workerscompensation.com article. Scheduled to go live on April 1, the portal allows full or partial demand payments to be made electronically. “It brings it into the 21st Century,” he notes.
Read it Here

April 1st Brings Electronic Payment Option to MSPRP

March 15, 2019

Red Medicare button on a keyboard to illustrate Medicare conditional payment.

In a March 13, 2019 webinar, CMS provided a high-level overview of the electronic payment option to be added to the Medicare Secondary Payer Recovery Portal (MSPRP) effective April 1, 2019. Below are the step-by-step instructions for using this E-Payment service:

 

  • Login to the MSPRP and select the Case ID link from the Cases table for the case in which you would like to make a payment.
  • On the Payment Information tab select the Make a Payment button on the lower left-hand corner.
  • Then, on the Make a Payment page you will find the Remaining Principal Amount, Remaining Interest Amount and Total Remaining Balance Amount. In the Amount Field the amount to be paid is entered, either a partial or full amount, and in the Account Holder Name field the account holder name as it appears on the account under which payment will be made. Click Continue.
  • Once you click Continue you will be taken to Pay.gov in a new internet browser window (Pay.gov is a secure, online payment system run by the U.S. Department of Treasury).   On this screen Pay.gov requires you to choose one of the following payment methods: Direct payment from checking or savings account, debit card or PayPal. Credit card transactions are not allowed (We assume this is to avoid the credit card fees which would otherwise limit the government’s recovery).
  • Once the payment method is chosen you will be taken to an Enter Payment Information screen and then a Review and Submit Payment screen (Maximum amount for a debit card is $24,999.99 and for PayPal it is $10,000). Once payment is submitted the next screen will indicate either the payment is in process or declined with a confirmation number, Case ID and Debtor Name.
  • After the payment process has been completed on Pay.gov you will then be taken back to the Case Information page in the MSPRP. Here you can view a tab with the electronic payment history.

CMS advised that payment processing time is 1 to 3 days on average and the statement will indicate a payment to “HMSCMS.” Importantly, CMS advised that for the purpose of interest calculations the date the electronic payment is made will be the receipt date for payment, not when the payment is processed.

If in the process of using Pay.gov any problems are experienced Pay.gov customer support can be contacted at 800-624-1373 (Select Option #2) or pay.gov.clev@clev.frb.org.

Notably, if following an electronic payment, Medicare determines that a refund of all or part of the payment is required, the refund will not be credited back to the form of payment, i.e. debit card, used to make the electronic payment. Instead, a physical check will be issued to the address on file.

 

Practical Implications

The addition of the electronic payment option to the MSPRP is a welcome upgrade to not only the portal, but the process of resolving Medicare conditional payments. Importantly, electronic payment of a Medicare conditional payment demand requires you to have access to the MSPRP and have an authorization on file with the recovery contractor allowing for access to the demand on the particular case (Medicare beneficiaries do not need an authorization on file but must access the MSPRP through MyMedicare.gov). If you do not have such access or choose not to make an electronic payment, then the traditional method of mailing a check to either the CRC or BCRC is still available.

CMS advised that the slides from the webinar will be available on the CMS website next week. If you have any questions, please contact Dan Anders at (888) 331-4941 or daniel.anders@towermsa.com.

 

 

CMS to Hold Webinar on Electronic Payment Enhancement to MSPRP

March 7, 2019

hands on a laptop sending an email with dollar sign icons spilling out

CMS recently announced it will hold a webinar on March 13, 2019 at 1:00 PM ET for the purpose of introducing an electronic payment functionality to the Medicare Secondary Payer Recovery Portal (MSPRP). This functionally will become available on April 1st.

For some time, payors have been asking CMS for an option which allows electronic payment of conditional payment demands and it looks like that day is finally here. Webinar information is as follows:

Webinar URL: https://engage.vevent.com/index.jsp?eid=5779&seid=1505

 

Conference Dial In: 877-251-0301

Passcode: 7556747

 

Note, there is no need to pre-register for the webinar.

The full CMS webinar invitation may be found here.

We encourage anyone that utilizes the MSPRP to attend CMS’s webinar. Tower will of course provide a summary of this new electronic payment functionality post-webinar.