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