U.S. Attorney Recovers Against Plaintiff Attorney for Failure to Reimburse Medicare

July 2, 2018

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

A Philadelphia personal injury firm and its principal recently entered into a settlement agreement with the U.S. Attorney for the Eastern District of Pennsylvania to pay a lump sum of $28,000 for repayment of Medicare conditional payments. The June 18, 2018 press release from the U.S. Attorney’s Office explains that the law firm, Rosenbaum & Associates, and its principal, Jeffrey Rosenbaum, Esq., allegedly failed to reimburse this amount to Medicare stemming from nine settlements handled by the firm.

According to the release, Rosenbaum agreed to enter into a settlement with the federal government requiring not only reimbursement of the conditional payments but also 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.

Rosenbaum also acknowledged as part of the agreement that “any failure to submit timely repayment of Medicare secondary payer debt may result in liability for the wrongful retention of a government overpayment under the False Claims Act.”

Practical Implications

This is another shot across the bow to plaintiffs’ attorneys warning them of their obligation under the Medicare Secondary Payer Act to ensure Medicare is appropriately reimbursed out of the settlement funds. Medicare regulations are clear in stating under 42 CFR 411.24 (g): “CMS has a right of action to recover its payments from any entity, including a beneficiary, provider, supplier, physician, attorney, State agency or private insurer that has received a primary payment.”

In regard to implications of this decision going forward, U.S. Attorney William M. McSwain said, “When an attorney fails to reimburse Medicare, the United States can recover from the attorney—even if the attorney already transmitted the proceeds to the client. Congress enacted these rules to ensure timely repayment from responsible parties, and we intend to hold attorneys accountable for failing to make good on their obligations.”

The provisions of the settlement agreement act as a roadmap for plaintiffs’ attorneys in ensuring Medicare conditional payments are properly resolved as part of settlement. 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.

 

 

Tower MSA Partners Names Jesse Shade Director of Information Technology.

June 29, 2018

Tower created an extremely sophisticated technology to drive best practices for MSP compliance and seamlessly link everything from Section 111 reporting through conditional payments, interventions, and MSA preparation and closure. The technology is complex on our end to make things easier for our customers, and it takes an expert to manage and constantly improve it. So, we are delighted to announce that Jesse Shade has joined Tower to do just that. For more information, click here Tower MSA Partners Names Jesse Shade Director of Information Technology.

Tower CEO and NAMSAP President Rita Wilson and other NAMSAP officers warned employers about MSAs allocating for opioids when speaking at the National Council of Self-Insurers (NCSI) last week.

June 22, 2018

Tower CEO and NAMSAP President Rita Wilson and other NAMSAP officers warned employers about MSAs allocating for opioids when speaking at the National Council of Self-Insurers (NCSI) last week.

Tower MSA Partners’ Rita Wilson and Other NAMSAP Directors Discussed Opioids and MSAs at the National Council of Self-Insurers Conference

Proposed PAID Act Intends to ID Medicare Part C, Part D and Medicaid Enrollees for Insurers

June 1, 2018

US Capitol dome

On 5/18/2018, the Provide Accurate Information Directly Act (or the proposed PAID Act) was introduced in Congress for the purpose of allowing settling parties an easy method to identify if a claimant is enrolled in a Part C or D plan or Medicaid.  The bill, H.R. 5881, sponsored by U.S. Rep. Gus Bilirakis R-Fla and U.S. Rep. Ron Kind, D-Wisc, requires the Centers for Medicare and Medicaid Services (CMS) to share information on not only whether a claimant is a Medicare beneficiary, but also whether the claimant is enrolled in a Part C Medicare Advantage (MA) Plan, Part D Prescription Drug Plan or Medicaid.  It also requires CMS to provide the identity of the MA or Part D Plan or state Medicaid program in which the claimant is or was enrolled.

The catalyst for this legislation comes from stepped up efforts by these various plans and programs, especially by MA Plans, to seek reimbursement from settling parties. MA Plans have largely prevailed against insurance carriers in seeking reimbursement under the Medicare Secondary Payer Act which has led to a heightened awareness of the potential for such claims and the need to identify claimants enrolled in such plans and programs prior to settlement.

While liability and no-fault carriers and workers’ compensation plans are now on notice of the potential for such reimbursement claims, there presently exists no universal method to identify a claimant’s enrollment status, short of asking the claimant.  Accordingly, the bill provides a solution by requiring CMS to share such enrollment information.

A review of the proposed PAID act shows the enrollment information would be shared through the Section 111 Mandatory Insurer Reporting query process.  In short, along with identification of whether a claimant is a Medicare beneficiary, the query response would also provide whether the claimant is or has been enrolled in a MA or Part D Plan or a state Medicaid program for the past three years and the name of the plan or program.  The insurance carrier or self-insured entity would then be able to readily contact the Part C or D plan or Medicaid program to resolve any claim for reimbursement.

The bill was referred to the Committee on Ways and Means and the Committee on Energy and Commerce for further action.  Tower MSA Partners will provide updates on the legislation when warranted.

2018 Annual Meeting and Vendor Showcase

banner announcing 2018 NCSI Florida conference

Please join us June 10 – 13! We are pleased to be a Silver Sponsor and Exhibitor at the NCSI annual Meeting and Vendor Showcase.

Tower’s CEO, Rita Wilson, will be presenting on Tuesday, June 12 @ 9:30am as part of the NAMSAP Panel.

Tower MSA Chief Compliance Officer featured in WorkCompWire Leaders Speak Series

May 29, 2018

Tower MSA Partners’ Chief Compliance Officer, Dan Anders, is featured this month in the WorkCompWire Leaders Speak series with two articles.

In the first article, Don’t Get Taken Advantage of by Medicare Advantage, Dan provides an easy to understand explanation as to why Medicare Advantage plans can seek reimbursement in workers’ compensation claims and the steps necessary to resolve such reimbursement claims.

In the second article, Building a Better Relationship with your MSA Vendor, Dan discusses how active engagement with your MSA vendor results in a beneficial partnership to settle claims and lower claims costs.  The article addresses such matters as the importance of reading the MSA report, creating an escalation process and monitoring key performance metrics.

WorkCompWire’s Leaders Speak highlights the thought leaders in the field of workers’ compensation.  In a series of articles, professionals throughout the industry bring forth their ideas, thoughts, and research to matters most impacting the day-to-day handling of workers compensation claims.

2018 Annual Meeting and Vendor Showcase

Please join us June 10 – 13! We are pleased to be a Silver Sponsor and Exhibitor at the NCSI annual Meeting and Vendor Showcase.

Tower’s CEO, Rita Wilson, will be presenting on Tuesday, June 12 @ 9:30am as part of the NAMSAP Panel.