March 2, 2020 The 11th Circuit Court of Appeals weighed in on the question of whether the Medicare statute, which provides a three-year timeline to the government to request repayment, applies to a private entity providing Medicare benefits (Medicare Advantage plans). The Court’s answer is that the claims filing provision does not bar a claim…

February 13, 2020 Some of the most frustrating and murky issues facing attorneys representing injured clients stem from alleged direct provider “liens” against settlement proceeds. The positions of various state bar associations on these issues, and the limited law delineating them, have historically been ever-shifting and evolving. Ethical Obligation to Protect Liens One constant in…

1/17/2020 By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC Failure to Pay Equals Personal Liability The government takes its reimbursement rights seriously and is willing to pursue trial lawyers who ignore Medicare’s interest.  On March 18, 2019, the United States Attorney for the District of Maryland announced that a Maryland personal injury law firm had…

1/17/2020 In Publix Super Markets, Inc. v. Figareau et. al., Case No. 8:19-cv-545, 2019 WL 6311160 (M.D. Fla. Nov. 25, 2019), the Court permitted an ERISA self-funded health plan’s equitable lien claim to attach to the plaintiff attorney. This case is further evidence that using Synergy Settlement’s Lien Resolution service can be essential to fully resolve…

Teresa S. Kenyon A fleeting memory of Montanile may have plaintiff attorneys encouraging injured parties to quickly spend their settlement funds thereby avoiding the lien asserted by their health plan. This would be a false narrative that could prove to be costly. No doubt about it, ERISA self-funded plan rights are often unyielding. But overall,…

Jason D. Lazarus, J.D., LL.M., CSSC, MSCC On March 18, 2019, the United States Attorney for the District of Maryland announced that the law firm of Meyers, Rodbell & Rosenbaum, P.A., has agreed to pay the United States $250,000 to settle claims that it did not reimburse Medicare for payments made on behalf of a…

How subrogation and reimbursement claims impact the injury victim’s settlement. When an individual suffers an injury and seeks medical attention, typically that care is paid for by an insurance carrier. Those bills might be paid by Medicare, Medicaid, TRICARE, or a plan provided through their employer. This is true even if the injury suffered was…

There are a myriad of benefits when law firms outsource lien resolution services. Law firms that partner with a reliable, third-party consultant that specializes in resolving liens can enjoy the following benefits: Reduced Operating Costs: Time is money and law firms improve their bottom line by outsourcing time-consuming tasks to experienced professionals.    Effective Results:…

Some of the most frustrating and murky issues facing attorneys representing injured clients stem from alleged “liens” against settlement proceeds. The Florida Bar’s position on these issues, and the limited laws delineating them, have been ever-shifting and evolving. Ethical Obligation to Protect Liens One constant in this otherwise uncertain area, is this: Attorneys representing injured…

Michael Walrath, J.D. Plaintiff lawyers and injury victims are often required to resolve hospital liens and debts which arise from an injury caused by the negligence of another. These hospital charges attach to a plaintiff’s settlement proceeds in most states.[1] Most state statutes or county ordinances limit hospital liens to reasonable charges but fail to…

When a group of individuals (claimants) encounter a similar harmful experience that was the result of the actions of the same entity (defendant), this can result in either a mass tort case or a class action lawsuit. Both of these legal actions are designed to assist legal counsel with representing these individuals by grouping their…

On June 18, 2018, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania announced a recently concluded settlement with a plaintiff firm involving the repayment of Medicare Conditional Payments.  The government’s investigation arose under the Medicare Secondary Payer provisions of the Social Security Act, which authorizes Medicare, as a secondary payer,…

Increasingly trial attorneys are discovering that settlement of a personal injury or wrongful death claim with the tortfeasor can be the beginning not the end of negotiations or even litigation. Once settlement funds are received, the often-protracted lien resolution process begins, especially hospital liens. Hospitals typically demand reimbursement of their full, undiscounted list prices for…

An intriguing case, Mayo v NYU Langone Med. Ctr., just came out of the Supreme Court of New York, reminding the trial bar that when resolving a conditional payment for a Medicare beneficiary only the “Final Demand” letter is final.  Reliance upon a “Conditional Payment Letter” (CPL) is inappropriate.  The Mayo case revolved around whether…

ERISA is a very complex federal statute that has been interpreted very negatively for personal injury victims by the United States Supreme Court. The goal of this blog post is to explain ERISA and its impact when settling case in a very simple way. Key takeaways: ERISA is a federal statute that protects self-funded employer-based…