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…

Since the landmark decision by the US Supreme Court in Arkansas Department of Health and Human Services v. Ahlborn in 2006, state Medicaid agencies have grappled with how to recover monies spent for injury related care through their third party liability statutes without violating the Ahlborn decision.  Many states continued to apply third party recover…

One of the most difficult issues trial counsel must resolve involves addressing hospitals/providers liens for Medicare clients.   Recently the Centers for Medicare and Medicaid Services (CMS), via the Medicare Learning Network (MLN), released policy memo SE17018 which provides excellent and concise answers to most of these issues. This memo addresses when a hospital/provider should bill,…

On April 18, 2017 in Coventry Health Care Of Mo., Inc. V. Nevils the United States Supreme Court held that the subrogation/reimbursement plan language contained in the health insurance contracts of Federal Employee Health Benefit plans (FEHBA) preempted state law.   This decision by the Supreme Court puts to rest over a decade of uncertainty in…

After nearly five years, on October 6, 2016, the Florida Supreme Court issued Opinion SC16-104 and declined to make any change to the existing Rules Regulating the Florida Bar in relation to lien resolution outsourcing. As Florida’s trial attorneys know, the issue of whether there was a need for a change in the existing rules…