In the past, reporting to Medicare was largely ignored; however, the growing concern over depleting Medicare funds and insolvency has led to Medicare’s aggressive pursuit of compliance. Under the Medicare Secondary Payer (MSP) statute, Medicare has the ability to implement and enforce its statutory right of recovery. Due to legal implications, attorneys must also consider Medicare in every award, judgment, or settlement.
What is MSP?
The MSP statute was created to ensure that in cases where a Medicare beneficiary, or one who will become a beneficiary within 30 months, receives a settlement that the burden of the medical expenses will be shifted to the primary party (insurer or self-insured), and not Medicare. Medicare is considered a secondary payer.
When Medicare makes a payment that should be covered by a primary payer, they will issue a conditional payment. The conditional payment must then be reimbursed by the responsible party. Medicare can seek recovery from any party including the beneficiary, attorney, providers, private insurers, and physicians. If settlement funds have been routed to a client’s attorney, Medicare can bring a lawsuit against an attorney.
MSP Reimbursement Obligations
A notice of claim must be made to the Centers for Medicare or Medicaid Services (CMS), and its Coordinator of Benefits Contractor (COBC). A medicare attorney does not need the approval of their client to provide a notice of a claim to CMS. As an attorney, the federal government considers both the client and their attorney responsible parties. Failing to report and comply with MSP requirements can have legal consequences for an attorney including paying damages plus interest, a refusal to recognize the settlement, or disqualifying the beneficiary from future benefits.
How Synergy Helps Medicare Attorneys
Medicare Attorneys have a lot of responsibility where Medicare compliance is concerned. Attorneys must remember that Medicare beneficiary cases must be handled differently and that Medicare’s interests must be taken into account from the onset. To do so, you must take a lot into consideration. This can take up a lot of your firm’s time and can be quite expensive due to the time it can take away from other client cases in progress. In the end, the process can become more of a hassle, leaving you and clients completely frustrated.
This doesn’t have to be the case. You need a skilled partner such as Synergy to handle all of your client’s Medicare compliance and post-settlement issues for you. Our services include MSA analysis, allocation, and submission, MSA administration, structuring attorney fees, MSA training, and more. Our comprehensive approach to Medicare compliance guarantees that in the end all parties will be protected.
For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.
Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.