Synergy Blog

Medicare Compliance: Failing to address Medicare issues at settlement exposes personal injury law firms to DOJ actions

February 25, 2020

By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC

If you do not resolve Conditional Payments, DOJ might come knock on your firm’s door. When you do not take Medicare compliance very seriously at your firm, you might end up writing a check to the government like these four firms did:

  1. 1/8/2020: Philadelphia law firm agrees to pay $6,604.59 for unresolved Medicare debts. The DOJ stated: “Lawyers need to set a good example and follow the rules of the road for Medicare reimbursement. If they don’t, we will move aggressively to recover the money for taxpayers.
  2. 11/4/2019: Maryland law firm agrees to pay $91,406.98 to resolve allegations it failed to pay back Medicare for conditional payments. The firm was apparently in a joint representation agreement with co-counsel who in turn did not reimburse Medicare at settlement. The DOJ “intends to hold attorneys accountable for failing to make good on their obligations to repay Medicare for its conditional payments, regardless of whether they were the ones primarily handling the litigation for the plaintiff.
  3. 3/18/2019: Maryland law firm agrees to pay $250,000 to resolve claims that it did not reimburse Medicare for payments made on behalf of firm clients. As part of the settlement, 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.”
  4. 6/18/2018: Pennsylvania law firm agrees to pay $28,000 to satisfy outstanding Medicare conditional payment final demands. The terms of the settlement also included an agreement by the firm 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.” The DOJ stated that 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.

In today’s complicated regulatory landscape, a comprehensive plan for Medicare compliance has become vitally important to personal injury practices. Lawyers assisting Medicare beneficiaries are personally exposed to damages and malpractice risks daily when they handle or resolve cases for Medicare beneficiaries. The list of things to be concerned about is growing daily. So, what do you do? The answer is to develop a process to identify those who are Medicare beneficiaries in your practice and make sure that process is put into place to deal with the myriad of issues that can arise. Synergy can help you focus on what you do best by dealing with these issues at your firm and implementing a sound Medicare compliance program. Contact us today about our Total Medicare Compliance program.

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Panter, Panter & Sampedro

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Jeffrey Meldon & Associates, P.A.

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