March 1, 2023
Rasa Fumagalli, , JD, MSCC, CMSP-F
It is absolutely crucial that trial lawyers don’t neglect their obligation to address Medicare’s conditional payment recovery claims at settlement. While trial lawyers in a liability settlement usually address this responsibility, it’s essential to remember that Medicare has the right to recover payments from providers, suppliers, physicians, attorneys, state agencies, or private insurers that have received a primary payment (as per 42 CFR Sections 411.24). If Medicare is required to pursue legal action to recover conditional payments, it may end up recovering twice the amount of the primary payment, which can be a hefty sum.
The United States government has shown a willingness to investigate and pursue personal injury law firms that fail to reimburse conditional payments for even relatively small amounts. In fact, a recent investigation into the Baltimore-based law firm, Kandel & Associates, P.A., resulted in a settlement agreement with the United States Attorney for the District of Maryland. The US Attorney alleged that the firm failed to resolve at least 12 Medicare Secondary Payer conditional payment debts and simply disbursed the settlement proceeds. As a result, the Kandel firm had to pay the United States nearly $40,000 to resolve the government’s claims. Additionally, the firm had to designate and train an employee to pay MSP debts and commit to periodic reviews of any outstanding MSP debts with the designated employee. To read more, click HERE
It’s clear that ignoring Medicare Secondary Payer compliance issues at settlement is not an option. As personal injury lawyers, you must have a well-established process to audit/verify an individual’s Medicare status and identify the type of Medicare coverage in place from the date of the injury until settlement. Furthermore, it’s important to document discussions regarding the potential impact of the Medicare Secondary Payer Act on post-settlement injury-related care and add them to the client’s file.
If you’re looking to establish your firm’s MSP compliance protocol, reach out to Synergy’s team of MSP compliance experts for help. By taking the necessary steps, you can avoid this type of government legal action and ensure that your client’s obligations with Medicare are compliantly resolved. Don’t let Medicare Secondary Payer compliance issues derail your settlements—work with Synergy’s team of MSP compliance experts to protect your clients and your practice.
