By Jason D. Lazarus, J.D., LL.M., MSCC
“Although the statute is structurally complex—a complexity that has produced considerable confusion among courts attempting to construe it—the MSP’s function is straightforward.” US v. Baxter Intern., Inc., 345 F. 3d 866 (11th Cir. 2003). Attorneys are consistently exposed to liability risks when handling cases for Medicare beneficiaries. This practitioner-based article addresses the growing concerns when working for Medicare beneficiaries and advises attorneys how to deal with Medicare issues strategically instead of ending up in federal court. Jason Lazarus develop answers to help address attorney’s questions when working with Medicare beneficiaries. In this Article, the author reviews the basics of Medicare coverage. Once representing a Medicare beneficiary, both the attorney and Medicare beneficiary client should be aware of the implications of the Medicare Secondary Payer Act as it relates to Conditional Payments as well as Medicare set asides. The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), triggers important compliance requirements impacting attorneys involved in the representation of those who are Medicare eligible. Next the author suggests ways to navigate the resolution process for clients and how to deal with conditional payment issues before turning to Part C Advantage Plans (MAO) as the “hidden” lien. The author discusses the threat of Medicare’s denial of care in future personal injury cases and the four levels of internal appeals process. The author urges lawyers to stay aware and educated when working for Medicare beneficiaries.
About the Author
Jason Lazarus is a founding Principal and Chief Executive Officer of Synergy Settlement Services. He is also the managing partner and founder of the Special Needs Law Firm in Florida. Formerly he was the President of a National Settlement Planning firm and previously spent ten years assisting injury victims as a settlement planner. Prior to his experience starting his settlement practice, Mr. Lazarus practiced as a Medical Malpractice and Worker’s Compensation attorney. Mr. Lazarus has presented and published work on Elder Law topics in AAJ’s Trial Magazine, NAELA Journal, ElderLaw Report, and more. Mr. Lazarus received his J.D. from Florida State University and his LL.M. in Elder Law from Stetson University College of Law. Mr. Lazarus is also a Medicare Set Aside Consultant certified by the International Commission on Health Care Certification.