Personal Injury Attorney Suspended for Poor Handling of Medicare Conditional Payment Reimbursement

Conditional Payments, Medicare, Medicare Set-Aside Blog, MSP Litigation on December 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

Anyone can resolve a Medicare reimbursement. You don’t need to be a lawyer or MSP specialist. But the reason companies like ours exist is because CMS doesn’t make it easy. If you do not know how to navigate the process, it could take a long time. You may contact the wrong contractor and not receive a response because of it, or be told one thing by one employee just to hear something different the next time you call. This is one area where relying on a vendor that specializes in CMS bureaucracy can be a great value. And that is what Paul Silich found out.

Paul Silich was a personal injury attorney in Iowa suspended from the practice of law by the attorney disciplinary board on December 4th for his poor handling of his client’s Medicare reimbursement. This client was allegedly injured by her faulty wheelchair in 2008, died unexpectedly in 2011 and her estate reached a settlement agreement in December of that year conditioned on resolving any Medicare liens. Silich did resolve that lien but not until September 2014, 33 months later. The opinion provided a timeline that makes it evident that much of the delay was caused by his failure to provide proper proof of representation, due mostly to the death of his client. Silich was not very communicative with the parties and it appeared only followed up with MSPRC when status demands were made. Eventually Silish was held in contempt of court and then still took another year to finally resolve the issue.

In February 2015, the Board filed its complaint against Silich, alleging violations of several sections of the Iowa Rules of Professional Conduct. The commission found Silich’s handling of the Medicare lien violated rules of professional responsibility 32:1.3 (due diligence), 32:1.4 (client communication), 32:3.2 (expediting litigation), 32:3.4(c) (obligations to a tribunal), and 32:8.4(d) (conduct prejudicial to the administration of justice). The commission further found Silich’s dilatory responses to the Board violated rules 32:8.4(d) as well as 32:8.1(b) (cooperation with Board) and recommended a sixty-day suspension. Granted this was no great hardship as Mr. Silich was already suspended for failing to complete his CLEs and obviously exiting the profession. However the published opinion should still represent to other practicing attorneys that if you are going to handle such matters, you would be well served to understand the significance of the task you have undertaken. Fortunately the SMART provisions for self-determination of Medicare conditional payment reimbursements is only 25 days away.