U.S. Attorney’s Office Settles Conditional Payments Debts with Personal Injury Law Firm and Requires Attorney to Institute Best Internal Compliance Practices

Conditional Payments, Medicare, MSP News on June 20, 2018
Posted by Jean S. Goldstein, JD, CMSP

On Monday, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania issued a press release concerning a settlement arrangement involving the repayment of conditional payments.  U.S. Attorney William M. McSwain announced that the Philadelphia personal injury law firm, Rosenbaum & Associates, and its principal, Jeffrey Rosenbaum entered into a settlement agreement to resolve allegations that they failed to reimburse the United States for payments made by Medicare to medical providers on behalf of the firm’s clients.

The settlement agreement can be found here.  The press release, provides a key summary of the settlement agreement and specifically notes that,

“[u]nder the terms of the settlement agreement, Rosenbaum agreed to pay a lump sum of $28,000. Rosenbaum 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.”

This action by the U.S. Attorney is an unambiguous reminder for attorneys (and all parties) of the statutory obligation to reimburse Medicare for conditional payments.  When a party or entity fails to reimburse Medicare, the United States[1] can recover the conditional payments from attorneys or others who received settlement proceeds.  Specifically, 42 C.F.R § 411.24, provides a right to recover payments from a primary plan or  “any entity, including a beneficiary, provider, supplier, physician, attorney, State agency or private insurer that has received a primary payment.”  The U.S. Attorney also stated, that “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 furtherance of this statement, the settlement agreement notes and acknowledges that failure to submit timely repayment of Medicare conditional payments may result in liability under the False Claims Act, implying that attorneys and parties alike are well-aware of the statutory reimbursement obligations imparted on those resolving claims involving Medicare beneficiaries.  Of note, a violation of the False Claims Act can result in treble (or triple damages), attorney’s fees, and fines (per each fraudulent claim).

As we often note here on our blog, it is extremely important to identify and implement proper internal protocols and best practices to timely address conditional payments.  This is yet another example supporting the importance of putting the proper protections in place. 

For assistance with conditional payments or lien resolutions, please contact our team at info@medval.com.  Our Conditional Payment and Lien Resolution Team understands the complexities of conditional payments.  Our team is comprised of an experienced group of clinical, legal, and claims professionals.  We advocate on your behalf to make sure you can settle your claim.

 [1] (or a similarly situated party/entity, as we have written about, based on the ability to prove standing to bring an action)