Baltimore-Based Law Firm Repays U.S. Over 90K in Conditional Payments

Medicare Set-Aside Blog, MSP News on November 25, 2019
Posted by Jean S. Goldstein, JD, CMSP

Earlier this month, in a press release, the United States Attorney for the District of Maryland Robert K. Hur announced that a Baltimore-based law firm has paid the United States $91,406.98 to resolve allegations that it failed to reimburse Medicare for conditional payments that had been made to medical providers on behalf of firm clients.  This is the third recent settlement action which serves as an unambiguous reminder for attorneys and all parties involved in a settlement of a claim involving Medicare beneficiary, of the statutory obligation to reimburse Medicare for conditional payments.  You may recall that we saw similar enforcement actions in March of this year, and in June of 2018.   All three of these actions involve firms handling liability cases, but nonetheless are punitive actions that show the reach of the Medicare Secondary Payer statute.  When a party or entity fails to reimburse Medicare, the United States 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.”   

This settlement reminds attorneys of their obligation to reimburse Medicare for conditional payments after receiving settlement or judgment proceeds on behalf of their clients; and significantly points out that these obligations extend to “plaintiffs’ attorneys who refer cases to co-counsel or jointly represent plaintiffs.”   Specifically, the U.S. Attorney stated that “Plaintiffs’ attorneys cannot refer a case to or enter into a joint representation agreement with co-counsel and simply wash their hands clean of their obligations to reimburse Medicare for its conditional payments.”  In furtherance of this statement, the U.S. Attorney indicated that the government  “…intend[s] 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.”

This action is an explicit reminder that the United States has a statutory right to recover payments made by Medicare for medical services, and can extend that statutory right to anyone with some sort of a nexus to the claim.  Simply put:  MSP obligations cannot be circumvented.   The ultimate takeaway from this enforcement action is that it is extremely important to identify and implement proper internal protocols and best practices to timely address conditional payments.  This is can be done by proactively addressing the conditional payment issue prior to settlement of any claim by:

  • Confirming entitlement status; 
  • If the claim involves a Medicare beneficiary, conduct a conditional payment inquiry to determine if conditional payments have been made;
  • If charges exist, diligently advocate for removal of any charges that are unrelated to the claim; and
  • Ensure that the settlement terms address the manner by which all conditional payments and liens will be resolved and satisfied.

It is likely that moving into 2020, we will continue to see reminders, such as this action, that Medicare Secondary Payer compliance is being placed at the forefront; further supporting the need for implementation of the above noted internal protocols best practices.


For assistance with conditional payments, lien resolutions, or establishing proper internal protocols for MSP compliance, please contact our team at info@medval.com.  We understand the complexities of conditional payments, and have unparalleled experience in negotiating and resolving conditional payments.  Our team stands ready to help, and ensure you resolve your claims with confidence.