Warning: Another Law Firm Reprimanded for Failing to Repay Medicare Conditional Payments

Compliance, Conditional Payments, Medicare Set-Aside Blog, MSP News on January 9, 2020
Posted by Jean S. Goldstein, JD, CMSP

Yesterday, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania issued a press release stating that another Philadelphia-based personal injury law firm, has entered into a settlement agreement with the United States to resolve allegations that it failed to reimburse Medicare Conditional Payments.  You may recall we saw a similar action in June of 2018, by this Office, which we discussed here on our blog.

In this most recent matter, at various points between 2014 and 2019, Medicare made payments to medical providers for eight of the firm’s clients, to satisfy medical bills.  Although Medicare demanded that the firm repay the resulting Medicare debts, the firm allegedly failed to do so. 

Under the terms of the settlement agreement, the law firm agreed to repay the sum due for the conditional payments, and also agreed to establish an internal Medicare Secondary Payer compliance program by:

  1. naming a person at the firm responsible for paying Medicare secondary payer debts;
  2. training the employee to ensure that the firm pays these debts on a timely basis;
  3. reviewing any additional outstanding debts to ensure compliance; and
  4. provide written certifications of compliance.

In addition, the law firm acknowledged that any failure to submit any timely repayment of Medicare secondary payer debt may result in liability for the wrongful retention of a government overpayment under the False Claims Act.  This implies that the law firm is 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 (triple) damages, attorney’s fees, and fines (per each fraudulent claim).

This is the fourth action of its kind brought by the U.S. State’s Attorney’s Office that we have seen since June, 2018 (See additional posts: here and here).   These actions are clear reminders of the statutory obligation to reimburse Medicare for conditional payments.  When a party or entity fails to reimburse Medicare, the United States can recover payments from attorneys or any others who have received settlement proceeds.  Essentially this means recovery from any party with some sort of a nexus to the claim.  This also means that regardless of whether an attorney has distributed settlement proceeds to a client, that attorney can still be found responsible for the conditional payments made.  This is because 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’s Office is sending clear warning signals to parties that it is vitally important to identify and implement proper internal compliance protocols and best practices to attain compliance.  It is just a matter of who will fail to have these protocols in place next, and be the next party subjected to a similar enforcement action. 

We offer assistance with conditional payments, lien resolutions, as well as establishing proper Medicare compliance protocols. For more information on these services, please visit our website here, or contact our team at info@medval.com.