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Law firm pays to settle medical malpractice payment snafu

A recent Department of Justice (DOJ) press release shows that anyone, including attorneys, can run afoul of Medicare fraud regulations.
Maryland law firm Meyers, Rodbell & Rosenbaum, P.A., will pay $250,000 to resolve allegations that it failed to reimburse Medicare payments to medical providers on behalf of one of its clients. “This settlement reminds attorneys of their obligation to reimburse Medicare for conditional payments after receiving settlement or judgment proceeds for their clients. This settlement should also remind attorneys not to disburse settlement proceeds until receipt of a final demand from Medicare to pay the outstanding debt,” the DOJ announced March 18.
The settlement is related to conditional payments for a settlement, the DOJ explained.
According to the settlement agreement, in and prior to 2012, Medicare made conditional payments to health care providers to satisfy medical bills for a client of the firm. Under the Medicare statute and regulations, Medicare is authorized to make conditional payments for medical items or services under certain circumstances, with the requirement that when an injured person receives a tort settlement or judgment, those receiving the proceeds of the settlement or judgment, including the injured person’s attorney, are required to repay Medicare for the conditional payments.
Under Medicare Secondary Payer law (42 U.S.C. § 1395y(b)), Medicare does not pay for items or services to the extent that payment has been, or may reasonably be expected to be, made through a no-fault or liability insurer or through a workers' compensation entity. Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly conditioned upon reimbursement when the primary plan does pay. The Benefits Coordination & Recovery Center (BCRC) is responsible for recovering conditional payments when there is a settlement, judgment, award or other payment made to the Medicare beneficiary. When the BCRC has information concerning a potential recovery situation, it will identify the affected claims and begin recovery activities. Beneficiaries and their attorney(s) should recognize the obligation to reimburse Medicare during any settlement negotiations.
According to the DOJ, the firm helped one of its client win a more than $1.1 million settlement for a medical malpractice case at the end of 2015. Medicare asked for repayment of the conditional payments, but “the firm refused to pay the debt in full,” the DOJ explained.
The payment isn’t the end of the story for the firm. In addition to the $250,000 settlement, the practice agreed to:
  • Designate an employee who will be responsible for paying Medicare secondary payer debts.
  • Train the employee to pay the debts in a timely manner.
  • Review outstanding debts with the employee every six months.
Blog Tags: anti-fraud, OIG
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