Do you Know Your Obligations Under the Medicare Secondary Payer (MSP) Provisions?

Medicare secondary payerA Philadelphia-based personal injury law firm has paid $28,000 to settle allegations that it failed to reimburse the government for Medicare payments made to healthcare providers on behalf of its clients.

The agreement should serve as a reminder to personal injury lawyers and others of their obligation to reimburse Medicare for conditional payments after receiving settlement or judgment proceeds for their clients.

The agreement, reached between Rosenbaum & Associates and the U.S. Attorney’s Office Eastern District of Pennsylvania, ends allegations that arose under the Medicare Secondary Payer (MSP) provisions of the Social Security Act, which allows the government to recover conditional payments from an injured person’s attorney and others who receive a settlement or judgment proceeds. When an injured person receives a settlement or judgment, Medicare regulations require those who receive the proceeds, such as the injured person’s attorney, to repay Medicare within 60 days for its conditional payments. The MSP statute was created to prevent the burden of medical expenses for personal injury or illnesses caused by another from being shifted to Medicare.

The U.S. Attorney’s office alleged that between May 2011 and March 2017 Medicare made conditional payments to healthcare providers to satisfy the medical bills of nine of the firm’s clients. Medicare then demanded repayment of those debts it had incurred from those conditional payments.

In additional to agreeing to pay the $28,000, the firm’s principal, Jeffrey Rosenbaum, agreed to designate a firm employee to be responsible for paying Medicare secondary payer debts; train that employee to make sure the debts are paid on a timely basis; and to review any outstanding debts with the designated employee at least every six months to ensure compliance.

Rosenbaum also acknowledged that any failure to submit timely repayment of Medicare secondary payer debt could result in liability for the wrongful retention of a government overpayment under the False Claims Act.

U.S. Attorney William M. McSwain made it clear that the government would not tolerate such behavior.

“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,” he said in a news release.

Attorneys would be well advised to not ignore the Secondary Payer Act. Failure to report and reimburse Medicare can result in penalties and fines. The Health Law Offices of Anthony C. Vitale can assist personal injury firms and others with establishing an MSP compliance program.

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