About Dev Dev

This author has not yet filled in any details.
So far Dev Dev has created 27 blog entries.

Contacting Medicare and Medicaid | Best Practices Series

By: Paul R. Loudenslager, Esq., MSCC | Senior Lien Counsel, Precision Resolution, LLC  |  Click to Email Paul

Q: Is it a good idea to contact Medicare or Medicaid to ask if they intend to assert a lien for treatment during the relevant period? Who do I contact?

A: Not only is it a good idea, but it is imperative

When a settlement or plaintiff verdict has been awarded, both Medicare and Medicaid will look to assert liens for past accident-related treatment and in certain instances public assistance (Medicaid).

If your client does not have their insurance cards or statement of benefits, you can call Medicare and Medicaid to determine if your client was eligible for benefits during the relevant period. In our opinion, it is always best to get this process started early in the case.

For Medicare, you client can go to the local Social Security office to get an explanation of benefits, or you can call Medicare’s Coordination of Benefits Contractor at 1-855-798-2627.

For NY Medicaid, call your local county DSS or call HMS, a contractor for the NYS Medicaid Office at 1-877-331-1460 to determine eligibility.

Contacting Medicare and Medicaid | Best Practices Series2021-10-14T10:14:47-04:00

Unaddressed and Unsatisfied Liens | Best Practices Series

By: Paul K. Isaac, Esq., ChSNC  | Managing Partner, Precision Resolution, LLC and Yeganeh Gibson, Esq., CMSP

Q: What happens if there was a lien and it wasn’t addressed or satisfied?

A: The answer to this question varies greatly depending on the type of lien. Start with the Rules of Professional Conduct, Section 1.15 which state in relevant part:

(c) Notification of Receipt of Property; Safekeeping; Rendering Accounts; Payment or Delivery of Property.
          A lawyer shall:
                    (1) promptly notify a client or third person of the receipt of funds, securities, or other properties in which the client or third person has an interest;
                    (4) promptly pay or deliver to the client or third person as requested by the client or third person the funds, securities, or other properties in the possession of the lawyer that the client or third person is entitled to receive.

Comment 4 clarifies the above with [4] Paragraph (c)(4) also recognizes that third parties may have lawful claims against specific funds or other property in a lawyer’s custody, such as a client’s creditor who has a lien on funds recovered in a personal injury action.

A lawyer may have a duty under applicable law to protect such third-party claims against wrongful interference by the client. In such cases, when the third-party claim is not frivolous under applicable law, the lawyer must refuse to surrender the property to the client until the claims are resolved. A lawyer should not unilaterally assume to arbitrate a dispute between the client and the third party, but, when there are substantial grounds for dispute as to the person entitled to the funds, the lawyer may file an action to have a court resolve the dispute.

Medicare and Medicare Advantage
In US v. Harris the US was granted summary judgment with interest against the attorney for failure to pay the Medicare lien. Worse double damages can be awarded, The federal government has a private right of action for double damage against any primary payor who fails to pay Medicare.
In a number of jurisdictions, those Medicare Advantage plans have used that double damages provision to collect against attorneys, law firms, and defendants/ Insurers who have already paid out the settlement. See: Humana v Paris Blank , Humana v Western Heritage

With regard to ERISA plans an attorney risks losing his/her fee and all of the client’s proceeds. See Trs. of the 1199SEIU Nat’l Ben. Fund for Health & Human Serv. Emples. v. Cotto, 2020 U.S. Dist. LEXIS 178207, *17, 2020 WL 5763942, *6(E.D.N.Y. Sept. 28, 2020).

Unaddressed and Unsatisfied Liens | Best Practices Series2021-10-04T12:27:05-04:00

Addressing Pro-Rata Lien Amount Reductions | Best Practices Series

 

By: Paul K. Isaac, Esq., ChSNC  | Managing Partner, Precision Resolution, LLC and Yeganeh Gibson, Esq., CMSP

Q: Is there usually a percentage that Medicare, Medicaid, and Workers’ Compensation take of the lien after settlement?

A: While the case is ongoing, Medicare issues “conditional payment amounts.” These amounts are repayable to Medicare on the condition that the case settles or there is a plaintiff verdict.

Medicare will reduce this conditional amount and provide the plaintiff with a “final demand amount” which does reduce the conditional amount by a percentage based upon attorney fees and expenses, pursuant to 42 CFR 411.37. However, it is imperative that when settlement is reported to Medicare by plaintiff counsel or third-party administrator, also included with the gross settlement figure are the specific amounts of attorney’s fees and expenses. Without these figures, Medicare cannot compute the pro-rata final demand reduction.

Medicaid offers no such universally applied formula.

While there is no fixed percentage for a reduction in the Workers’ Compensation realm, in a case where no third-party component is present, the statute states that the carrier is entitled to recover its lien in entirety, with the exception of attorney fees.

Section 29 of the WCL requires recovery of liens be offset by the equitable share of costs incurred to obtain that recovery for them.

Therefore, the Workers’ Compensation lien must be reduced by the Cost of Litigation percentage. The carrier is also required to contribute the COL of the future benefits saved by virtue of their credit against future benefits to the extent of the third-party settlement.

We are experts in applying the formulas in Burns v Varriale, 9 N.Y.3d 207, 879 N.E.2d 140, 849 N.Y.S.2 1, and Matter of Kelly v State Ins. Fund 60 N.Y.2d 131, 456 N.E.2d 791)

Addressing Pro-Rata Lien Amount Reductions | Best Practices Series2021-09-27T10:47:09-04:00

Addressing Medicare Supplement Liens | Best Practices Series

Addressing Medicare Supplement Liens | Best Practices Series

By: Paul K. Isaac, Esq., ChSNC  | Managing Partner, Precision Resolution, LLC and Yeganeh Gibson, Esq., CMSP  | Lead Lien Attorney, Precision Resolution, LLC


Q:
If a person is on Medicare and a Medicare supplement plan like AARP, is the AARP plan also entitled to get reimbursed?

A: With Part D prescription plans, reimbursement is typically pursued. However, in New York State, Medicare Supplement plans are regular insurance with no rights in NYS under GOL 5-335 and therefore, no lien exists. Call us at 888-961-LIEN to discuss the specific laws in your state.


Q: When does a Medicare lien get triggered?

A: Medicare does not assert their recovery rights until they have received notice of the settlement of plaintiff verdict in a case.

In order for Medicare to have a lien, a number of conditions must be present:

  • The injured party must be Medicare-eligible;
  • Medicare must have paid for some accident-related admission or treatment; and
  • There must be settlement or plaintiff verdict.

While the case is ongoing, Medicare issues “conditional payment amounts.” These amounts are repayable to Medicare on the condition that the case settles or there is a plaintiff verdict.

Once settlement is reported to Medicare (be sure to report the gross settlement figure along with attorney fees and expenses) Medicare will perform its last and most thorough scan of charges and provide plaintiff with a “final demand amount” which does reduce the conditional amount by a percentage based upon attorney fees and expenses, pursuant to 42 CFR 411.37.

This Final Demand Amount does become a priority recovery. In fact, if the settlement proceeds have been received, and the demand goes unpaid, the debt, with monthly interest accrual may be referred to the Department of Treasury. Monthly Social Security payments can be offset by the debt. Also the government can pursue a claim for double damages.

Medicare will always find out about a settlement due to the insurer’s duty to report under Section 111 of the MSP Statute. It is best to get ahead of the mandatory reporting and take control of the recovery case or allow a third-party to handle it for your firm.

Best Practices Tip:
Even if an appeal or post-demand dispute has been submitted by Medicare, it may be best to pay the final demand debt if proceeds have been received.
Paying of the demand amount prohibits interest from accruing or a referral to the Department of Treasury.
If the appeal is deemed successful by Medicare, they will issue a refund check for the difference of the amount paid and the reduction of the demand amount.


Q: What documents does Medicare need to open a case and issue a conditional payment letter?

A: Reporting cases to the Medicare contactor can be done in two ways: through the Medicare portal or by calling the Coordination of Benefits and Recovery Contractor.

In order for Medicare to open a recovery case you will need to relay the following details:

  1. Beneficiary’s Medicare number or Social Security Number;
  2. Beneficiary’s Date of Birth;
  3. Beneficiary’s Address (the address on file with the Social Security Administration);
  4. Date of Incident;
  5. Specific injuries claimed.
  6. Type of case (liability, no-fault or workers’ compensation).

With the above information Medicare will open a liability case and begin pulling claims for accident-related treatment provided to the beneficiary on or following the provided date of incident. These ledgers will be sent to the beneficiary at the address provided.

If you wish to receive copies of these ledgers, you will need to fax or mail to Medicare either an executed retainer agreement or a Proof of Representation agreement, executed by both the beneficiary and the attorney/firm.

The Proof of Representation will contain the firm’s address, and correspondences will be sent to the address provided in addition to the beneficiary.

If the beneficiary is deceased, certificate of death, letters testamentary and other documentation may need to be provided prior to being authorized on the case.

Addressing Medicare Supplement Liens | Best Practices Series2021-09-02T15:25:21-04:00

Stay in the know.

We are dedicated to keeping attorneys informed about cases and changes in the law that will impact their practice. Subscribe to our newsletter to and gain access to analysis of the most recent case law & legislative updates impacting your practice, as well as information about upcoming events & seminars.


By submitting this form, you are consenting to receive marketing emails from: Paramount Settlement Planning, LLC, 3686 Seneca Street, Buffalo, NY, 14224, http://www.planningisparamout.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact