Medicare Compliance Team

Medicare Compliance Practice

In personal injury litigation of all types, damages frequently include past and future medical expenses. When a claimant is a Medicare beneficiary, the federal government expects any medical-related funds received by the beneficiary to be exhausted on Medicare-covered medical expenses and not, for example, on a trip to the Bahamas. While in theory a simple concept, in practice the federal rules and regulations create a complex set of issues and procedures which all parties to a lawsuit must navigate in order to avoid penalties, interest, and double damages.

Our Network of Services

  • Consulting – Identifying Medicare compliance issues and developing the best strategy forward in partnership with our clients.

  • Settlement Process Facilitation – Focusing on cost-containment, finalizing settlements, and ultimate Medicare compliance.
  • Medicare Conditional Payment Determination and Resolution – Liability (including self-insurance) and workers’ compensation insurance are primary plans under the Medicare Secondary Payer Act. If Medicare makes a payment where a primary payer is responsible, that payment is conditioned on repayment. The Practice works with Medicare contractors to favorably resolve conditional payment issues and protect clients from paying unrelated expenses.
  • MSA Legal Analysis and Allocation – In certain cases, an MSA is used to avoid shifting the responsibility for future medical expenses to Medicare. Our attorneys determine when an MSA is warranted, develop an appropriate MSA, and provide detailed administration guidelines.
  • Section 111 Mandatory Insurer Reporting (MIR) – MIR mandates insurance carriers and self-insurers timely report the identity of Medicare beneficiaries receiving a settlement. Our Practice assists clients in complying with MIR by designing integrated protocols to avoid monetary penalties.