The Consequences of Ignoring Medicare Advantage Liens

Attorneys are individually liable to Medicare if they receive a settlement or payment on behalf of a Medicare beneficiary. US v. Harris, 2009 US Dist. LEXIS 23956 (N.D. W. Va. 2009). It’s that simple: make sure Medicare gets repaid for its lien. If you don’t: they can come after you.

A new case in a Virginia US District Court (Click here to view the Humana v. Paris Blank complaint) shows the same liability can be imposed when you fail to protect a Medicare Advantage Plan’s lien. Humana Insurance Company is suing Paris Blank LLP for nearly $400,000.00 because the law firm allegedly ignored a Humana Medicare Advantage Plan lien of $191,612.09.

Humana argues that its rights arise under 42 USC 1395w-21 et. seq. It reminds us that any conditional payments are subject to recovery when and if the other insurance does make payment. As with any “lien” or right to reimbursement, “other insurance” means the defense in your cases. Most important is where Humana notes, “CMS has interpreted the MSP law as it applies to MA organizations in a formal regulation, which states that, ‘[t]he MA organization will exercise the same rights to recover from a primary plan… that the Secretary exercises under the MSP regulations.’ 42 CFR 422.108(f).”

Humana uses the above to say: You must reimburse Medicare Advantage Plans!

What Happened to Paris Blank LLP?

The case was just filed on February 8, 2016. Click here to view the Humana v. Paris Blank complaint. The expectation is that Paris Blank will turn this over to its insurance carrier and settle for an undisclosed amount. But what happened to get them to this point?

Paris Blank’s client (the plaintiff) was involved in a motor vehicle accident. He was eligible for Medicare and covered by Humana’s Medicare Advantage Plan. The case settled piecemeal for a total of $475,000 in 2014. One of the settlement checks included “Humana” on the check, but, the law firm deposited that check without Humana’s endorsement on April 29, 2014. It is unclear if Paris Blank ever reached out to Humana; however, Humana eventually sent a “lien.”

On January 15, 2015, Humana sent a statement of benefits showing $191,612.09 owed. We know that Paris Blank and BCRC (regular Medicare) communicated regarding Medicare claims and that BCRC sent notice that it had not paid. Regular Medicare’s lack of payments is not surprising because we know that the plaintiff was covered by Humana Medicare. Paris Blank attempted to use BCRC’s zero-dollar closure notice in a waiver request to Humana, which they denied. Paris Blank apparently ceased communication with Humana at that point.

How Do You Avoid the Same Mistake?

Paris Blank made a mistake. Perhaps the firm is unaware of how Medicare’s various parts function. Perhaps they thought they could pull a fast one on Humana. Regardless, you need to know how to avoid that mistake and protect yourself and your client. The bombshell answer: Contact your clients’ health insurers. You can ask for insurance cards. You can review medical records. You can talk to your client. This information is obtainable. Once you know the health insurers you can obtain their liens. You don’t want to spend that time on lien resolution? No problem! Contact an expert lien resolution service!

Had Paris Blank held the funds and contacted Humana they wouldn’t be on the hook for $400,000.00. In fact, they could have reduced Humana’s claim to $120,000.00 through Medicare’s statutory procurement formula. Then, the worst case scenario would have been that the plaintiff’s take-home would have been a bit smaller. The best case scenario? More reductions of this Medicare lien.

Reducing Law Firm Liability

How do you reduce your law firm’s liability? Spend time to work on the liens. Then, dispute those liens, negotiate them, and notify lien holders that your case has settled. If you give lien holders the opportunity to finalize a lien, they will. Then you can pay them and protect yourself, your client, and your client’s right to future medical care.

Or, the simplest way to reduce your lien-related liability is to utilize a lien resolution service. For help with Medicare Liens, Medicare Advantage Plans, and any other Health Insurance Lien please contact us.

 

Ryan Weiner

[email protected]

Chief Operating Officer

Massive

(844) Med-Lien