After even a short period of time studying the Medicare Secondary Payer Statute (MSPS) or MMSEA, your research will lead you to a federal district court order involving a lawyer being held liable for failure to repay Medicare. It’s a case worth discussing and understanding as it may be the beginning of a precedent.
The case is United States v. Paul J Harris (N.D.W.Va. 2008) and involves a plaintiff lawyer who settled a personal injury case for $25,000. The underlying plaintiff was a Medicare beneficiary for whom CMS paid $22,550 in medical services. Prior to settlement, Medicare agreed to accept a little over $10,000 of the $25k settlement.
But plaintiff’s counsel apparently did not distribute CMS’ money within the required sixty day period after settlement and CMS upped the amount to $11,367.78 (notably, CMS was not seeking double pay or other penalties).
On a motion to dismiss, plaintiff-attorney-turned-defendant argued that he could not be liable since he allegedly had forwarded the details of settlement to the government and they did not act.
The Court held that MSPS (1395y(b)(2)(B)(ii)) gave the government a right of recovery on CMS’ condition payments for medical services and that the government could bring suit to exercise that right. Specifically, anyone who benefited from CMS’ payment could be liable, including any “supplier, physician, attorney, state agency or private insurer…” see section 1395y(b)(2)(B)(iii) or 42 CFR 411.24(g).
In short, this order reflects a case where the federal government is chasing after a small figure against a plaintiff lawyer because CMS did not get its full recovery of medical services payments. Lawyers are concerned, of course, because this case illustrates that Medicare can and will do what it can to recover its “secondary” payment, even to the extent of suing lawyers…
U.S. v. Harris: First Case on Attorney Liability for Failure to Pay Medicare
After even a short period of time studying the Medicare Secondary Payer Statute (MSPS) or MMSEA, your research will lead you to a federal district court order involving a lawyer being held liable for failure to repay Medicare. It’s a case worth discussing and understanding as it may be the beginning of a precedent.
The case is United States v. Paul J Harris (N.D.W.Va. 2008) and involves a plaintiff lawyer who settled a personal injury case for $25,000. The underlying plaintiff was a Medicare beneficiary for whom CMS paid $22,550 in medical services. Prior to settlement, Medicare agreed to accept a little over $10,000 of the $25k settlement.
But plaintiff’s counsel apparently did not distribute CMS’ money within the required sixty day period after settlement and CMS upped the amount to $11,367.78 (notably, CMS was not seeking double pay or other penalties).
On a motion to dismiss, plaintiff-attorney-turned-defendant argued that he could not be liable since he allegedly had forwarded the details of settlement to the government and they did not act.
The Court held that MSPS (1395y(b)(2)(B)(ii)) gave the government a right of recovery on CMS’ condition payments for medical services and that the government could bring suit to exercise that right. Specifically, anyone who benefited from CMS’ payment could be liable, including any “supplier, physician, attorney, state agency or private insurer…” see section 1395y(b)(2)(B)(iii) or 42 CFR 411.24(g).
In short, this order reflects a case where the federal government is chasing after a small figure against a plaintiff lawyer because CMS did not get its full recovery of medical services payments. Lawyers are concerned, of course, because this case illustrates that Medicare can and will do what it can to recover its “secondary” payment, even to the extent of suing lawyers…