As Medicare has become an increasingly important part of defense litigation, Marshall Dennehey has remained at the forefront of this emerging area of law since the Center for Medicare Services implemented its regulations in 2001. While our Medicare work began as a supplement to the workers’ compensation practice, it has rapidly expanded and is a necessity for all areas of defense litigation.
As such, we have formed a stand-alone practice group dedicated to Medicare compliance matters. Our boutique practice group provides accurate assessments and continuity of service. Cases are handled from start to finish by the same attorney, providing a single point of contact for information and advice throughout the pendency of the case.
Our Medicare team has the comprehensive knowledge necessary to effectively handle set-asides in all parts of the country. We are well-versed in federal and state liability systems, as well as the workers’ compensation systems. In addition to protecting Medicare’s interests through set-asides, we also alert our clients to the involvement of the State Children’s Health Insurance Program (SCHIP) Reporting Law. We offer cogent advice regarding case settlements, including the use of structured settlements and other strategies to bring cases to conclusion. We are willing and able to work with lawyers throughout the country to provide the support they need regarding Medicare issues.
National Medicare Services Provided:
- Medicare set-aside allocations for workers’ compensation and liability cases.
- Conditional payment searches.
- Submissions to Medicare for set aside approval.
- Consultations regarding Medicare issues.
- Attendance at mediations, along with your defense counsel, to effectively settle cases.
- Preparing Medicare language for settlement documents.
- Expedited services.
Not only do we have the requisite knowledge and experience to address any Medicare related need, we also provide these services on a cost-effective basis. The members of our Medicare Compliance Practice Group are available to help you find the right strategy to achieve your goals.
Results
Thought Leadership
Beware of the Language Used in Your Settlement Agreements: Medicare Is Watching
October 2, 2023
The workers’ compensation practitioner has now become a forced bedfellow of CMS, like it or not. If you fail to “issue spot” in relevant settlements, you will have problems.
What's Hot in Workers' Comp
What’s Hot in Workers’ Comp – Special PA Alert
June 10, 2022
The Supreme Court of the United States issued a decision affirming Medicaid’s right to seek reimbursement from a settlement amount allocated for past and future medical care. In Gallardo v. Marstiller, Gallardo suffered catastrophic injuries, resulting in permanent disability, when a truck struck her while exiting a school bus. Florida’s Medicaid agency paid initial medical expenses and continues to pay medical expenses related to this accident. Gallardo sued the owner and driver of the truck and the county school board. The litigation resulted in a settlement for $800,000.00, with $35,367.52 being allocated to past medical expenses. The settlement failed to allocate any amount for future medical expenses. The Medicaid Act requires participating states to pay for needy individuals’ medical costs and then make reasonable efforts to recoup those costs from liable third parties. Florida’s Medicaid Third Party Liability Act automatically assigned to the state agency any right to third-party payments for “medical care.” This Florida statute allowed the agency to a portion of the tort recovery that is presumptively for “past and future medical expenses.” Gallardo challenged the presumptive allocation and brought a law suit arguing that Florida was violating the Medicaid Act by trying to recover portions of the settlement compensating her for future medical expenses. The Eleventh Circuit concluded that a state is not prevented by the Medicaid Act from seeking such reimbursement. The Court agreed, noting that nothing in the Medicaid Act or lien provision limits such a mode of relief. This decision reinforces perhaps a forgotten point to ponder in any workers’ compensation settlement. While a major focus has been on considering Medicare’s interests when a settlement involves future medical care, do not lose sight of Medicaid’s potential lien in your settlement analyses.
