Personal injury attorney has filed a False Claims Act lawsuit against a number of insurance and self insurance companies doing business in the Western District of New York. J. Michael Hayes alleges he has personal knowledge of fraud by defendants in concealing disclosure of claims involving Medicare beneficiaries since 2003.( Read Part 1 of the Complaint ) ( Read Part 2 of the Complaint )
We are currently evaluating the 124 page complaint and will supplement this post with further comment. We have always advocated a proactive approach to resolving Conditional payments owed to Medicare. This process has been a challenge to the Industry as the responsibility to repay Medicare rests also with the Claimant and Claimant’s attorney as entities that receive payment from a Medicare beneficiary.
It will be interesting to follow this litigation as it unfolds. Plaintiff attorneys have an ethical obligation to resolve liens, including Medicare conditional payments. J. Michael Hayes seems to imply such attorneys were ignorant of their client’s status and it is the insurance company sole responsibility to complete the Medicare obligation. That theory may result in many defendants being added to the claim, such as other law firms, including Mr. Hayes himself.
We will further analyze and respond. One more point however in closing, the insurance carrier’s responsibility to pay is not triggered until the expiration if 60 days after a demand is issued. The implication is plaintiff Medicare beneficiary always has primary responsibility.