Medicare Attorney

In the past, reporting to Medicare was largely ignored; however, the growing concern over depleting Medicare funds and insolvency has led to Medicare’s aggressive pursuit of compliance. Under the Medicare Secondary Payer (MSP) statute, Medicare has the ability to implement and enforce its statutory right of recovery. Due to legal implications, attorneys must also consider Medicare in every award, judgment, or settlement.

What is MSP?

The MSP statute was created to ensure that in cases where a Medicare beneficiary, or one who will become a beneficiary within 30 months, receives a settlement that the burden of the medical expenses will be shifted to the primary party (insurer or self-insured), and not Medicare. Medicare is considered a secondary payer.

When Medicare makes a payment that should be covered by a primary payer, they will issue a conditional payment. The conditional payment must then be reimbursed by the responsible party. Medicare can seek recovery from any party including the beneficiary, attorney, providers, private insurers, and physicians. If settlement funds have been routed to a client’s attorney, Medicare can bring a lawsuit against an attorney.

MSP Reimbursement Obligations

A notice of claim must be made to the Centers for Medicare or Medicaid Services (CMS), and its Coordinator of Benefits Contractor (COBC). A medicare attorney does not need the approval of their client to provide a notice of a claim to CMS. As an attorney, the federal government considers both the client and their attorney responsible parties. Failing to report and comply with MSP requirements can have legal consequences for an attorney including paying damages plus interest, a refusal to recognize the settlement, or disqualifying the beneficiary from future benefits.

How Synergy Helps Medicare Attorneys

Medicare Attorneys have a lot of responsibility where Medicare compliance is concerned. Attorneys must remember that Medicare beneficiary cases must be handled differently and that Medicare’s interests must be taken into account from the onset. To do so, you must take a lot into consideration. This can take up a lot of your firm’s time and can be quite expensive due to the time it can take away from other client cases in progress. In the end, the process can become more of a hassle, leaving you and clients completely frustrated.

This doesn’t have to be the case. You need a skilled partner such as Synergy to handle all of your client’s Medicare compliance and post-settlement issues for you. Our services include MSA analysis, allocation, and submission, MSA administration, structuring attorney fees, MSA training, and more. Our comprehensive approach to Medicare compliance guarantees that in the end all parties will be protected.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.


"Synergy has been a trusted part of our legal team for many years. They have helped our clients in many cases to understand the benefits of structured settlements. Synergy has protected our clients and us by securing the best annuities on the market with the safest companies available. Our Synergy consultant is a great communicator in explaining the details and benefits of structured settlements to our clients. He has also mentored myself and the other lawyers in our firm in the benefit of Attorney Fee Annuities. Their work with our firm has secured our clients and our financial security and we expect to continue working with him for many years to come."

Brett Panter
Panter, Panter & Sampedro

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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