Medicare Solutions

The firm offers nationwide services for Medicare Set-Asides, Medicare Conditional Lien Negotiation, Section III Reporting and Risk Analysis. Our attorneys have years of experience in Medicare Compliance. Members combine their legal expertise with our expert medical staff to provide a solution that brings together both legal and medical arguments to protect Medicare’s interests, and equally important, protect our client’s interests.

Proactive early intervention is necessary in order to reduce the amount allocated to future Medicare covered medical treatment and to secure the lowest possible exposure to conditional payments. Our flat fee arrangements ensure that there are no extra costs to getting us involved in the early stages of a case in order to reduce exposure. We undergo a multi-tiered approach, developing a preliminary plan, collaborating with all parties to audit cost drivers and further limit dollars needed to fund the Medicare Set-Aside. Our assigned legal teams work with CMS on a routine basis and monitor case law. To learn more about the services, select from the menu on the side bar. Disclosure Forms to begin the process are located under RESOURCES on this site.

We may assist with any of the services listed here.

Conditional Payment Research & Negotiation

Our range of services include obtaining the conditional payment amount, reviewing the alleged conditional payments, reviewing records, discussions with parties to assess if the treatment is related, establishing medical and legal arguments that may lower or eliminate conditional payments, negotiating conditional payments with Medicare, and following up to ensure proper procedures for an efficient resolution.

Medicare Set-Asides

We will verify the injured party’s Medicare status, obtain all executed releases required by Medicare, review medical records, prescription history, payouts, and team with the parties to determine possible reductions in medical expenses, rated ages, and annuities. Our attorneys will conference with the doctors to try and reduce or eliminate medication cost drivers, and prepare allocations, ensuring that we protect Medicare’s interest as well as our client’s interests.

Section III

We will work with Insurers to ensure full compliance with Section III. We can also assist in identifying cases that may have a Medicare connection early on in the process so that a proactive approach may be applied.

Risk Analysis

We’ll review cases that may fall below Medicare’s current review thresholds. These cases may require additional protection given the possibility of Medicare enrollment in the near future or large dollar settlements.

Terms of Service

Our Standard MSA and Complex MSA services include:

• A review of all medical records
• Preparation of an MSA allocation and cost projections
• Projection of both allowable and non-allowable Medicare costs over the Plaintiff's or Claimant's life expectancy
• Projection of the future pharmaceutical costs
• A review of the Claimant/Plaintiff's Social Security and Medicare status
• A determination of the Claimant/Plaintiff's Medicare conditional payment status.V

MSA services may be purchased at a Flat Fee or Hourly rate.

CLICK TO READ Medicare White Paper by Daniel J. Santaniello, President-Elect FDLA and Reinaldo Alvarez, Member. This article was originally published in Trial Advocate Quarterly.

To learn more, click here to see our people who specialize in this practice area or click here to see a list of our verdicts for this practice area.