Medicare: Their Bite is Catching up with their Bark!
***NEWSLETTER***
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The boy who cried, “Wolf”? Howling at the Moon?
We are just going to keep barking about Medicare liens—and this time, you’ll want to listen closely.
Medicare has rolled out yet another initiative as part of its ongoing Conditional Payment Recovery efforts—this one aimed at recouping conditional payments made after the settlement date as part of their Final Demand.
Sounds like a lot of bark but no bite? Think again.
It’s not uncommon for plaintiffs to continue receiving medical care at the time their case resolves. In fact, continued care is often why the case settles—everyone knows the treatment train is still moving, and the time to resolve has come.
IN THE PAST
Plaintiff’s counsel would notify CMS of the personal injury claim, receive a Conditional Payment Notice (CPN), notify CMS when the matter resolved, and then receive a Final Demand. That Final Demand would historically include only CMS payments made up to the date of settlement.
While CMS’s obligation to cover future care remained secondary, resolving the past lien was treated as a distinct process, separate from LMSA concerns.
THE PRESENT
Recently, we’ve seen a game-changing shift. A CMS contractor issued a CPN after receiving notice of settlement from a liability carrier—but this one included payments made through the date of the CPN, not just through the settlement date.
Translation: CMS is seeking reimbursement for care provided both before and after the settlement.
This creates immediate and significant risk exposure—both for your client and for your firm.
How do you deal with this?
I’m going to be the big dog on the porch for a minute: recent case law makes it crystal clear that unless you begin tackling these issues early in the case, you may be inadvertently creating the problem. See, for example: Weis v. Azar, Dist. Ct. Maryland, Dec. 8, 2018.
Even worse? These new complications come with serious malpractice risk. U.S. Attorneys’ offices are increasingly targeting plaintiff firms for non-compliance with the Medicare Secondary Payer Act.
And the threat of False Claims Act liability? Yeah, that’s real—and growing.
CMS compliance is not optional. It’s not a checkbox. It’s not an afterthought. It’s a cornerstone of responsible settlement planning—and one that can no longer be ignored.
Here at The Lien Project, we’ve built systems and strategies to keep you compliant, protect your clients, and boost your bottom line. We’re trial lawyers helping trial lawyers.
We’re not lone wolves out here—we’re running in the pack. (Actually, we’re running the pack.)
Explore More Resources with Lien Project Network
For a deeper dive into lien resolution strategies, settlement planning, and reimbursement challenges, explore our educational modules. Lien Project Network serves as a trusted resource for plaintiff attorneys, providing insights on financial planning, public benefits, and structured settlements in the context of lien management.
Need Assistance? Work With The Lien Project, PC
If you need expert legal assistance in navigating lien resolution, reimbursement claims, or settlement planning, our team at The Lien Project, PC is ready to help. As an LPN member, you earn credits that can be applied toward lien reduction and resolution services provided by The Lien Project, PC, allowing you to offset up to $900 per year. Your investment in continuing education through Lien Project Network not only enhances your lien resolution skills but also reduces the cost of engaging legal experts when needed.
Schedule a Consult today to see how we can help maximize your client’s recovery.