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March 03, 2023

Maryland Law Firm Agrees to Pay $40,000 to Settle Allegations of Failure to Reimburse Medicare Conditional Payments

On February 23, the U.S. Attorney for the District of Maryland announced that Baltimore law firm Kandel & Associates, P.A. and Nelson R. Kandel, Esq. (collectively, “Kandel”), settled with the government to resolve allegations of failure to reimburse Medicare for conditional payments made to firm clients. Under certain circumstances described in the Medicare Secondary Payor (MSP) provisions of the Social Security Act, Medicare makes “conditional payments” to healthcare providers for services provided to Medicare beneficiaries. However, if beneficiaries receive a tort judgment or settlement for an injury that was treated, they or their attorneys are obligated to repay the conditional payment to Medicare. Here, the government alleged that Kandel and twelve of his clients failed to repay Medicare for conditional payments made through several years after receiving settlement proceeds. Under the terms of the settlement, Kandel agreed to pay $39,828.66 to the government, to designate an individual at the firm who will be responsible for ensuring all Medicare conditional payments are timely reimbursed, and to perform periodic reviews to ensure compliance with reimbursement obligations.

The Justice Department’s press release emphasizes that attorneys have an independent obligation to determine whether their personal injury clients had received Medicare conditional payments and to repay conditional payments to Medicare after they receive judgment or settlement proceeds on behalf of their clients, regardless of whether CMS has contacted them about the MSP debt. 

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