top of page

Plaintiffs’ Firm Pays Lump Sum to Resolve Conditional Payment Claims and Agrees to Establish Plan fo

The United States Attorney’s Office for the Eastern District of Pennsylvania recently announced that Simon and Simon, P.C., a Philadelphia-based plaintiff’s firm, has paid $6,604.59 to resolve allegations that the firm failed to ensure that conditional payment claims were repaid on behalf of eight of the firm’s clients between 2014 and 2019. In addition to the lump sum payment, Simon and Simon agreed to appoint and train an individual in their firm to be responsible for ensuring the timely repayment of Medicare Secondary Payer debts. The firm also agreed to review any additional outstanding debts to ensure compliance and provide written certifications of compliance. It was also acknowledged that failure to timely reimburse Medicare could result in liability for wrongful retention of a government overpayment under the False Claims Act.

This case is one of many in recent years in which United States Attorney’s Offices have sought reimbursement for unpaid conditional payment claims from plaintiffs’ firms. In November 2019, we highlighted the settlement reached with Saiontz & Kirk, P.A., a plaintiffs’ firm in Baltimore, for $91,406.98. Saiontz & Kirk, P.A., was not excused from liability for ensuring repayment was timely made to Medicare even though they had referred several of the relevant cases to co-counsel or had entered into joint representation agreements.

Similarly, in 2018, the plaintiffs’ firm of Rosenbaum and Associates settled with the United States after failing to ensure Medicare was timely reimbursed. In that case, the plaintiff’s attorney released the settlement funds directly to the plaintiff without first ensuring Medicare was timely reimbursed. The United States Attorney’s Office noted that attorneys would be held “accountable for failing to make good on their obligations”.

If you have questions regarding Medicare’s right to recovery under the Medicare Secondary Payer Act or if you would like our assistance with addressing conditional payment claims for your claim, we will be happy to assist you.

Recent Posts
bottom of page