U.S. v. Harris
No. 5:08 CV 102, 2009 WL 891931
(D. N.D. W. Va., March 26, 2009)
This case arose from an incident in which Mr. Ritchea fell off a ladder. Mr. Richea hired Mr. Harris as his attorney to represent him on his personal injury claim. Mr. Harris filed an action against the ladder retailer which eventually settled for $25,000.
As Mr. Ritchea was a Medicare beneficiary, Mr. Harris notified Medicare of the settlement and requested their conditional payment demand figure. In response, Medicare made a conditional payment recovery demand in the amount of $10,253.39 and advised that any appeal had to be filed with 120 days. Neither Mr. Ritchea nor Mr. Harris tendered reimbursement or filed an appeal. Medicare then sued Mr. Harris for reimbursement of its conditional payment amount.
The court ruled in Medicare’s favor and held Mr. Harris personally liable to reimburse Medicare’s conditional payment claim (plus accrued interest). In reaching its decision, the court noted that under the Medicare Secondary Payer Statute (MSP) Medicare has the right to seek reimbursement from a variety parties of who “receive” settlement payments, including attorneys (42 C.F.R. § 411.24(g)). (It should be noted that Medicare can also seek reimbursement from parties that are responsible for “making” primary payment. See e.g., 42 U.S.C. § 1395y(b)(2)(B)(iii). Furthermore, the court held that Mr. Harris’ failure to pursue administrative remedies (i.e. his failure to file a timely appeal) precluded him from now challenging Medicare’s reimbursement determination.