March 20: Pontiac Michigan, Oakland County Circuit Court

Attorney Bryan Schefman achieved a verdict in favor of his disabled client who lost his job, his livelihood, and suffered a traumatic brain injury in a low impact collision. After 13 days of trial, the jury said its decision was based on plaintiff’s vulnerability from several other concussions in his life and decided that the low-impact defense was not relevant.

 

“It was a difficult case that depended on medical testimony from 6 medical treaters, and while we rebutted the G-force arguments of the defense with accident reconstruction and biomechanical experts, in the end, even the defense medical witnesses agreed that my client’s vulnerability was a critical factor,” Mr. Call for a Consultation “Experienced representation fighting for you.”Schefman stated. “The defense reached pretty deep into the medical records to try and put together a pre-existing injury defense, but the jury rejected that,” Mr. Schefman added. Mr. Schefman’s co-counsel at trial was Norman Lippitt.

Representing a local resident in Southeast Michigan, Mr. Schefman first enforced his client’s no-fault insurance and forced it into settlement with overwhelming medical evidence. The third party defendant had to be taken to trial and the jury returned the verdict for $3,717,000.

The client expressed his joy with the outcome and satisfaction in his legal representation, “we are just overwhelmed and grateful for Mr. Schefman’s skill; he guided us through the insurance maze and got us this verdict to protect my family”; “we could not have gone through this without him”.

Attorney Bryan Schefman Wins for Architectural Firm and Developer
“Representing construction lien claimants can be a long and difficult process, especially in this economy,” Mr. Schefman stated. Representing one of the premier architectural firms in the Midwest, Neumann Smith, and a local developer, Mr. Schefman was able to successfully pursue foreclosure of two construction liens that had a total value in excess of $2,000,000 on a failed commercial venture in Pontiac, Michigan. Mr. Schefman was able to enforce verbal contracts for services, demonstrate superior title over a governmental mortgagee, and force a turnover of an 18+acre commercial parcel in satisfaction of the liens. The settlement was comprised of obtaining title and an undisclosed cash settlement. Gene Carroll, Managing Partner of Neumann Smith, stated, ” we are very pleased to have resolved this case, and feel that there is a terrific opportunity in the parcel”.

Attorney Bryan Schefman Settles Auto Negligence Claim for $740,000
“We are pleased to announce the successful resolution of another case on behalf of one of our clients,” Mr. Schefman stated. The client, stated that she was ” grateful for all of Mr. Schefman’s help, he believed in the case, even though my husband made some deadly mistakes”. Mr. Schefman noted that the individual and corporate defendants ” had some very obvious defenses of fault that reduced the value of the claim, and that ultimately could have proved fatal to the case.” The case was settled shortly after the
local case evaluation process required in the Circuit Courts.

Medical Providers’ Recovery Under the Medicare Secondary Payor Act
In trying to maximize the percent of charges for each medical provider, many large surgical practices and hospitals are concerned that seeking full payment from a no-fault payor after a Medicare payment has been made can violate the Medicare Provider Manual and jeopardize participation in the federal program. However, this should not be a concern if handled appropriately. A provider may intervene directly in that no-fault case pursuant to the Medicare Secondary Payor Act (” MSPA”). The statute authorizes an action
by a private party to enforce the reimbursement provisions of the statute by seeking double damages against a non-compliant no-fault insurer. See 42 USC 1395y(2)(B)(iii) & (b)(3)(A). In addition, the Michigan No-Fault Act provides for recovery of reasonable and customary charges, plus 12% interest on unpaid charges, and reasonable attorney fees, under certain conditions. See MCLA 500.3142 & MCLA 500.3148.

Generally, Medicare is the secondary payor when automobile or liability insurance pays or is liable to pay for medical care related to an accident. Normally Medicare does not pay until the beneficiary has exhausted all remedies to secure payment from the no-fault insurer. However, Medicare can make “conditional payments” if court action or settlement negotiations will delay the insurance payment by more than 120 days from the date of the accident. The provider who receives the payments must later reimburse Medicare, and has a private right of action to collect not only what the provider received from Medicare, but also the differential between that payment and charges, which increased percentage payment is also reinforced under state no-fault law.

There is ample support in the Medicare statutes, the Medicare Secondary Payor Act, and the Regulations governing Medicare operations that enforce this ability of the provider to seek its full payment from the no-fault carrier in higher order of priority. Therefore, the Medicare Secondary Payor Rules are written in such a manner that the provider can enforce Medicare’s right to reimbursement and seek its own full payment. The provider undertaking such a recovery is not “balance billing” a member or another payor that is secondary after accepting payment in full, but rather, billing the correct primary payor, seeking the Medicare reimbursement for a claim that it should not have paid as a matter of federal law, and in the process, seeking its own full payment at charges.

The applicable statutory environment is as follows. The general application of Title 42 §1395y creates a federal pre-emption of Medicare as secondary payor for all purposes and under all scenarios. No-fault carriers are specifically identified as primary where the injuries arise out of the coverage afforded under that policy. The statutory section and regulation establish a conditional payment process, in order to allow providers to render care and maintain cash flow, and then to pursue a private cause of action. Both the statute and the regulations establish by specific example, the right to recoup and retain the balance of Medicare payment and charges. The regulations also establish a definition for the promptness of a provider’s actions.

In other words, a provider cannot sit back and wait having received full payment from Medicare. If you want to increase your revenue, the law makes a recovery available to you. Call me, and I can explain what we do.

[1] All invoices for services have been timely submitted but have not been paid and are now overdue pursuant to section (2) of MCLA 500.3142, as having not been paid within 30 days after Defendant received reasonable proof of the fact and of the amount of loss sustained, and for which, pursuant to section (3), now bear simple interest at the rate of 12% per annum. Pursuant to MCLA 500.3148 (1) Plaintiff is entitled to attorney’s fees as Defendant has unreasonably refused to pay the claims made and unreasonably delayed in making proper payment.