Cattie & Gonzalez: A Full Spectrum of MSP Legal and Compliance Services

Rafael Gonzalez, Esq.

Did you hear the news? I have decided to join John Cattie to create Cattie & Gonzalez, PLLC, the first national law firm which will focus its entire law practice on Medicare and Medicaid secondary payer legal and compliance services. Our focus is on serving the specific needs of each of our clients. No cookie cutter or template solutions. Ours will be a client focused, solutions driven, legal and compliance service firm that listens to your needs and provides products and services that respond to and satisfies such needs. As a result, we provide a full spectrum of Medicare and Medicaid secondary payer legal and compliance services.

Medicare Set Aside (MSA) Legal Opinions

Just as clients seek advice from tax lawyers about tax issues or from real estate lawyers about real estate issues, it only makes sense that clients seek Medicare and Medicaid secondary payer advice from an MSA lawyer. 

The MSA Legal Opinion advises whether a future medical obligation exists based on the case-specific facts of your auto, liability, no-fault, or work comp claim. If one does, it then proceeds to present the client with potential vehicles (i.e., MSAs, Medical Savings Accounts, etc.) to ensure Medicare is not billed prematurely. It presents potential funding and administrative options. It contemplates whether one must ask Medicare to review/approve the MSA. Finally, it shares a path to obtain a judicial allocation on the merits of the case, which Medicare must respect. The MSA Legal Opinion transfers all risk away from the client, and ensures the client will not have to pay an additional dime above and beyond that amount recommended in the MSA Legal Opinion.

Workers' Compensation Medicare Set-Asides (WCMSAs)

According to Medicare, its future interests must be considered in ALL workers' compensation cases, regardless of whether a case meets its arbitrary workload review threshold. A Cattie & Gonzalez WCMSA helps you predict what portion of a potential settlement, judgment, or order may need to be "set-aside." This medically-based review fully adheres to CMS pricing methodology as set forth by CMS in its WCMSA Reference Guide. Getting a Cattie & Gonzalez WCMSA report allows you to consider Medicare's interest in all workers' compensation cases, meeting Medicare's expectations and standards.

Liability Medicare Set-Asides (LMSAs)

A moving target over the past decade, Cattie & Gonzalez offers a medically-based LMSA to help parties achieve resolution of their case. While it cannot be said that LMSAs are "required" today, most understand that Medicare possesses some right of recovery for future medicals in a liability case. A Cattie & Gonzalez LMSA provides you with a snapshot of the maximum amount CMS may be able to claim at a later date.

MSA Review, Re-Review, and Amended Review 

We are able to submit our own MSA Allocation or one you obtained from someone else. Importantly, CMS will recognize one and only one representative at a time when it comes to reviewing MSAs. The first one to the CMS window, in effect, can lock out the other side. If you do choose to seek CMS review and approval of your MSA, you should maintain as much control of that process as possible. Working with Cattie & Gonzalez to get your MSA approved by CMS accomplishes that goal.

In the past, Medicare did not offer any appeals process. You were stuck with the result. It's a very different scenario these days. CMS offers re-reviews and amended reviews under certain circumstances. You may have a right to an immediate re-review if CMS made an obvious mathematical error or did not consider certain documentation dated prior to the initial submission date. In addition, you may have a right to an amended review if your case meets a specific criteria. 

Medical Cost Projections 

Medical Cost Projections (MCPs) serve a valuable purpose when trying to make your case. This snapshot provides a comprehensive look at potential future medicals in play. Different from an MSA in form and function, an MCP provides critical information for parties trying to maneuver a case towards settlement. MCPs are useful for all cases in which a Life Care Plan (LCP) may be excessive (in scope and cost). Cattie & Gonzalez routinely provides MCPs for clients seeking to establish the value of a case.

Medicare Conditional Payments

Cattie & Gonzalez will obtain verification from the appropriate CMS contractor as to whether there are any outstanding conditional payments. Upon receipt of the conditional payment letter, Cattie & Gonzalez will review the itemization carefully to determine whether the items listed are/not related to the claim. If there are unrelated payments, Cattie & Gonzalez will dispute the unrelated charges.

After settlement, Cattie & Gonzalez will ask Medicare for a final demand letter. Immediately upon receipt of that letter, we will review it to determine how much Medicare is demanding for repayment; when payment is due; and whether all charges listed are related to the compensable claim.

If the client agrees with the amount that Medicare demands as repayment, we will provide instructions on how to send payment to Medicare. If you disagree with the amount, Cattie & Gonzalez will file a Request for Redetermination, Request for Reconsideration, Request for a Hearing by Administrative Law Judge, and Request for Review by Medicare Appeals Council, if necessary.

Medicare Advantage Plans and Prescription Drug Plans

Cattie & Gonzalez will identify the potential involvement of a MAP or PDP, reach out to either or both and investigate whether the plans have made any payments related to your claim. If so, we will analyze such payments and inform our client of our conclusions and recommendations. If appropriate, we will dispute all requests for reimbursement unrelated to your claim.

Medicaid Liens 

State Medicaid agencies, or the contracted State Medicaid Managed Care Organization, may also make payments related to your claim. When Medicaid/MCO has made payments for medical expenses related to an injury, it may assert a lien against the payer or the beneficiary’s recovery. Each of the fifty (50) State Medicaid agencies and three (3) United States territories have unique recovery statutes that affect how a State agency can recover medical payments paid from a personal injury, workers compensation or liability settlement. 

As each State Medicaid agency has a unique recovery statute, each agency has different reduction formulas or guidelines pursuant to their statute. Some Medicaid agencies will only grant a reduction through a compromise process. Cattie & Gonzalez has experience working with these agencies and negotiating lien reductions based on the current statutory and regulatory environment. 

Military Liens

Military veterans and their family members may have health insurance coverage under the Veterans' Administration (VA), Tricare or ChampVA. When settling a case involving beneficiaries of one of those programs, parties need to be aware of the potential recovery rights of each program. 

After rendering treatment, all three programs may seek recovery for medical care it provides that is related to a claim. They have both a right of subrogation as well as an independent right of recovery when some responsible third party exists. Cattie & Gonzalez has experience working with these agencies, and negotiating lien reductions based on the current statutory and regulatory environment.

Mandatory Insurer Reporting

Although Cattie & Gonzalez does not currently serve as an MSP reporting agent, we incorporate mandatory reporting components in every one of the services we provide. In other words, if hired to put together an MSA Legal Opinion, we will reach out to the client’s reporting agent and obtain all relevant information regarding ORM, ICD, and TPOC. If we are hired to work on Medicare conditional payments, we will ascertain for accuracy and consistency ORM dates and termination, ICD reported codes, and TPOC dates and amounts. In addition, as Civil Money Penalties are finalized, adopted and implemented, Cattie & Gonzalez will provide clients advise and counsel regarding any attempted or imposed mandatory reporting penalty.

About Cattie & Gonzalez, PLLC

The only national law firm focusing its entire law practice on Medicare and Medicaid secondary payer issues, Cattie & Gonzalez, PPLC provides its clients the highest quality MSP compliance advice in a law firm environment, establishing an attorney/client relationship. The Firm stands behind its work and advice, meaning the Firm will defend its opinions, advice, and work product, including any post settlement conditional payments arising from the client’s application of and reliance on the Firm’s Medicare Set-Aside (MSA) Legal Opinion. To reach the firm, you may email us at [email protected] or [email protected], call us at (844) 546-3500, or visit us at www.cattielaw.com.

About Rafael Gonzalez, Esq.

Rafael is a partner in Cattie & Gonzalez, PLLC, the first national law firm focusing its entire law practice on Medicare and Medicaid compliance issues in the liability, no-fault, and work comp industries. He is an attorney with extensive expertise in auto, medical malpractice, products liability, nursing home, med-pay, and workers compensation claims, as well as social security, medicare, medicaid, and affordable care compliance. He is active on LinkedIn, Twitter, Facebook, Instagram, and YouTube.