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Phila. Firm Busted for Unpaid Medicare Debts
A Philadelphia-based personal injury law firm, Simon & Simon, P.C., is facing heat for allegedly failing to reimburse the United States for certain Medicare payments. The government had made these payments to medical providers for the firm’s clients.
The government’s investigation arose under the Social Security Act’s Medicare Secondary Payer provisions, which require entities who receive settlement or judgment proceeds to repay Medicare within 60 days for its conditional payments.
At various points between 2014 and 2019, Medicare made conditional payments to healthcare providers to satisfy medical bills of eight of the firm’s clients. Although Medicare demanded that Simon & Simon repay the resulting Medicare debts, the firm allegedly failed to do so.
Under the terms of the settlement agreement, Simon & Simon agreed to pay a lump sum of $6,604.59. The firm also agreed to name a person responsible for paying Medicare secondary payer debts, train the employee to ensure timely payments, review any additional outstanding debts to ensure compliance, and provide written certifications of compliance.
“This settlement agreement should remind personal injury lawyers and others of their obligation to reimburse Medicare when they receive settlement or judgment proceeds for their clients,” said U.S. Attorney McSwain. “Lawyers need to set a good example and follow the rules of the road for Medicare reimbursement. If they don’t, we will move aggressively to recover the money for taxpayers.”
The government alleged that the firm’s actions were a clear breach of federal regulations, and the settlement highlights the consequences of failing to meet these obligations. The resolution follows a similar one against Rosenbaum & Associates, a Philadelphia personal injury firm that settled with the United States in 2018.
Key Facts
- State: Pennsylvania
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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