Closing the Loop on Trostle: USDOJ Did Not Satisfy “Must File” Provision of MSP Regulations So Netted $54,000 Instead of $84,000

On Friday, August 21, 2020, the United States Department of Justice released notice it had reached a settlement with Angino Law Firm to accept almost $54,000 in satisfaction of outstanding conditional payments with the Centers for Medicare and Medicaid Services (“CMS”). What is notable about this case is that the defendants paid what they had ultimately agreed to pay after losing a 2016 lawsuit against CMS, and nothing more.

In our February 2019 blog covering this matter, we shared news that the United States District Court for the Middle District of Pennsylvania denied the government’s motion for summary judgment where CMS sought to obtain full reimbursement of close to $84,000 in conditional payments. The Court found the mere filing of a lawsuit by CMS is not enough to prove CMS was “forced to file” it. It is indeed a rare defeat for the government.

We were left wondering if the Trostle estate and Attorney Angino would pay the steep price of an additional $30,000 for bringing suit against CMS in 2016?  And if so, who would pay that additional amount: the Trostle estate or Attorney Angino? Finally, we wondered how the Court would interpret the “must file” suit requirement of the statute. Today, we have some answers.

The USDOJ ultimately accepted $53,295.15 on behalf of CMS to resolve the conditional payments, so neither the Trostle Estate nor Attorney Angino was forced to pay the additional $30,000 sought by CMS. Ultimately, the Trostle Estate did not pay anything further. Instead, the Angino Law Firm and the original target of the late Mr. Trostle’s injury lawsuit, Bio-Medical Applications of Pennsylvania, made payment to resolve the conditional payments:  

• Bio-Medical Applications of Pennsylvania paid $33,750 of the settlement, and
• Angino Law Firm paid $19,545.15

Because the parties reached this settlement, we will not yet learn more on how the Court interprets the “must file” suit requirement under the MSP statute. We suspect the USDOJ will refrain from using this tactic in future unless and until they are presented with the right set of facts.

How to Avoid this Situation on Your Cases

It pays to be proactive and responsive:

1. Research conditional payments prior to settlement.
2. Ensure the settlement or release documents indicate how the parties intend to resolve conditional payments in the event a final demand comes back higher than conditional payment letter indicates.
3. Repay CMS for the conditional payments promptly within 60 days of receipt of the demand and/or file an appeal to remove unrelated charges within 120 days.

ExamWorks Compliance Solutions routinely assists our clients in all manner of conditional payment research, appeal, and resolution to avoid a situation like this. If you have questions about conditional payment matters or if you would like assistance with a specific case, please contact our Director of Conditional Payment Services, Louis Porrazzo at 678-256-5085 or Louis.Porrazzo@examworkscompliance.com. 

About ExamWorks Compliance Solutions

ExamWorks Compliance Solutions is a leader in Medicare Secondary Payer compliance, combining Medicare Set-Aside, conditional payment, and post-settlement services. ECS is your expert partner for custom solutions for Claims Resolution, Medicare Compliance, Outcome Management and Mandatory Insurer Reporting. ECS, an ExamWorks Company, is headquartered in Lawrenceville, Georgia. Learn more at: www.examworkscompliance.com.