What Do the Numbers Say?

Some victims will be hurt more than others. Some will have more medical expenses than others. Some will have higher liens than others. If the negotiated lien repayment figure applies to everyone, it is likely that those hurt more severely are receiving a greater reduction than those hurt less severely. 

Let’s put some numbers around this. Assume a lawyer represents 100 victims. The most severely hurt victim has $100,000 in medical expenses paid by a lienholder while the least severely hurt victim has $1,000 in medical expenses paid by the lien holder. In fact, eighty percent (80%) of the victims have medical expenses totaling less than $10,000 paid by the lien holder. The lawyer strikes a deal with the lien holder in which every injury victim will pay the lien holder $15,000. That type of deal happens regularly when liens are handled on an inventory or global basis instead of individually. The lien holder is able to agree to large reductions for the most severely injured because it knows it will make up for it with the majority of victims paying more than they would actually need to pay but for the chosen lien resolution approach.

Our firm is seeing this scenario play out in real time in the Roundup MDL. While a Medicare global resolution process exists, that process is currently stuck pending ongoing discussions between Medicare and the U.S. Department of Justice. Medicare provided Roundup victims a path by which they could opt out of the global and pursue Medicare conditional payment resolution via a traditional path.

Cattie & Gonzalez represents Roundup claimants opting out and pursuing the traditional path.

We recently completed work on the first Medicare conditional payment obligation for a Roundup claimant (last visited June 24, 2023). Total gross settlement value for this claimant was approximately $180,000. The lien resolution administrator had applied a global resolution figure of $50,014.46 or 28% of gross settlement to the claimant's case. Our firm advised the claimant to opt out, and pursue a traditional resolution path, believing we could achieve a better result. From the day we obtained the information requested of the client, here is what happened:

• We obtained the Medicare conditional payment figure of $7,179.51 in thirteen (13) days.
• We disputed all unrelated charges Medicare listed, reducing the conditional payment
  obligation to $2,797.33 twenty-one (21) days later.
• We finalized the obligation for $1,552.52 six (6) days later with client consent.

From the day we obtained the information requested of the client, the total Medicare conditional payment resolution time was forty (40) days, resulting in a ninety-seven percent (97%) reduction from the lien resolution administrator’s Medicare global resolution figure. By making the decision to opt out, the claimant maximized their net settlement proceeds, paying Medicare back for exactly what they owed instead of some global figure meant to account for many other claimants’ obligations.

Still, for some, if the efficiencies of the process yield faster disbursement of settlement proceeds, the victims might be willing to pay a little more in liens. That is the balance to be struck: process efficiencies leading to faster disbursements versus true client advocacy to minimize lien repayments. But perhaps one could have the best of both worlds: true client advocacy and speedy results from the date of notice to date of lien resolution.