New Medicare False Claims Act Litigation May Have Impact on Workers’ Compensation Benefits

Under New Jersey law, if you have been injured in a motor vehicle accident, you have the choice of claiming your personal health insurance carrier as the primary source for reimbursement of medical bills. If, however, your insurance is through Medicaid or Medicare, you may not select this option. Under the Medicare False Claims Act (FCA), if you are aware that someone is claiming benefits from Medicare or Medicaid as a “first payer,” you can file a whistleblower claim and have the right to recover a percentage of any amounts wrongfully paid by Medicaid/Medicare.

A lawsuit currently being litigated in the federal courts in New Jersey addresses this very issue. The whistleblower, Elizabeth Negron, filed a lawsuit under the FCA, contending that Progressive Casualty and Progressive Garden State Insurance had wrongfully given Medicare and Medicare beneficiaries the opportunity to choose primary coverage in an auto accident from those agencies. Negron says that she was a Progressive policyholder, and that, when she went to the company’s website to file a claim in 2009, the website did not limit her choice of primary payer to Progressive, but allowed her to select Medicare. In addition, when her healthcare providers submitted bills directly to Progressive, they were returned, with the instruction that they be submitted to her primary health care provider, which Progressive knew to be Medicare.

Progressive sought to have Negron’s lawsuit dismissed arguing that she had not met the standards set forth in the FCA. The court disagreed and denied Progressive’s motion, concluding that Progressive had caused Negron to wrongfully submit bills to Medicare that it could never pay.

Contact the Workers’ Compensation Attorneys at Mallon & Tranger

We offer a free initial consultation to anyone who has suffered any type of workers’ compensation matter.  To set up a meeting, contact us online or call us at 732-780-0230 for an appointment. We have offices in Freehold, Toms River and Point Pleasant.

Our Office Locations

Freehold

86 Court Street,
Freehold NJ 07728

Telephone: 732-780-0230
Fax: 732-780-5002

Toms River

250 Washington St
Toms River NJ 08753

Telephone: 732-780-0230
Fax: 732-780-5002

Point Pleasant

3247 Route 88
Point Pleasant NJ 08742

Telephone: 732-780-0230
Fax: 732-780-5002