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Medicare liens can be a headache for plaintiffs attorneys. They can be tough to monitor or parse, and they typically force lawyers to negotiate their settlements with a blind spot, not knowing exactly how much of the lien will need to be paid back and how much might be forgiven. And now the feds are adding to that pressure by making sure personal injury lawyers know there will be consequences if their clients' Medicare liens aren't properly and timely reimbursed.

"I think it's been pretty clear over the last year or so that U.S. attorneys across the country have seemingly made a more concerted effort in tracking down plaintiffs firms that aren't satisfying their Medicare secondary payer requirements," Michael Davey of Eckell, Sparks, Levy, Auerbach, Monte, Sloane, Matthews & Auslander in Media, Pennsylvania, said. "It's a shot across the bow."

Over the past 18 months, there have been several "shots" across the bow from U.S. attorney's offices on the East Coast announcing settlements with plaintiffs law firms that failed to fully pay back their clients' Medicare debts.

The latest was from William McSwain, the U.S. attorney for the Eastern District of Pennsylvania, announcing that the Philadelphia-based personal injury firm Simon & Simon, which specializes in limited tort auto litigation, agreed to pay $6,600 to settle claims it failed to properly reimburse Medicare liens for eight of the firm's clients. The Eastern District announced a similar action in 2018 against the personal injury firm Rosenbaum & Associates, which is also based in Philadelphia. The claims against that firm settled for $28,000.

Other firms outside Pennsylvania have seen much larger settlements.

In November, the U.S. attorney for the District of Maryland announced a more than $91,000 settlement against Saiontz & Kirk in Baltimore, and, in March, the office announced a $250,000 settlement with the Gaithersburg firm Meyers, Rodbell & Rosenbaum.

Each press release included quotes for the U.S. attorneys saying they intended to hold lawyers accountable.

"Plaintiffs' attorneys cannot refer a case to or enter into a joint representation agreement with co-counsel and simply wash their hands clean of their obligations to reimburse Medicare for its conditional payments," Maryland U.S. Attorney Robert K. Hur said in announcing the settlement with Saiontz & Kirk in November. "We intend to hold attorneys accountable for failing to make good on their obligations to repay Medicare for its conditional payments, regardless of whether they were the ones primarily handling the litigation for the plaintiff."

According to Davey, who teaches CLE classes on subrogation matters, the law mandating Medicare reimbursements has been on the books for decades, but it appears that the feds are increasingly making public their efforts at enforcing the law. Several other attorneys agreed they had not seen similar enforcement efforts announced before.

Press releases from federal prosecutors announcing each settlement noted that it had been officials with the U.S. Department of Health and Human Services who referred the cases to the corresponding U.S. attorney's office.

When asked to comment for the story, Health and Human Services referred any statements to the Department of Justice, which did not return a message seeking an interview. With U.S. attorney's offices for both Maryland and the Eastern District of Pennsylvania not responding to requests for comment, questions remain about whether prosecutors are cracking down harder than before, or simply starting to make their settlements known through public announcements.

But, regardless of the legal community seeing more press releases about these cases, lawyers said the message coming from the feds is one attorneys should heed.

"For whatever reason, policy, politics or the purse, the DOJ seems to be making an example out of plaintiffs lawyers these days," Davey said. "If you're a plaintiffs lawyer practicing in this area, you need to know your obligations involving Medicare, or you're practicing at your own peril."

In general, attorneys said drilling down into medical liens can be time consuming, especially when a plaintiff is also receiving treatment for conditions unrelated to the case, or if there are disputed dates about when the plaintiff's injury manifested.

Timothy Lawn of the personal injury firm Raynes Lawn Hehmeyer said dealing with medical liens can be a headache and misunderstandings can occur, but all liens must be closely monitored and handled timely.

"It's something you have to do, and do right," he said.

Personal injury lawyer Slade McLaughlin of McLaughlin & Lauricella said Medicare liens need to be taken very seriously, which is why, he said, his office has developed checklists of tasks to make sure each different type of lien is identified and handled properly. The tasks include locating the liens, checking on them every few months to make sure they're up to date as the litigation progresses, and then sending out letters notifying the lienholders as soon as it seems that the case might be settling.

An added difficulty is that the liens oftentimes need to be negotiated as the broader settlement talks are ongoing. Depending on the agency holding the lien, liens can be reduced by as much as a third, with the plaintiffs attorney essentially taking their fee from the liens since they are the ones who ultimately obtained the money to pay back the lienholder. According to McLaughlin, most lienholders are easy to deal with, but some take very tough negotiating tactics, which, he said, can be disadvantageous to the broader case, as it can force lawyers to take cases to trial even when there may be liability problems.

But regardless of the difficulty, the ultimate responsibility for handling liens properly is on the lawyer.

"If you don't pay a lien, they're not looking for the client. They go straight to you," McLaughlin said. "It's a very sticky wicket and if you're not paying close attention, you can get yourself in all sorts of trouble."