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Removing Unrelated Medicare Charges Meant Going the Distance in a Recent Nursing Home Abuse Case

By April 24, 2024May 3rd, 2024No Comments

Precision Resolution Case Manager Lucia Giglia’s experience navigating the intricacies of nursing home case liens paid off in a big way when she secured a savings of $18,908.31 by reducing a Medicare lien from $28,969.32 to $10,061.01 in a recent nursing home abuse case. This outcome brought justice to the plaintiff and underscored the importance of expertise in the constantly evolving lien resolution industry.

Case Overview

A 100-year-old skilled nursing facility resident was harmed following an incident involving staff negligence in 2022. Lucia’s initial efforts to dispute medical charges she believed were wrongly included in Medicare’s Final Demand Amount were denied by the BCRC. Not satisfied with this decision, Lucia wasted no time preparing to advance her case to avoid missing the deadline to request an appeal. Her belief in the plaintiff’s right to a reduced lien not only reflected the clear ethical imperative established by the mistreatment the plaintiff experienced but also the strength of her arguments. She leveraged the legal acumen of Precision Resolution’s Senior Lien Attorney, Paul Loudenslager, Esq., to compile additional materials supporting her arguments prior to commencing an appeals process that ended with a hearing in front of an Administrative Law Judge (ALJ).

Strategies for Lien Reduction

Lucia determined that the unrelated Medicare charges included in the original lien calculation were incurred for care the victim would have received regardless of the nursing home injury underlying the primary cause of action in the plaintiff’s personal injury case. This conclusion was reached based on her previous experience resolving liens in nursing home abuse cases. Her approach required a deep understanding of Medicare’s processes and procedures, and with it, Lucia successfully navigated the complexities of the case and was eventually granted a favorable appeal by an ALJ.

The experience Lucia gained successfully appealing Medicare’s decision to deny her requests to remove unrelated medical charges from the lien amount will add to the how Lucia and Precision Resolution serve attorneys in single-event ERISA, Medicare, Medicaid, and private insurance lien cases in New York and beyond.

Lucia’s expertise helps her attorney clients avoid the frustrations caused by common lien-related case roadblocks, such as faulty Section 111 reporting and surprise Final Demand amounts, to maximize settlement proceeds and close more cases.

Hello, from Chicago!

Lucia is excited about the opportunity to meet with nursing home abuse litigators and the broader elder law community in Chicago for the 2024 Elder Abuse College: Winning Elder Abuse Cases in Discovery conference on April 25th and 26th, 2024!

Talk with Lucia today about shrinking your firm’s administrative workload and closing more cases with Precision Resolution.