Every year, significant amounts of money that are legally and rightfully due a company – funds that could have been directed to the bottom line – are lost through ineffective, inefficient or even inactive subrogation practices.
McAfee & Taft’s subrogation and strategic recovery services team is composed of highly experienced lawyers and skilled paralegals dedicated to recovering healthcare medical claims paid primarily as a result of third-party liability. In cases where another person or entity (tortfeasor) is deemed to have been responsible for the injury that prompted the medical claim – usually the result of an auto accident, medical malpractice, product liability or other accident or act of negligence – we step in to enforce the rights of employers, third party administrators (TPAs), stop loss carriers, HMOs and self-insured plans who seek reimbursement of paid medical claims. The firm also investigates and recovers revenues resulting from the overpayment of medical claims, whether unintentional or the result of waste, fraud and abuse.
Subrogation is a complex process requiring an in-depth understanding of the healthcare and insurance industries and expertise in multiple areas of law, including healthcare, insurance, employee benefits and litigation. We focus on providing the highest quality of legal representation with sophisticated technical expertise and resources delivered as efficiently as possible.
In addition to recovering funds through first party coordination and overpayment solutions, we offer a variety of services to ensure the most successful outcomes:
- Comprehensive plan language review and recommendations
- Electronic data mining, claim tracking and review
- Legal research and claim advice
- Stop loss negotiations
- Accident questionnaires and police report gathering
McAfee & Taft’s subrogation and strategic recovery services team can serve as an extension of your staff, becoming your subrogation department and delivering the services expected by you and your groups. Best of all, these services are provided on a contingency fee basis. There is no cost to you unless we recover funds on your behalf.
Attorney Representation
In the litigious environment in which we live, the greatest obstacle to plan recovery can be the plaintiff’s personal injury attorney. To avoid unnecessary losses, health plans cannot afford to go without legal representation of their own.
McAfee & Taft’s subrogation and strategic recovery services team has more than 20 years experience representing employers, positioning health plan interests and negotiating with personal injury lawyers, liable parties and adverse carriers.
Strategic Recovery Process
Identifying recovery opportunities begins with your claims data. Our proven technology and proprietary internal resources scrub your data to initially indicate the broadest subset of claims that may have been the result of third party liability. We then perform multiple levels of legal investigation to identify potential recovery opportunities. In addition to mining medical claim data, this process can also include pharmacy claim data for additional recovery potential.
Experience has shown that making contact with an affected member in a punctual manner greatly improves the recovery success rate. Upon identification of a potential case, our system automatically generates a member inquiry questionnaire. To facilitate the timely flow of information, multiple response formats are provided and follow-up reminders are automatically generated when a member questionnaire is not returned by a pre-determined deadline.
Upon identification of third party liability or overpayment, a case file is opened and the active pursuit of recovery from the responsible third party begins. Liens are generated, contact is made with the tortfeasor’s attorneys and third party insurance carrier, and settlements are negotiated. In those instances where a favorable settlement cannot be reached on a potentially large recovery, litigation will be initiated. Throughout the life of a case, our robust case management platform offers a systematic approach to managing critical information, action items, contact information, deadlines and member communications and to monitoring case inventory and performance. Activity reports will be provided to the client on a regular basis which may be used for internal underwriting as well as financial and operational purposes. As payments are recovered, the funds are credited to the appropriate party and a closed case summary is generated.
At McAfee & Taft, we recognize that subrogation is a legal matter and offer our subrogation recovery services to ensure the most successful outcome possible.
To learn more about McAfee & Taft’s Subrogation and Strategic Recovery Services, please contact:
Bill Freudenrich
(918) 574-3013
bill.freudenrich@mcafeetaft.com
Richard Nix
(405) 552-2219
richard.nix@mcafeetaft.com