| Law Firm Name |
|
| Law Firm Mail Address |
|
| Law Firm Office Number |
|
| Law Firm Fax Number |
|
| Law Firm Website |
|
| Law Firm Size By Lawyers |
|
| Areas of Practice |
|
| Eligible to Pratice Law |
|
| Number of lawyers committed to working MSP cases |
|
| Number of paralegals committed to working MSP case |
|
| Number of Cases Your Firm Would Like to Handle |
|
| |
Potential Conflicts (we will work with our ethics counsel to ensure there are no legal or ethical issues/potential conflicts): |
| |
1. Please list entities that your firm represents that could be potential defendants. This includes property and casualty insurers, pharmaceutical companies, pharmacy benefits managers, medical device manufacturers or others: |
| Entity_1 |
|
| |
2. Please list cases wherein you represent individuals in cases you would like to file a case representing an MSP entity: |
| Case_1 |
|
| |
Description of MSP Cases (including but not limited to the following):
MSP determines the primary insurance coverage and/or other responsible parties for secured and unsecured claims. A secured claim is one in which payment is required pursuant to an insurance agreement whereby either the terms of the policy and/or by statutory requirement, the insurer is required to pay for medical services before any other available sources of payment. An unsecured claim is one whereby there is either no contractual obligation to be a primary payer or where the primary payer has paid the limits of its contractual obligation. |
| |
Antitrust Cases
MSP antitrust cases derive from one of two scenarios. The first scenario involves manufactures of similar products who collectively decide to raise product prices irrespective of market fluctuations. The second involves “pay for delay” agreements, where brand-name drug manufactures pay generic drug manufactures not to launch a version of a competing drug for a set period.
|
| |
Contractual Reimbursement Cases
When Medicare, as a secondary payer, makes a payment on behalf of a Medicare beneficiary for injuries related to the use, maintenance, or operation of a vehicle, that payment may be recovered from the No-Fault Insurer, as a primary payer. No-Fault coverage does not require an assessment of liability, and thus, when covered medical expense is incurred, the insurer must accept primary payer responsibility. The No-Fault insurer’s failure to pay or reimburse Medicare and/or a Medicare Part C plan constitutes a breach of the Medicare beneficiary’s No-Fault coverage.
|
| |
False Claims Act
MSP uses the underlying predicate acts arising from a FCA settlement or judgment to establish liability, and recover expenditures for products and/or services rendered by its clients to pursue a Civil RICO cause of action.
|
| |
Settlement Reimbursement Cases
The MSP Act allows Medicare beneficiaries, providers, and MAOs to seek reimbursement from any entity or person that has settled a dispute and failed to pay or reimburse Medicare and/or Medicare Part C plan for an enrollee’s medical expenses related to a dispute.
|
| |
Product Liability Cases
Product liability cases generally arise from instances in which an implantable medical device causes an adverse reaction due to a design or manufacturing defect. MSP brings claims against product manufacturers on behalf of its clients for medical expenses due to a defective product.
|
| |
Pharmaceutical Cases
Lawsuits against pharmaceutical companies typically concern claims that a drug was defectively manufactured or caused dangerous side effects resulting in serious injury or illness, such as cancer. Other claims arise from deceptive trade practices, such as misleading consumers.
|
| Type of MSP case interested in pursuing |
|
| What type of case management softw system does use |
|
| Is your case management softw system HIPAA comp |
|
| Identify any other IT and/or software systems used |
|
| IP Address_1 |
|
| |
Designate a contact person for each category:
LAW
|
| First Name – Law |
|
| Last Name – Law |
|
| Email – Law |
|
| Office Phone Number – Law |
|
| Office Fax Number – Law |
|
| |
LEGAL ASSITANCE
|
| First Name – Legal Assistance |
|
| Last Name – Legal Assistance |
|
| Email – Legal Assistance |
|
| Office Phone Number – Legal Assistance |
|
| Office Fax Number – Legal Assistance |
|
| |
IT
|
| First Name – IT |
|
| Last Name – IT |
|
| Email – IT |
|
| Office Phone Number – IT |
|
| Office Fax Number – IT |
|
| |
Next Steps:
ShareFile Access: List names of all firm attorneys/staff authorized to have access to the MSP Recovery Law Firm Secure Share File (SFTP) and receive internal MSP news and updates
|
| First Name_ShareFile_1 |
|
| Last Name_ShareFile_1 |
|
| Email_ShareFile_1 |
|
| Phone_ShareFile_1 |
|
| First Name_ShareFile_2 |
|
| Last Name_ShareFile_2 |
|
| Email_ShareFile_2 |
|
| Phone_ShareFile_2 |
|
| First Name_ShareFile_3 |
|
| Last Name_ShareFile_3 |
|
| Email_ShareFile_3 |
|
| Phone_ShareFile_3 |
|
| First Name_ShareFile_4 |
|
| Last Name_ShareFile_4 |
|
| Email_ShareFile_4 |
|
| Phone_ShareFile_4 |
|
| First Name_ShareFile_5 |
|
| Last Name_ShareFile_5 |
|
| Email_ShareFile_5 |
|
| Phone_ShareFile_5 |
|
| First Name_ShareFile_6 |
|
| Last Name_ShareFile_6 |
|
| Email_ShareFile_6 |
|
| Phone_ShareFile_6 |
|
| First Name_ShareFile_7 |
|
| Last Name_ShareFile_7 |
|
| Email_ShareFile_7 |
|
| Phone_ShareFile_7 |
|
| First Name_ShareFile_8 |
|
| Last Name_ShareFile_8 |
|
| Email_ShareFile_8 |
|
| Phone_ShareFile_8 |
|
| First Name_ShareFile_9 |
|
| Last Name_ShareFile_9 |
|
| Email_ShareFile_9 |
|
| Phone_ShareFile_9 |
|
| |
Firm Representative: List name of contact person designated to be the liaison between your firm and MSP Recovery Law Firm. |
| First Name_FirmRepresentative_1 |
|
| Last Name_FirmRepresentative_1 |
|
| Email__FirmRepresentative_1 |
|
| Phone__FirmRepresentative_1 |
|
| First Name_FirmRepresentative_2 |
|
| Last Name_FirmRepresentative_2 |
|
| Email__FirmRepresentative_2 |
|
| Phone__FirmRepresentative_2 |
|
| First Name_FirmRepresentative_3 |
|
| Last Name_FirmRepresentative_3 |
|
| Email__FirmRepresentative_3 |
|
| Phone__FirmRepresentative_3 |
|
| First Name_FirmRepresentative_4 |
|
| Last Name_FirmRepresentative_4 |
|
| Email__FirmRepresentative_4 |
|
| Phone__FirmRepresentative_4 |
|
| First Name_FirmRepresentative_5 |
|
| Last Name_FirmRepresentative_5 |
|
| Email__FirmRepresentative_5 |
|
| Phone__FirmRepresentative_5 |
|
| First Name_FirmRepresentative_6 |
|
| Last Name_FirmRepresentative_6 |
|
| Email_FirmRepresentative_6 |
|
| Phone_FirmRepresentative_6 |
|
| First Name_FirmRepresentative_7 |
|
| Last Name_FirmRepresentative_7 |
|
| Email_FirmRepresentative_7 |
|
| Phone_FirmRepresentative_7 |
|
| |
MSP Forum Co-Counsel Committee Member(s): List name of firm representative/partner who has decision-making power to represent your firm’s interest in MSP Co-Counsel Committee group discussions, strategy sessions, and implementation meetings. |
| First Name_Members_1 |
|
| Last Name_Members_1 |
|
| Email_Members_1 |
|
| Phone_Members_1 |
|
| First Name_Members_2 |
|
| Last Name_Members_2 |
|
| Email_Members_2 |
|
| Phone_Members_2 |
|
| First Name_Members_3 |
|
| Last Name_Members_3 |
|
| Email_Members_3 |
|
| Phone_Members_3 |
|
| First Name_Members_4 |
|
| Last Name_Members_4 |
|
| Email_Members_4 |
|
| Phone_Members_4 |
|
| First Name_Members_5 |
|
| Last Name_Members_5 |
|
| Email_Members_5 |
|
| Phone_Members_5 |
|
| First Name_Members_6 |
|
| Last Name_Members_6 |
|
| Email_Members_6 |
|
| Phone_Members_6 |
|
| First Name_Members_7 |
|
| Last Name_Members_7 |
|
| Email_Members_7 |
|
| Phone_Members_7 |
|
