The attorney for the Louisiana State Troopers Association is being sued for allegedly ignoring a “legal and ethical obligation” in a Medicare reimbursement case.
Humana Health Benefit Plan of Louisiana is suing attorney Floyd Falcon Jr. and his law firm, Avant and Falcon, in Baton Rouge federal court, seeking “at least $26,776”—plus pre- and post-judgment interest, legal fees and court costs.
Humana, which administers federal Medicare benefits for Medicare Advantage, alleges Falcon and the firm “failed or refused to ensure” that a $24,000 settlement a client received after an accident was used to reimburse Medicare costs stemming from the collision.
“This suit and others like it challenge these and similar practices that drain money from the Medicare Trust Funds and increase the costs borne by elderly and disabled beneficiaries who enroll in Medicare Advantage plans,” Humana attorney James Busenlener writes in the complaint filed last week.
Messages left Wednesday with Avant and Falcon were not returned.
At the center of the lawsuit is the Medicare Secondary Payer Law, which Congress enacted in 1980 to stem skyrocketing costs. Humana notes in its filing that numerous courts have interpreted that law such that an attorney who receives a tort settlement or other primary payment on behalf of a Medicare beneficiary may be sued personally to recover payments. An enforcement provision doubles the damages.
The client, who is not named in Humana’s lawsuit, was a passenger in a serious car accident in December 2013, according to the filing. At the time, the victim had Medicare Part C coverage through Humana, which paid more than $182,000 for medical services—including $13,388 in Medicare benefits. Humana later discovered the victim’s settlement and placed a lien, which thus far has not been honored by Avant and Falcon, according to the lawsuit.
Falcon is a high-profile Baton Rouge attorney who most recently has represented the Louisiana State Troopers Association through a 2015 scandal involving political campaign contributions that prompted a federal grand jury investigation in March. He also represents one of the Louisiana state troopers involved in an unauthorized trip to Las Vegas and the Grand Canyon last year en route to a law enforcement conference in California, for which taxpayers were billed for expenses and overtime.
—Penny Font
