Rafael Gonzalez, Esq. serves as Flagship’s President & Chief Legal Counsel. He oversees the strategic direction and planning for Flagship in areas such as Medicare, Medicaid and Special Needs Trust Administration, delivering valuable legal and claim solutions to each Flagship client. He is responsible for legal consultation to clients and prospective clients of Flagship Services Group with a focus on mitigating risk, protecting financial resources and 100% compliance with Medicare regulations, including:
- Consultative direction in resolving legal issues on complex claims
- Expert guidance on CMS, case law, legislative issues, and updates/changes to Medicare regulations
- Direct access and consultation for in-house Legal and Claims departments
As Chief Legal Counsel, Rafael directs the company’s Medicare/Medicaid compliance services providing liability, worker’s comp, commercial, auto, and no-fault clients with resolution of:
- Technical and legal issues involving Mandatory Insurer Reporting obligations (i.e. appropriate reporting of ORM, ICD codes, and TPOC).
- Procedural and legal issues involving Conditional Payment Resolution (i.e. the BCRC and CRC conditional payment process, MAP and PDP private cause of action, and beneficiary/estate/medical provider private cause of action).
- Administrative and legal issues involving Medicare Set Asides (i.e. putting together an allocation, submitting same to CMS for approval, and administering such MSA funds)
Rafael has over 30 years of experience and expertise in workers’ compensation, liability insurance and Medicare and Medicaid compliance. He has served as CEO of the Center for Lien Resolution, the Center for Medicare Set Aside Administration, and the Center for Special Needs Trust Administration, as well as Vice President of Medicare and Medicaid Compliance at Gould & Lamb. Prior to joining Flagship, Rafael served as Vice President of Strategic Solutions at PMSI/Helios/Optum.
With a keen understanding of trends and issues surrounding Medicare, Medicaid and Social Security, Rafael frequently lectures to industry groups, senior executives and industry leaders offering insights and direction on topics ranging from Medicare Secondary Payer Act, Social Security disability, Medicare Settlements, Workers’ Compensation and Mandatory Insurer Reporting obligations. He has also authored numerous respected publications on these subjects.
Rafael’s vision and direction is complemented by the many professionals at Flagship who deliver outstanding support to clients by ensuring they mitigate risk, protect financial resources, and secure 100% Medicare compliance.
Learn more about Medicare Law from Rafael and Flagship.
- Florida Federal District Court Concludes Medical Providers Are Not Subject to Double Damages Under MSP Act Private Cause of Action (3/15/2018) - Rafael Gonzalez, Esq. President, Flagship Services Group On March 2, 2018, the United States District Court for the Middle District of Florida, Orlando Division, published its opinion on MSPA Claims 1, LLC v. Halifax Health, Inc., in which the court found that a private right of action under the Medicare Secondary Payer Act, 42 U.S.C. […]
- New Work Comp MSA Review Contractor Starts 3/19/18; No Expected Changes and No News on Liability MSAs (3/14/2018) - Rafael Gonzalez, Esq. President, Flagship Services Group It has been a long time coming, two years to be exact. After the Centers for Medicare and Medicaid Services (CMS) announced their anticipated release of a solicitation for the Workers’ Compensation Review Contractor (WCRC) in 2016 and 2017 and further announced it was continuing to consider expanding […]