Flagship Services Group is pleased to announce that Rafael Gonzalez, Esq. has joined our Medicare Compliance Service Company as President and Chief Legal Counsel. With over 30 years of experience and expertise in workers’ compensation, liability insurance and Medicare and Medicaid compliance, Rafael has become the industry’s leading expert on Section 111 reporting, Conditional Payment Lien resolution, Medicare Set-Aside Allocations, Social Security and Special Needs Trust Administration.
Having practiced law in the areas of first and third party liability, work comp, social security, Medicare, and Medicaid for many years, and then serving 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, and most recently as Vice President of Strategic Solutions at PMSI/Helios/Optum, Rafael is well prepared to direct the Medicare/Medicaid compliance services offered at Flagship.
Commenting on his new positons Rafael said “From technical and legal issues involving Mandatory Insurer Reporting obligations, including appropriate reporting of ORM, ICD codes, and TPOC, to procedural and legal issues involving Conditional Payment Resolution, including the BCRC and CRC conditional payment process, MAP and PDP private cause of action, and beneficiary/estate/medical provider private cause of action, to administrative and legal issues involving Medicare Set Asides, including putting together an allocation, submitting same to CMS for approval, and administering such MSA funds, I am ready to assist our liability, work comp, commercial, auto, and no-fault clients with all components of Medicare compliance.”
Rafael offers valuable legal and claim solutions to each Flagship client including but not limited to:
- 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
Brian Cox, CEO of Flagship Services Group said “In this leadership role Rafael will be responsible for proving 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. Additionally, he will oversee the strategic direction and planning for Flagship in areas such as Medicare, Medicaid and Special Needs Trust Administration. Rafael will continue to be actively involved in providing expert opinion and advice on legislative matters throughout the industry.”
Cox went on to say “At a time of significant change within the Medicare/Medicaid, Workers’ Compensations and Liability Insurance industries, it is a privilege to have the experience and expertise of one of the industries true leaders providing insights, strategy and direction to Flagship Services Group and our clients. Rafael’s vision and direction is complemented by the many professionals at Flagship who deliver outstanding support to clients”.
With a keen understanding of trends and issues surrounding Medicare, Medicaid and Social Security, Rafael is frequently found lecturing 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. His expertise can also be found in the numerous publications authored.
As a result of his expertise, Rafael is frequently called upon to provide guidance and leadership in the legislative process on both the national and state levels. He has offered expert testimony to legislative committees and hearings as well as testifying before executive commissions. Additionally, he has drafted, amended, reviewed and provided opinions on proposed federal and state legislation. As a consultant to congressional staff, Rafael is regularly called upon to provide his insights on proposed legislation.