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.
- Bilirakis and Kind Introduce PAID Act, Requiring CMS Provide Identity of Advantage, Prescription, and Medicaid Plans (6/4/2018) - Rafael Gonzalez, Esq., President, Flagship Services Group On May 18, 2018, Congressman Gus Bilirakis (R-FL) and Congressman Ron Kind (D-WI) introduced HR 5881, amending the Medicare Secondary Payer (MSP) statute and clarifying its application to Medicare Part C Advantage Plans (MAP), Medicare Part D Prescription Drug Plans (PDP), and Medicaid. The Provide Accurate Information […]
- Louisiana Appellate Court Rules CMS Approval of MSA Was a Suspensive Condition that Suspended Obligation to Fund the MSA Until CMS Approval (5/21/2018) - Rafael Gonzalez, Esq. President, Flagship Services Group On May 2, 2018, the Third Circuit Court of Appeal of Louisiana published its opinion on Mary Ortega v. Cantu Services, Inc., concluding that the settlement of the workers compensation claim at hand was conditioned on CMS approval of a Medicare Set-Aside. Because the settlement agreement did not […]