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Medicaid Reimbursement – What is Your Obligation?

Unlike Medicare reimbursement, the Medicaid programs are only entitled to reimbursement from settlement funds apportioned as medical costs.  The Supreme Court of the United States held in the 2006 case Arkansas Department of Health and Human Services, et al., v. Ahlborn that the federal Medicaid statute does not allow states to place liens on any funds not marked for medical reimbursement costs.  Ahlborn is not news – but it remains as important today as the day it came down.

The federal Medicaid statute, 42 U.S.C. § 1396 et. seq., essentially forces states to subrogate personal injury claims where the state Medicaid agency has paid claims on the plaintiff-beneficiary’s behalf.  As with any “mandatory” provision, the statute includes qualifications and loopholes.  For the most part, the state Medicaid programs will make determinations to pursue subrogation on a case by case basis, without your input.  These programs may waive a lien if it is relatively small.  But a plaintiff’s attorney remains obligated to report any liability case to the state Medicaid programs.

In addition to previous laws, President Obama signed the Patient Protection and Affordable Care Act (“PPACA”) on March 23, 2010.  Not too much has changed (yet) for lien resolution purposes; however, non-reporting penalties for both Medicare and Medicaid have been strengthened.  The failure to timely report and return any Medicare and Medicaid overpayment can have severe consequences.  This includes potential liability under the False Claims Act, civil monetary penalties, and exclusion from the Medicare and Medicaid programs.  See, PPACA §§6402(d)(2), and 6502.

Protect your clients’ interests.  Report existence of lawsuits to Medicare and to your state Medicaid programs.  Lastly, never forget that these programs are not entitled to monies from the entire lawsuit.

If you have additional questions or would like assistance with lien resolution, please contact us.

Ryan J. Weiner
Co-Founder Lien Resolution Services

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

One comment on “Medicaid Reimbursement – What is Your Obligation?

  1. Medical credentialing service…

    […]Medicaid Reimbursement – What is Your Obligation? « Lien Resolution Services – Healthcare Lien Resolution Blog[…]…

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