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Tevra Johnson, Director of Lien Resolution and Medicare Compliance shares tips, news, and facts about subrogation, reporting, compliance, and everything in between. For more information about Lien Settlement Solutions and our services, contact us at info@lienss.com, or by phone at (877)907-5436.
Question:Â
Do the VA subrogation rights apply to UM coverage, or do they only apply to the responsible third-party?
Answer:Â
The right of the VA to recovery from UM is not a definite yes or no answer.      Â
When the VA cannot recover:
In researching UM recovery in VA cases, we have to look to the language within the UM plan. According to Government Employees Insurance Co. v. Andujar, 773 F.Supp. 282, it was determined that the ability of the US Read the rest of this entry »
Question:Â
“I am the executor of estate on behalf of my mother who was a Medicare beneficiary. This is a wrongful death case, so does Medicare have a lien in this situation?“ – Florida Resident
Answer:
According to the Medicare Secondary Payer Manual (Chapter 50.5.4.1.1), Medicare’s right to recover against a wrongful death claim depends on two things, 1. The beneficiary’s state of residence, and if the state law allows for the recovery of medical expenses in a wrongful death claim, and 2. If the state’s law allows for recovery of medical claims, the amount Medicare is entitled to recover against may vary (full recovery in some states, limited recovery in others). So basically, depending on where the beneficiary lived, there may or may not be an obligation to Medicare. Some states do not allow for the recovery of medical payments, so in those states Medicare cannot assert a claim against the deceased beneficiary or survivors. Read the rest of this entry »
QUESTION:Â 
Will the new Health Care Reform Law have any affect on ERISA plans and subrogation in the future? – FL AttorneyÂ
ANSWER:
Right now there are many unknown variables regarding ERISA plans and the new Patient Protection and Affordable Care Act of 2010 that was signed into law on March 23, 2010. What we do know is that health insurance practices, including Subrogation and Recovery will experience changes over the next few years.Â
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans (US Department of Labor, www.dol.gov). Employer provided health plans are governed by ERISA, which also loosely defines their right of recovery, allowing for “appropriate equitable relief” (29 USC 1132(a)(3)). Plans that are Read the rest of this entry »
I have a case that has a private insurance lien. I sent in a notice to the insurer, but got a response from another company. What do I do with this? - Orlando AttorneyÂ
Answer:Â
 When resolving a possible lien with a private insurer, it is important to know who the involved parties are, and their role in the resolution of a case. You have received a response from a “Recovery Contractor” which is a separate company hired by the insurer to address all subrogation and recovery issues on their behalf.  Recovery contractors have the authority to initiate collection activity against the insured, to provide information about the claims included in the lien, and act as the liaison between the lien holder and the insured in matters of lien negotiation. In order to get the best results from a recovery contractor, there are three things you should know. Â
Question:
I have a case where the hospital has a claim that needs to be submitted to Medicaid for payment. However, since the hospital knows that there is a liable third party, they are refusing to submit the claim to Medicaid. How can I force the hospital billing office to submit the claim for payment? – FL Attorney
Answer:
In this instance, the provider has the right to go either way, so there is no real avenue to “force” a provider to bill Medicaid for services. Under Medicaid’s provider agreement, the hospital has the right to bill all other insurers first, with Medicaid being the final payer.   On the other hand, Medicaid has the right to subrogate for payments made when a third party is responsible.Â
Medicaid as Final Payer – Why the Provider can bill liable insurer:Â
 FL Statute 409.907(3)(f) – Medicaid Provider Agreement
 (3)  The provider agreement developed by the agency, in addition to the requirements specified in subsections (1) and (2), shall require the provider to: Read the rest of this entry »
 
Dear Lien Settlement Solutions;Â Â
I’ve got a settlement and an 18 y/o client whose mother works for the federal government. All the medical bills appear to have been paid by the mother’s private insurance company, but I suppose that they may be the administrator. This is an Anti Subrogation state, but we assume that FEHBA plans are preempted. We have received no notice from the FEHBA or Private Insurer plans about any sort of subrogation interest. Have you been down this road before?Â
- Confused in the Carolinas
In reviewing FEHBA subrogation, it generally preempts state law and is not beholden to ERISA law in which North Carolina is an Anti Subrogation state for some insured plans.  I’ve been looking for any type of loophole where NC’s anti subrogation can be can be argued for a FEHB plan, but everything I’ve found is to the contrary. The strength of the right of recovery in a FEHBA plan lies in the specific description within the plan.Â
 I looked through a few plans to get an idea on how NC FEHBA plans are written. Specifically, I reviewed the BCBS of NC FEHBA Standard and Basic Operation plan for 2009 to get an idea of what the plan language may look like in this situation. According to the 2009 plan, it is the responsibility of the beneficiary to notify BCBS of any claim made against another party for compensation of an illness or injury where BCBS has made payment. According to their plan language, they are entitled to full recovery, and not subject to reduction for procurement. However it does express a willingness to grant a reduction at their discretion.  It was not specified if the incident occurred in 2009, you would need to review the plan document for that year of enrollment. Hope this helps!
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