Medicare and Medicaid Liens on a Georgia Injury Settlement

By the FigureMyTax Editorial Team · How we calculate

The Georgia Department of Community Health is subrogated only to the reasonable value of the medical assistance paid for the injury and has a lien on what you recover from a third party. Medicare recovers under federal rules.

Subrogation

O.C.G.A. 49-4-148(a) says that when Medicaid pays for care for an injury for which another person is legally liable, the Department may seek reimbursement and is subrogated, but only to the extent of the reasonable value of the medical assistance paid and attributable to that injury. The commissioner may compromise, settle, release or expressly waive a claim, in whole or in part. Paying a hospital provider does not discharge a third party's duty to satisfy a hospital lien.

The lien

Section 49-4-149 gives the Department a lien for the charges for medical care on moneys accruing to the recipient as a result of the injury, due to a third party's liability. It is perfected and enforced by following the hospital lien procedures, except that the Department has one year from the date the last item of care was furnished to file its verified lien statement, filed with the clerk in the recipient's county of residence and in Fulton County. The statute says it does not affect the priority of any attorney's lien.

The made-whole statute does not apply

Georgia's statute limiting reimbursement by health insurers to cases where you are fully compensated does not apply to the Department's recovery under the Medicaid article (33-24-56.1(l)). In Arkansas Department of Health and Human Services v. Ahlborn (2006), the U.S. Supreme Court held that Medicaid may reach only the portion of a settlement that represents medical costs. How your settlement is allocated can therefore matter.

What we could not confirm

We did not find in these sections a formula that reduces the Department's claim for your attorney fees, or a notice deadline for you. Ask the Department for its itemized claim in writing and whether it will reduce it.

Medicare

Under the Medicare Secondary Payer statute, 42 U.S.C. 1395y(b)(2), the United States may bring an action to recover conditional payments and may collect double damages from responsible entities; 42 CFR 411.24 governs recovery. When Medicare's payments are less than the settlement, 42 CFR 411.37(c) reduces its recovery by its share of the procurement costs. On a $100,000 settlement with $36,333 of fees and costs, $15,000 of Medicare payments would shrink to about $9,550.

Next steps

See how provider liens work and how Georgia protects you from health insurer claims, then enter every claim in the Georgia medical lien calculator.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Georgia's rules apply to your specific case with a licensed Georgia attorney.