Jina Garcia found herself entangled in a legal battle with Centura Health Corp. after receiving medical treatment and subsequently facing a lien on any potential settlement or judgment in In Re Garcia v. Centura Health Corp....more
Since 2020, healthcare providers have struggled to reconcile Idaho’s medical lien law with the Idaho Patient Act (IPACT). The lien statute allows healthcare providers who render treatment to a person injured by the acts of a...more
On June 6, 2022, the U.S. Supreme Court in Gallardo By & Through Vassallo v. Marstiller, No. 20-1263, 2022 WL 1914096 (U.S. June 6, 2022), held that the Medicaid Act allows states to seek reimbursement from settlement...more
On August 11, 2021, the California Court of Appeals for the Second District extended the Pebley v. Santa Clara Organics (“Pebley”) Court’s analysis as applied to the admissibility of unpaid medical liens. Based on the Court’s...more
The first two parts of this series on mass tort tips discussed the best practices for intake and how to develop an inventory of mass tort cases. Now that all that hard work has paid off, and it’s time for settlement. In any...more
In order to reach a fair and equitable settlement when mediating catastrophic injury medical malpractice cases, it is essential for the respective parties to provide the mediator with detailed medical chronologies (timelines)...more
Medicaid is expected to cover auto accident injuries in Michigan under the new No-Fault law. The reason: once a car accident victim’s medical bills reach his or her No-Fault PIP medical benefits coverage limit and No-Fault...more
The Holding - In Dignity Health v. Farmers Ins. Co. of Ariz., 1 CA-CV-18-0292, 2019 WL1499855 (Ariz. App. June 11, 2019), the Arizona Court of Appeals recently held MedPay benefits are subject to health care provider liens...more
MLTSS Medicaid pays for long term care for individuals with low income (below $2,313 gross monthly in 2019) and low assets. Post-mortem (after death) Medicaid liens protect the fiscal integrity of the MLTSS Medicaid...more
Assume that you are involved as a plaintiff or a defendant (carrier) in a serious injury case and that the injured party has collected workers’ compensation so the issue of a lien payback will be part of any settlement. Also...more
Currently pending before the Tennessee Supreme Court is a case that could change the face of personal-injury litigation in the state. Accepted for review on October 24, 2016, Dedmon v. Steelman asks whether the amount billed...more
In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more
Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more
On August 8, the Eleventh Circuit Court of Appeals decided an issue of first impression in the circuit under the Medicare Secondary Payer (MSP) Act. In sum, the Eleventh Circuit held that a Medicare Advantage Organization...more
On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more
Editor’s Overview - This month we review the U.S. Supreme Court’s decision in Montanile v. Board of Trustees of National Elevator Industries Health Benefit Plan where the Supreme Court considered the scope of...more
In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, the US Supreme Court held that when an ERISA plan participant completely dissipates a settlement from a third party on items that are...more
Most self-funded ERISA medical plans provide that participants who have been injured by other people (think car accidents) must reimburse the plan if the participant recovers from the other person for those injuries. In order...more
On January 20, the Supreme Court released its decision in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, concluding that although health plan fiduciaries can generally seek subrogation...more
Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan is the fourth decision by the U.S. Supreme Court addressing the subrogation rights of self-insured ERISA-covered health plans. Three...more
Group health plan administrators should take actions to address the recent U.S. Supreme Court decision holding that an ERISA plan cannot enforce its equitable lien, which had been established through the plan’s reimbursement...more
A new U.S. Supreme Court decision is a reminder that Employee Retirement Income Security Act (ERISA) plans must act promptly if they want to assert a lien to secure a participant’s obligation to reimburse medical expenses or...more
The Supreme Court of the United States recently handed down a decision that opens the door for participants in ERISA-covered benefits plans to stop a lawsuit against them in its tracks by doing something that most people love...more
It’s like a simple set of facts on a law school exam with an answer that defies logic. And, yet, Supreme Court precedent has brought us to this illogical conclusion. Facts: Participant agrees to reimburse the plan money it...more
It’s a common scenario when dealing with a benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA): an employee participating in the plan is injured by a third-party, the plan pays covered medical...more