Medical Malpractice Recovery Program
Txog Peb
The Department of Health Care Services’ (DHCS) Medical Malpractice Recovery Program seeks reimbursement for services that Medi-Cal paid on behalf of its members who are involved in third party actions, such medical and dental malpractice, birth injuries, elder abuse and wrongful death. When a Medi-Cal member receives a settlement, judgment or award from a liable third party as compensation for injuries they incurred, the Medical Malpractice Recovery Program is required by federal and State law to recover funds for any related services paid by Medi-Cal.
Rau cov ntaub ntawv hais txog kev raug mob ntawm tus kheej, kev hais plaub hauv chav kawm, lossis cov nyiaj them rau cov neeg ua haujlwm, siv cov kev sib txuas hauv qab no mus rau chav kho kom rov zoo.
Lien txheej txheem
The Medi-Cal member or personal representative is required by law to report an action or claim in writing to DHCS pursuant to Welfare and Institutions (W&I) Code Section 14124.70 et seq. Notifications must be submitted to the
online case notification webpage or by mail within 30 days of filing an action or claim, and MUST include the following pursuant to W&I Code Section14124.73(c):
(1) The date of the Medi-Cal member’s injury,
(2) the Medi-Cal member’s Medi-Cal identification number,
(3) cov ntaub ntawv tiv tauj ntawm lub luag haujlwm thib peb lossis tus neeg tuav pov hwm,
(4) cov ntaub ntawv tiv tauj ntawm tus thawj tswj hwm kev thov suav nrog lawv tus lej thov, thiab
(5) cov ntaub ntawv tiv tauj ntawm ib tus kws lij choj tiv thaiv uas sawv cev rau tus neeg thib peb lub luag haujlwm lossis tus tuav pov hwm.
Thov cia 30 hnub rau DHCS xa ib tsab ntawv lees paub tias tau txais daim ntawv ceeb toom.
DHCS Lien Txheej txheem cej luam: Kev kho mob tsis zoo
-
Kev raug mob raug qhia rau DHCS
Per Welfare and Institutions Code 14124.73, the injured party is required to notify DHCS within 30 days of filing a claim or action. The notification must include the date of injury, Medi-Cal member's identification number, and the name and contact information for the liable third party. The notification should be reported via Online Forms.
-
DHCS checks to determine if the injured party is a Medi-Cal member
If the injured party is not a Medi-Cal member, DHCS will notify the submitting party.
-
If the injured party is a Medi-Cal member, a Medical Malpractice case is created
A DHCS representative will contact the attorney, insurance, or member to request documentation regarding the injury event. Per Welfare and Institutions Code 14124.71, DHCS has the right to assert a lien against any settlement, judgment, or award obtained from a liable third party.
-
Hnub Kawg Kev Kho Mob (FDOT) lossis Hnub Txiav Txim (SD) muaj?
FDOT thiab/lossis SD tso cai rau DHCS los txiav txim txog cov kev pabcuam uas muaj feem cuam tshuam rau tus neeg thib peb lub luag haujlwm. Yog tsis muaj FDOT lossis SD, DHCS tsis tuaj yeem ua tiav nws txoj kev lav phib xaub raws li Kev Noj Qab Haus Huv thiab Cov Tsev Kawm Ntawv Txoj Cai 14124.76. Yog tias muaj FDOT lossis SD, koj tuaj yeem ua tiav Daim Ntawv Thov Ua Ntej lossis zaum kawg (saib hauv qab kom paub meej ntxiv).
-
Ua ntej xaj cov ntaub ntawv them nqi DHCS yuav tso cai tsawg kawg 120 hnub kom dhau los ntawm FDOT lossis SD
Raws li Txoj Cai Kev Noj Qab Haus Huv thiab Tsev Kawm Ntawv Ntu 14115, cov kws kho mob muaj sijhawm txog li ib xyoos txij li hnub tau txais kev pabcuam los sau nqi Medi-Cal. Cov kws kho mob feem ntau them Medi-Cal li ntawm plaub lub hlis txij li hnub ua haujlwm. Los ntawm kev tos 120 hnub tom qab FDOT lossis SD, DHCS tso cai rau cov kws kho mob lub sijhawm tsim nyog los sau Medi-Cal.
-
DHCS xaj cov ntaub ntawv them nyiaj los ntawm Managed Care Plan (MCP)
Data may be ordered from multiple MCPs if the member is enrolled in multiple plans during the treatment period. DHCS does not store MCP payment data in-house and does not control the MCPs' response time. Typically a MCP will respond to DHCS' request for records within 120 days, but additional time may be needed. Records may need to be ordered from multiple Independent Physician Associations (IPAs).
-
Thaum cov ntaub ntawv them nyiaj tuaj txog, DHCS yuav tshuaj xyuas thiab tsim daim ntawv lav, yog tias muaj
Per Welfare and Institutions Code 14124.71, DHCS is authorized to recover the reasonable value of benefits provided on behalf of the member.
-
DHCS yuav xa ib tsab ntawv "lien" lossis "no lien" rau cov tog neeg uas tsim nyog
Per Welfare thiab Institutions Code 14124.75, DHCS khaws cov cai them rov qab rau tus nqi tsim nyog ntawm cov txiaj ntsig tau muab kom txog thaum tag nrho cov kev daws teeb meem cuam tshuam txog qhov kev thov thawj zaug lossis kev nqis tes ua tiav.
Thov Kev Pab Ua Ntej lossis Kawg Lien
Ib rooj plaub yuav tsum raug tsim los ntawm Lub Tsev Haujlwm ua ntej yuav xa daim ntawv thov nyiaj, thiab tag nrho cov kev thov qiv nyiaj ua ntej thiab zaum kawg yuav tsum xa hauv online. Txhawm rau thov qhov kev lees paub ua ntej lossis zaum kawg los ntawm Lub Tsev Kho Mob Tsis Txaus Siab ntawm qhov teeb meem tsim, nyem rau ntawm qhov txuas hauv qab no. Thaum ua tiav daim ntawv thov, koj yuav tsum muab cov ntaub ntawv tseem ceeb ntsig txog koj qhov kev thov thiab cov ntaub ntawv txhawb nqa raws li qhov xav tau.
Daim Ntawv Thov Kev Pab Ua Ntej lossis zaum kawg
Thov nco ntsoov: Lub Tsev Kho Mob Tsis Txaus Siab tsis lees txais qhov kev thov ua ntej lossis zaum kawg ntawm TMU@dhcs.ca.gov.
When the member has completed treatment or a settlement has occurred, DHCS will order and review the payment records to establish a “lien,” or list of injury related services subject to collection. Use the
Cov ntawv online to tell DHCS when treatment ends or a settlement has occurred or use the Preliminary or final lien Request Form to request a lien. DHCS has the right to recover up to the date of settlement or full resolution of all actions associated with the injury, pursuant to W&I Code Section 14127.785. Upon each settlement, the member or personal representative is required to notify DHCS so that an updated lien may be prepared pursuant to W&I Code Section 14124.76 and 14124.79. For more information on the lien process and timeframes, visit our
Cov lus nug nquag .
Yog tias cov nyiaj yuav muab tso rau hauv Special Needs Trust, thov mus rau lub vev xaib Special Needs Trust rau cov lus qhia ntxiv txog kev ceeb toom DHCS 'Special Needs Trust Unit.
