Medical Malpractice Recovery Program
About Us
The Department of Health Care Services’ (DHCS) Medical Malpractice Recovery Program seeks reimbursement for services that Medi-Cal paid on behalf of its beneficiaries who are involved in third party actions, such medical and dental malpractice, birth injuries, elder abuse and wrongful death. When a Medi-Cal beneficiary 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.
For claims involving personal injury, class action litigation, or workers’ compensation, use the links below to the appropriate recovery unit.
Lien Process
The Medi-Cal beneficiary 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
online 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 beneficiary’s injury,
(2) the Medi-Cal beneficiary’s Medi-Cal identification number,
(3) the contact information of the liable third party or insurer,
(4) the contact information of the claims administrator including their claim number, and
(5) the contact information of any defense counsel representing the liable third party or insurer.
Please allow 30 days for DHCS to send a letter confirming receipt of the notification.
DHCS Lien Overview: Medical Malpractice
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Injury is reported to 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 beneficiary's identification number, and the name and contact information for the liable third party. The notification should be reported via Online Forms or emailed to TMU@dhcs.ca.gov.
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DHCS checks to determine if the injured party is a Medi-Cal beneficiary
If the injured party is not a Medi-Cal beneficiary, DHCS will notify the submitting party.
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If the injured party is a Medi-Cal beneficiary, a Medical Malpractice case is created
A DHCS representative will contact the attorney, insurance, or beneficiary 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.
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Final Date of Treatment (FDOT) or Settlement Date (SD) available?
A FDOT and/or SD allows DHCS to determine the services attributable to the liable third party. Without a FDOT or SD, DHCS is unable perfect its lien under Welfare and Institutions Code 14124.76.
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Prior to ordering payment data DHCS will allow at least 120 days to pass from the FDOT or SD
Per Welfare and Institutions Code section 14115, providers have up to one year from the date of service to bill Medi-Cal. Providers typically bill Medi-Cal within four months of the date of service. By waiting 120 days after the FDOT or SD, DHCS is allowing providers a reasonable time to bill Medi-Cal.
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DHCS orders payment data from the Managed Care Plan (MCP)
Data may be ordered from multiple MCPs if the beneficiary 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).
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Once payment data arrives, DHCS will review and create a lien, if applicable
Per Welfare and Institutions Code 14124.71, DHCS is authorized to recover the reasonable value of benefits provided on behalf of the beneficiary.
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DHCS will send a "lien" or "no lien" letter to the appropriate parties
Per Welfare and Institutions Code 14124.75, DHCS retains reimbursement rights for the reasonable value of benefits provided until all settlements related to the original claim or action have been reached.
When the beneficiary 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
Online Forms to tell DHCS when treatment ends or a settlement has occurred. 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 beneficiary 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
Frequently Asked Questions.
If funds will be placed into a Special Needs Trust, please go to the Special Needs Trust webpage for further instructions on notifying DHCS’ Special Needs Trust Unit.
Paying a Lien
In order to apply a payment to the correct account, the DHCS account number must be included with each payment submission. For your convenience, the following payment options are available:
1. Payment via Electronic Funds Transfer (EFT) – To get started go to the
EFT website. Two unique EFT options are available to suit your needs:
One-Time Payment – Ideal for Medi-Cal beneficiary and entities with few claims
Enrolled User Payment – Ideal for entities that
manage numerous cases and make multiple payments. This option allows the user
to schedule future payments and track payment history. To become an enrolled
user, complete the following:
Step 1: Submit a New enrollment request. Allow five (5) business days for DHCS to confirm the information and create your Enrolled User account
Step 2: Register as an Enrolled User. Follow the instructions provided by DHCS upon receiving your confirmation of enrollment.
For further clarification on submitting an EFT payment, review the EFT Info Guide.
2. Payment via check – Submit to:
Department of Health Care Services
Third Party Liability and Recovery Division
Medical Malpractice Unit - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Please reference the DHCS account number on the check and allow 15 to 30 business days for DHCS to receive and apply the payment.
If an insurance company issues a single check with both you and DHCS listed, please review instructions under item #25 in the
Frequently Asked Questions.
Contact Information
- Email Address:
TMU@dhcs.ca.gov
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Online Forms – notify and update DHCS electronically!
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TPLRD - Online Inquiries
- Phone Support Unit - (916) 445-9891
- Hours of operation: Monday through Friday - 8:00 a.m. to 5:00 p.m., closed from 12:00 p.m. to 1:00 p.m.
- Closed on weekends and State Holidays
- Mailing Address for written correspondence:
Department of Health Care Services
Third Party Liability and Recovery Division
Medical Malpractice Unit - MS 4720
P.O. Box 997425
Sacramento, CA 95899-7425
