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 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.
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 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) 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 member's identification number, and the name and contact information for the liable third party. The notification should be reported via Online Forms.
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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.
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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.
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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. If a FDOT or SD is available, you may complete the Preliminary or final lien Request Form (see below for more details).
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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 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).
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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 member.
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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.
Requesting a Preliminary or Final Lien
A case must be established with the Department before a lien request can be submitted, and all preliminary and final lien requests must be submitted online. To request a preliminary or final lien from the Medical Malpractice Unit on an established case, click on the link below. When completing the request form, you will be required to provide relevant information related to your request and supporting documentation as required.
Preliminary or final lien Request Form
Please note: The Medical Malpractice Unit no longer accepts preliminary or final lien requests via 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
Online Forms 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
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.
