§446. Recovery of medical assistance payments; notice; pleadings; compromise;
prescription; privilege for reimbursement of Medicaid payments
A. As used in this Section, the following terms have the meaning ascribed in this
Subsection:
(1)"Department" means the Louisiana Department of Health.
(2)"Medicaid" means the medical assistance program provided for in Title XIX of
the Social Security Act.
(3)"Medicaid managed care organization" means any private entity that contracts
with the department to provide Medicaid benefits and services to enrollees of the Medicaid
program.
B. When an injury has been sustained or an illness or death incurred by any person
under circumstances creating in some third person or legal entity a legal liability or
obligation to pay damages or compensation to that
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§446. Recovery of medical assistance payments; notice; pleadings; compromise;
prescription; privilege for reimbursement of Medicaid payments
A. As used in this Section, the following terms have the meaning ascribed in this
Subsection:
(1) "Department" means the Louisiana Department of Health.
(2) "Medicaid" means the medical assistance program provided for in Title XIX of
the Social Security Act.
(3) "Medicaid managed care organization" means any private entity that contracts
with the department to provide Medicaid benefits and services to enrollees of the Medicaid
program.
B. When an injury has been sustained or an illness or death incurred by any person
under circumstances creating in some third person or legal entity a legal liability or
obligation to pay damages or compensation to that person or to his spouse, representative,
or dependent, the department shall have a cause of action against such third party to recover
the medical assistance payments the department has paid or is obligated to pay on behalf of
the injured, ill, or deceased person in connection with the injury, illness, or death. The
department, a Medicaid managed care organization, or both, may intervene in a suit filed by
or on behalf of the injured, ill, or deceased person or his spouse, representative, or dependent
against such third party to recover the medical assistance payments the department, Medicaid
managed care organization, or each, has paid or is obligated to pay on behalf of the injured,
ill, or deceased person in connection with said injury, illness, or death.
C. Any person or his spouse, representative, or dependent who files suit for the
recovery of damages or compensation as the result of an injury, illness, or death for which
medical assistance payments in whole or in part have been paid by the department, a
Medicaid managed care organization, or both, for which the department, Medicaid managed
care organization, or each, has an obligation to pay therefor, shall at the time suit is filed
cause a copy of the petition to be served on the department, Medicaid managed care
organization, or both, in the manner prescribed by Article 1313 of the Louisiana Code of
Civil Procedure. Such person filing suit shall be responsible to the department, Medicaid
managed care organization, or both, to the extent of the medical assistance payments
received, interest, and attorney fees if he fails to have service made upon the department,
Medicaid managed care organization, or both. Such person shall also be responsible to the
department, Medicaid managed care organization, or both, if he compromises his claim
without giving the department, Medicaid managed care organization, or both, written notice
at least thirty days before the compromise is affected. This written notice shall include the
name and date of birth of all injured or ill recipients and the name and address of the party
or parties potentially liable for damages or compensation.
D. Pleadings filed on behalf of the department or Medicaid managed care
organization shall be accompanied by an itemized statement of its monetary claim, and when
accompanied by an affidavit to the correctness thereof to the best of the affiant's knowledge
and belief, such itemized statement shall be accepted as prima facie proof of the amount,
purpose, and necessity of such payments.
E. No compromise of any claim referred to in Subsections B and C of this Section
shall be binding upon or affect the rights of the department or a Medicaid managed care
organization against a third party if the department or Medicaid managed care organization
has notified such third party in writing of the amount of its claim prior to the date the
compromise settlement is made. The notice provided for herein may be directed to either the
third party or his agent.
F. An intervention filed by the department or a Medicaid managed care organization
as provided by Subsection B of this Section is not barred by prescription if it was not barred
at the time the main demand was filed, provided such intervention is filed within ninety days
of the date of service of the main demand upon the department.
G. The department and a Medicaid managed care organization shall have a privilege
for the medical assistance payments made by the department or Medicaid managed care
organization on behalf of an injured or ill Medicaid recipient on the amount payable to the
injured recipient, his heirs, or legal representatives out of the total amount of any recovery
or sum had, collected, or to be collected, whether by judgment, settlement, or compromise,
from another person on account of such injuries, and on the amount payable by any insurance
company under any contract providing for indemnity or compensation to the injured person.
The privilege of an attorney shall have precedence over the privilege created under this
Section.
H. The privilege created in Subsection G of this Section shall become effective if,
prior to the payment of insurance proceeds, or to the payment of any judgment, settlement,
or compromise on account of injuries, a written notice containing the name and address of
the injured person, and if known, the name of the person alleged to be liable to the injured
person on account of the injuries received, is mailed by the department, a Medicaid managed
care organization, or an attorney or agent of either, by certified mail, return receipt requested,
to the injured person, to his attorney, to the person alleged to be liable to the injured person
on account of the injuries sustained, to any insurance carrier which has insured such person
against liability, and to any insurance company obligated by contract to pay indemnity or
compensation to the injured person. This privilege shall be effective against the persons
given notice according to the provisions hereof, and shall not be defeated nor rendered
ineffective as against the persons who have been given such notice, because of failure to give
such notice to other persons named herein.
I. Any insurer, potentially liable third party, or other person who, having received
notice in accordance with the provisions of this Section, pays over any monies subject to the
privilege created herein to any injured person, or to the attorney, heirs, or legal
representatives of any injured person, and any injured person, his legal representative, or
attorney who receives monies subject to the privilege created in Subsection G of this Section
shall be liable to the department, Medicaid managed care organization, or both, for the
amount of the privilege not to exceed the amount paid by the insurer, potentially liable third
party, or other person.
J. Nothing in this Section shall be construed to create any statutory lien or privilege
on any life insurance proceeds or trust proceeds in favor of any third person.