Order Allow,Deny Deny from all Do I have to pay back Medicare or Medicaid if i win my nursing home case? | Jay Cooper Law Office

Attorney at Law since 1986

Florida Circuit Civil Mediator & Qualified Arbitrator


Toll Free (855) 346-5897

Medicare and Medicaid liens are a very difficult area for plaintiff’s lawyers and their clients to deal with. We do it on an everyday basis. The short answer is Medicare has a right by virtue of subrogation to come in and collect any damages for expenses it has paid out for hospitalization, doctor care, nursing care for a nursing home resident. A typical example might be someone slips and falls in a nursing home and breaks a hip. They are covered by Medicare. Medicare pays out a certain amount of expenses to mend the hip and put them back in the nursing home. Medicare has a subrogation lien on the settlement or judgment to recover the money.

Medicaid is an area where it’s a little more complex. Medicaid, there’s two types of Medicaid liens. One for actual events, say for example, someone breaks a hip and Medicaid pays for it. There is also something called a Medicaid lifetime lien. If a resident is a long-term Medicaid recipient and they die without a spouse, Medicaid through the state of Florida has the right to swoop down on the estate and basically impress a lien for the amounts of benefits paid out during the person’s lifetime.

It’s incredibly unfair. It puts the plaintiff and the plaintiff’s estate in a position where they end up having to pay a debt to Medicaid and it’s a debt that they can’t recover from the at fault party. In some cases the presence of Medicaid makes it a case that isn’t cost effective for the people who want to bring the case and in some instances a lawyer has to tell the client, “Listen, the liens in this case are going to eat up your recovery. I would advise you that it’s not in your best financial interest to pursue this matter.”