HOSPITAL LIENS (CC 3045.1 et seq.) SUBSTANTIVE DEFENSES
SUBSTANTIVE--Where Hospital Lien Properly Served and Perfected
"Source" of Underlying Payment to Hospital or Provider listed below 1-9
Plaintiff’s Argument and Authority listed below 1-9
1. MediCal: Balance billing in any state Medicaid program barred by operation of federal law; federal regulations Olszewski v. Scripps Health, 30 Cal.4th 798 (2003), S. Ct. struck W&I 14124.791 under federal supremacy clause;42 CFR §447.15; 42 USC §1396a (a)(25)(C); Cal. W & I 14019.4;
Likely Outcome: Lien invalid
2. HMO/PPO: Balance billing to patient by provider with contract with HMO barred; Knox-Keene Act, California Health and Safety Code §1379. May depend on contract between HMO & provider per Parnell v. Adventist Health Systems, 35 Cal.4th 595 (2005).
Likely Outcome:
3. CMS (County Medical Services): Balance billing allowed by (San Diego) CMS hospital agreement revision 7/94.
Likely Outcome: Probably valid
4. MediCare: Balance billing barred by federal law. 42 USC §1395cc(a)(1)(A); 42 CFR §489.21(a); Rybicki v. Hartley, 792 F.2d 260 (1st Cir. 1986).
Likely Outcome: Lien invalid
5. Social Security: Balance billing barred by federal law. Same authority as #4; see Holle v. Moline Public Hospital, 598 F. Supp. 1017 (1984).
Likely Outcome: Lien invalid
6. Champus: Balance billing barred by federal law. 32 CFR 199.6(a)(8).
Likely Outcome: Lien invalid
7. Plaintiff's Private Health Insurance: Balance billing prohibited where contractValidity depends on between hospital and health insurance plan contract. causes the underlying patient debt to be extinguished. Hospitals can use HLA to balance lien if their contracts with plans permit it. Parnell v. Adventist Health Systems, 35 Cal.4th 595 (2005). Such billing clearly prohibited for out of network emergency care per Prospect Med. Grp. (2009) 45 Cal.4th 497, 28 CCR 1300.71.39 and Exec. Order S-13-06. Providers must resolve issue directly with plans.
Likely Outcome: Depends on contract
8. Group Health Insurance through Private Employer (ERISA): Sereboff, supra, on 5/15/06 allows ERISA Lien & claim plans to sue in federal court for equitable lien likely enforceable to or constructive trust to enforce plans reimb/ some extent unless subro provisions against beneficiaries holding defeated by make the funds. Ct distinguished Knudson,supra, whole rule. on basis that defendant there not in possession of funds.
Likely Outcome: Lien & claim likely enforceable to some extent unless defeated by make whole rule, also known as make whole doctrine.
-align: justify;">9. Prepaid Health Plans by MediCal: Plans barred from attempting "recovery Health Plan funded in circumstances involving casualty lien invalid insurance, tort liability or worker's compensation" per Cal. Code of Regulations §53222(b).
Likely Outcome: Health Plan funded lien invalid
Mark C. Blane is a San Diego Personal Injury Attorney, and the managing lawyer of the Law Offices of Mark C. Blane, a San Diego, California Personal Injury Law Firm dedicated to representing families of people injured in personal injury accidents including car accidents, slip and falls, dog bites, product defects, and the like. If you or a loved one has been killed or injured in an accident in San Diego, or Southern California, due to the negligence of another, please order your free copy of Mr. Blane's book, The 10 Secrets You Need To Know About Your Injury Case, BEFORE You Call A Lawyer. It is full of helpful information that will help you protect your legal rights and it normally sells for $16.95. However, it is free to all California residents, or those injured in an California accident.