Medical liens and letters of protection: how the bills, the records and the settlement have to line up

A medical lien is a claim against the injured person's recovery by someone who provided or paid for their care. That is the whole idea. The complexity comes from the fact that "someone" can be 8 different kinds of creditor, each with its own source of law, its own notice rules and its own reasons it will or will not take less.

This guide calls them all "liens", as most practitioners do. Strictly, some are statutory liens, some are contract or plan reimbursement rights, and some are federal claims that need no filing to be enforceable. The label changes the argument: an unperfected hospital lien may not bind the settlement, while a Medicare claim needs no perfection at all.

Lien

A legal claim against property, here the settlement or judgment proceeds, to secure payment of a debt. Hospital lien statutes create one for hospital charges.

Letter of protection (LOP)

A promise, usually from the claimant's attorney, that a treating provider will be paid from any settlement or judgment. The provider treats now and waits for payment.

Subrogation

The payer steps into the injured person's shoes and can pursue the at-fault party for what it paid.

Reimbursement

The payer's right to be repaid out of the injured person's own recovery. Most health plan claims in practice are reimbursement claims.

Conditional payment

A Medicare payment for care that another payer, such as a liability insurer, is responsible for. Medicare pays so the patient gets care, on the condition it is repaid.

Factoring

A provider selling its accounts receivable to a third party at a discount. Florida now defines it by statute and requires disclosure in LOP cases.

Made-whole doctrine

An equitable rule, adopted in some states, that a payer cannot be reimbursed until the injured person has been fully compensated. Plan language can often override it.

Why the records and the bills have to agree

Liens are paid from the same bills that make up the special damages claim, which ties 3 documents together: the itemized bill, the record for the date of service, and the lien that claims it. A billed line with no visit note is weak in the demand and weak against the lienholder. An unrelated visit on a conditional payment list is money Medicare is not owed. A duplicate charge inflates the specials and the lien at once. So reconcile every billed line to a record page before the demand goes out, and reuse that reconciliation to answer every lien.

The "reduction lever" column is where the argument starts. Rules vary by state and plan; confirm each row for your case.

How hospital lien statutes work

Hospital lien statutes differ more than any other row in the table. Read your state's statute before you trust a lien letter, and ask these questions of it.

1. What does the lien attach to? Usually the claim against the at-fault party and its proceeds. Some statutes do not reach the patient's own uninsured motorist or med-pay coverage.
2. Was it perfected? Many statutes require written notice to named parties, filing with a county clerk or court, or both, often within a fixed number of days of discharge. A hospital that skipped a step may not have an enforceable lien against the funds, though it may still have an unsecured claim against the patient.
3. Is there a cap? Some states limit the lien to a percentage of the recovery, to reasonable charges, or to charges for emergency care. Do the arithmetic before you negotiate.
4. Did the hospital have to bill insurance first? Some states restrict liens where the patient had coverage the hospital could have billed. If a plan also paid for the same date, the hospital's plan contract may limit what it can collect.
5. Who else is in line? The statute may set priority against other liens and against the attorney's fee.

Medicare is a secondary payer when a liability, no-fault or workers' compensation carrier is responsible for the care. If Medicare pays anyway, the payment is conditional. Under 42 USC 1395y(b)(2)(B), a primary plan must reimburse the Medicare trust fund once its responsibility is shown, and interest can run if repayment is not made within the 60-day period. The statute also lets the United States sue and collect double damages under (b)(2)(B)(iii), and it can pursue anyone who received the primary payment, including the attorney.

Under 42 CFR 411.24, a party who receives a primary payment must reimburse Medicare within 60 days. Do not disburse on a beneficiary's case without a final Medicare figure or a written plan for one.

Who handles the claim

When the beneficiary settles, the Benefits Coordination & Recovery Center (BCRC) handles recovery; older checklists call its predecessor the MSPRC. When Medicare pursues the insurer directly, the Commercial Repayment Center (CRC) does. Medicare Advantage plans assert their own rights under 42 CFR 422.108, outside the BCRC's letters. Ask the client for every card in their wallet.

Keep 3 tools apart. A dispute challenges whether a listed claim relates to the injury, before the final demand, and is won on the records. An appeal challenges the final demand itself. A waiver request asks Medicare not to recover, usually on hardship or equity grounds under section 1870(c) of the Social Security Act.

The procurement cost reduction

Under 42 CFR 411.37, Medicare's recovery is reduced by its share of the fees and costs spent to obtain the settlement. When Medicare's payments are less than the settlement, the ratio of procurement costs to the settlement is applied to those payments.

The arithmetic is hypothetical; the method is the regulation's. The $1,800 came off because someone matched each claim to a note and showed it was cardiology follow-up, not accident care.

Small settlements: 2 shortcuts

CMS offers demand calculation options for liability cases involving physical trauma. The self-calculated conditional payment option covers settlements of $25,000 or less, where treatment ended at least 90 days before submission, the incident was at least 6 months earlier, and no further treatment is expected. A fixed percentage option covers smaller physical trauma settlements; CMS raised its ceiling from $5,000 to $10,000 effective October 2, 2023. The fixed percentage option must be elected before Medicare issues a demand letter. Both are limited to physical trauma, and the self-calculated option expressly excludes exposure, ingestion and implant injuries.

Whether a liability settlement needs a Medicare set-aside for future care is a separate, contested question; see Medicare set-aside drafting.

States must seek repayment from liable third parties when Medicaid paid for injury care, and the patient assigns those rights to the state as a condition of coverage. The limit on that recovery comes from the federal anti-lien provision, and 3 Supreme Court cases define it.

Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268 (2006), held unanimously that the state could recover only from the portion of the settlement that represented medical expenses. It could not take its full payments out of money that compensated pain, lost wages and everything else.

Wos v. E.M.A., 568 U.S. 627 (2013), addressed how that share gets set. North Carolina presumed, with no chance to rebut, that 1/3 of any tort recovery was for medical expenses. The Court held that an irrebuttable fixed percentage conflicts with the anti-lien provision. States may still set procedures for fixing the medical share, such as a hearing, as long as the claimant can contest the allocation.

Gallardo v. Marstiller (2022) went the other way for the states. In a 7 to 2 decision, the Court held that a state may recover its past payments from the portion of the settlement allocated to medical care, including future medical care as well as past medical expenses. After Gallardo, labeling most of the medical allocation "future care" no longer keeps it away from the state.

The allocation argument runs on the records. Showing a small medical share needs a full-value figure built from bills matched to related treatment. A padded specials total inflates the very share you are trying to shrink.

Health plan reimbursement claims turn on a question most people skip: is the plan insured or self-funded? The answer decides whether state law helps the client at all.

The ERISA cases to know

• US Airways v. McCutchen (2013). Clear plan terms control. A beneficiary cannot use equitable doctrines such as unjust enrichment to override them. Where the plan is silent on attorney fees, the common fund doctrine fills the gap and the plan shares in the cost of recovery.
• Sereboff v. Mid Atlantic Medical Services (2006). A plan can enforce a reimbursement provision as an equitable lien on specifically identified settlement funds under ERISA section 502(a)(3).
• Montanile v. Board of Trustees (2016). If the participant spends the settlement on nontraceable items, the plan cannot collect from the participant's general assets under 502(a)(3). This is why plans send notice letters early and why no attorney should disburse around a known ERISA claim.

The order: get the plan document, confirm funding status, read the reimbursement clause word by word, then check the plan's itemization against the records. Recovery vendors often pull claims by date range and diagnosis family, so unrelated claims show up. Those come off first.

VA, TRICARE and military treatment facilities

The Federal Medical Care Recovery Act gives the United States its own claim whenever it furnished or paid for care after an injury caused by someone else. The statute opens:

"In any case in which the United States is authorized or required by law to furnish or pay for hospital, medical, surgical, or dental care and treatment (including prostheses and medical appliances) to a person who is injured or suffers a disease, after the effective date of this Act, under circumstances creating a tort liability upon some third person..."

The claim covers the reasonable value of care, and section 2651(b) extends it to a service member's pay while unable to perform duty. The agency can compromise or waive the claim, which is where the negotiation happens.

An LOP lets an uninsured or underinsured client get treatment now. The provider accepts the risk of the case and, in exchange, usually bills its full chargemaster rate and waits. Florida's 2023 statute defines it broadly:

"any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action."

Note the word "arrangement". Under that definition the paper does not have to be titled "letter of protection" to count.

When an LOP makes sense, and when it does not

Whether the client still owes the bill if the case recovers nothing depends on the letter's wording and state law. The attorney who signed it may also owe the provider payment from the proceeds under state ethics rules on third-party interests in settlement funds.

The discovery and bias fight

Defense counsel attack LOP treatment on 3 fronts: charges above what any payer pays; bias, since a doctor paid only if the case wins has a stake in it; and referral patterns that suggest treatment built for the case. Courts differ on how much of this is discoverable.

Florida settled the question by statute in 2023. Under section 768.0427(3), a claimant who seeks medical expenses for treatment under an LOP must disclose:

1. A copy of the letter of protection.
2. All billings for the medical expenses, itemized and, where applicable, coded.
3. Factoring details if the provider sold the receivable: the buyer's name and the dollar amount it paid, including the discount below the invoice.
4. Whether the claimant had health care coverage when treated, and if so, its identity.
5. Whether the claimant was referred for LOP treatment and by whom. If the claimant's attorney made the referral, the statute permits disclosure and makes evidence of it admissible notwithstanding the lawyer-client privilege in section 90.502.

Outside Florida, treat that list as the defense's discovery plan anyway. If your file cannot answer those 5 questions cleanly, fix that before the demand, not after the deposition notice arrives.

The collateral source rule traditionally keeps a defendant from reducing damages because the plaintiff's insurance paid the bills. The fight in the last 15 years has been over what "the bills" are: the chargemaster amount on the statement, or the smaller amount the provider actually accepted.

In Howell, the plaintiff's plan paid $59,691.73 on $189,978.63 in bills, and the providers wrote off the rest under their contracts. The California Supreme Court held that an insured plaintiff's recovery for past medical expenses is limited to the amounts actually paid or incurred, and that the collateral source rule does not reach a negotiated discount nobody ever paid. The rule still protects the paid amount: the jury does not hear that insurance paid it.

LOP care sits awkwardly here, because an LOP bill is fully incurred and fully unpaid. In California, Pebley v. Santa Clara Organics (Ct. App. 2018) let an insured plaintiff who treated on a lien basis prove billed amounts through expert testimony on reasonable value. Florida now answers by statute.

Florida's evidence rules after 2023

Section 768.0427(4) then caps the damages themselves: no award for medical expenses beyond the evidence admitted under subsection (2). Evidence of reasonable amounts billed is still admissible for unpaid charges under (2)(b)5, but the jury also hears the benchmark figures above. An LOP provider in Florida that insists on its full chargemaster bill at settlement is asking for a number a jury may not award. That is a reduction argument, and an honest one.

Every billed line claims that on a given date, a given provider did a given thing for a given diagnosis. The record either shows it or it does not.

Reading a professional claim form

Physician bills usually arrive on a CMS-1500. Hospital bills arrive on a UB-04 summary grouped by revenue code; ask for the itemized statement behind it. The mock form below is hypothetical.

The decision path for every bill

What a reconciliation shows

Run the decision path across the whole bill and you get a bill-to-record map. The one below is the orthopedic LOP bill from the worked example in chapter 9, before any negotiation.

The client, 44, was rear-ended on 02/27/2025 and had no health coverage at the time. She went by ambulance to a hospital emergency department, then treated with an orthopedic practice and a physical therapy clinic, both under letters of protection signed by the firm. In June she enrolled in Medicaid, which paid for 2 later primary care visits and medication. The case settled in 2026 for the $120,000 policy limit. Fee: 1/3. Case costs: $8,000.

Step 1: build the lien list from the records, not the letters

The firm had 3 lien letters: hospital, orthopedics, therapy. The primary care notes on pages 402 to 418 showed a 4th payer, Medicaid, for 2 visits. No letter had arrived, but the state's claim existed anyway. Read the file for payers; do not wait for letters.

Step 2: reconcile each bill

• Hospital, $24,000 claimed. The itemized statement matched the ED record on pages 1 to 88. The lien had been filed and noticed. 1 line, a CT of the head, was supported by an order and report on page 41. No unmatched lines. The reduction argument here is reasonableness, not support.
• Orthopedic practice, $13,800 claimed. The map in chapter 8: $300 with no note, a $3,200 duplicate injection line and a $450 visit for the right shoulder, which the client injured at work in 2024 (prior record, page 377). $3,950 unsupported; $9,850 supported.
• Physical therapy, $6,500 claimed. 26 visits billed at $250. Daily notes existed for all 26 (pages 300 to 355), but 4 notes said "patient cancelled, no treatment". Those 4 billed visits, $1,000, were unsupported, leaving $5,500.
• Medicaid, $4,000 paid. Both visits addressed neck and back pain from the crash and a medication refill. Related.

Step 3: request reductions with the evidence attached

Each provider received the reduction letter in chapter 10 with the reconciliation table and page citations. The orthopedic practice accepted $8,000 on the $9,850 supported balance in exchange for payment within 14 days of disbursement. The therapy clinic accepted $5,000. The hospital, after a request citing the limits settlement and the client's net, accepted $16,000. Medicaid's claim, $4,000, was below the Ahlborn share on any reasonable valuation, so the firm paid it in full rather than spend time on an allocation hearing.

Check the arithmetic: $120,000 less $40,000 in fees, $8,000 in costs and $33,000 in liens is $39,000. A settlement statement should close to the cent before anyone signs it.

Give the lienholder a reason. Rank arguments by how hard they are to refuse.

LIEN TRACKING SHEET
Case: [CLIENT] v. [DEFENDANT]    Date of injury: [MM/DD/YYYY]    Updated: [DATE] by [INITIALS]

Lienholder | Type | Legal basis | Notice received (date, method) | Perfected? (filing, date) | Dates of service (first to last) | Visits billed | Amount claimed | Date of that figure | Lines with no record | Duplicate lines | Unrelated lines | Supported amount | Record pages cited | Reduction requested (date, amount) | Response | Final figure (in writing, date) | Paid (date, check no.) | Release received

Types: HOSPITAL LIEN / LOP / INSURED PLAN / ERISA SELF-FUNDED / MEDICARE / MEDICARE ADVANTAGE / MEDICAID / FMCRA (VA, TRICARE) / OTHER
Legal basis examples: [STATE] hospital lien statute [SECTION]; LOP dated [DATE]; plan document section [X]; 42 USC 1395y(b)(2); 42 USC 2651

Status codes: OPEN / ITEMIZATION REQUESTED / DISPUTED / REDUCTION REQUESTED / FINAL / PAID / RELEASED
Rule: pay only from a FINAL figure in writing. Never from a balance letter.

[FIRM LETTERHEAD]
[DATE]

[LIENHOLDER NAME]
Attn: [LIEN / RECOVERY DEPARTMENT]
[ADDRESS]

Re:  Patient: [CLIENT NAME]   DOB: [MM/DD/YYYY]
     Date of injury: [MM/DD/YYYY]
     Your account / reference no.: [NUMBER]
     Amount claimed: $[AMOUNT] as of [DATE OF YOUR STATEMENT]

Dear [NAME]:

This firm represents [CLIENT NAME] in a claim arising from the [DATE] [INCIDENT TYPE], which has resolved for $[GROSS]. We write to confirm your final figure and request a reduction.

1. Charges not supported by the records
We matched each line of your itemized statement dated [DATE] to the medical records produced by your office. The attached table lists every line with the record page that supports it. The following lines are not supported:

   Date of service | Code | Billed | Issue | Record reference
   [MM/DD/YYYY]    | [CPT] | $[X] | No visit note produced | Records received [DATE], pages [RANGE]
   [MM/DD/YYYY]    | [CPT] | $[X] | Billed twice for 1 documented procedure | Procedure note p. [N]
   [MM/DD/YYYY]    | [CPT] | $[X] | Treatment of [BODY PART / CONDITION] unrelated to this injury | Visit note p. [N]

   Total unsupported: $[SUM]. Supported balance: $[CLAIMED minus SUM].

If you have records supporting any of these lines, please send them.

2. Request for reduction of the supported balance
[Choose the grounds that apply:]
[ ] The recovery is limited. Gross: $[GROSS]. Fees and costs: $[FEES + COSTS]. Total claimed liens: $[TOTAL]. If every lien were paid as claimed, [CLIENT] would net $[NET].
[ ] Your recovery was obtained through this firm's work. We ask that the balance be reduced by a pro rata share of fees and costs ([PERCENT]%).
[ ] [STATUTE / PLAN SECTION / CASE] limits the amount recoverable because [REASON].
[ ] We can pay within [14] days of disbursement.

We request that you accept $[OFFER] in full satisfaction of all charges for [CLIENT]'s care from [FIRST DATE] to [LAST DATE], and release any claim against [CLIENT] and the settlement proceeds for those charges.

Please confirm your final figure in writing by [DATE]. Payment will be made only against a written final figure.

This letter does not waive any defense to the lien, including [notice / perfection / statutory cap].

Sincerely,
[ATTORNEY NAME]
[BAR NO.] | [PHONE] | [EMAIL]

Enclosures: reconciliation table ([N] lines, record pages cited); [settlement statement or limits letter]; [authorization, if required]

Before a dollar leaves the trust account

• Every payer identifiedClient interview, bills, EOBs, face sheets and enrollment dates, as well as lien letters
• Medicare status confirmedBeneficiary or not; if yes, case reported and a final demand or approved option on file
• Medicare Advantage checked separatelyThe BCRC's figure does not cover it
• ERISA funding status confirmedPlan document and Form 5500 in the file
• Hospital lien perfection checkedFiled lien and proof of notice, against the statute's deadlines
• Every billed line reconciledRecord page cited or line marked unsupported
• Final figures in writingNo payment from balance letters or phone calls
• Settlement statement closes to the centGross minus fee, costs and liens equals net
• Disputed funds heldAmounts in genuine dispute stay in trust until resolved, per your state's rules

0 of 9 checked

Lien work is mostly reading and matching: find every bill, pull every line, find the note for each date, decide whether the note supports the code and the injury. AI medical record review software handles the first 3 well. The 4th is judgment, and it stays with people.

What a large language model does well here

• Pulling line items off messy bills. OCR plus a large language model (LLM) can read CMS-1500s, UB-04 summaries, itemized statements and EOBs into rows: date, code, units, charge, paid, adjusted.
• Finding the note for each date. An AI medical chronology sorted by date of service puts the visit note next to the billed line, which is most of the reconciliation.
• Catching duplicates and cancelled visits. The same code, date and provider billed twice; a therapy note that says "no treatment" against a billed session.
• Reading codes. Clinical NLP expands CPT and ICD-10 codes into plain terms a paralegal can check.

Where it fails

• Faxed bills and poor scans. OCR can read $3,200 as $8,200, or 64483 as 64493. A number error in a lien letter is worse than none.
• Handwritten notes. Therapy flow sheets and ED nursing notes are often handwritten; ambiguous entries need a person.
• Relatedness. Software can surface the prior shoulder injury on page 377; it cannot decide causation.
• Hallucination. Ask a general chatbot to total a bill and it may produce a confident figure that is not on any page. Generative AI fills gaps; lien work needs the gaps shown.

Why grounded citations decide whether the output is usable

Every lienholder will ask "where does it say that?" about a disputed line. An answer without a page is an opinion. Grounded, page-level citations let you answer with the bill page and the treatment note side by side, and human-in-the-loop review decides which charges are related. In Mata v. Avianca, Inc. (S.D.N.Y. 2023), lawyers were sanctioned under Rule 11 for filing fabricated case citations a chatbot produced. The same duty to verify applies to a lien dispute letter.

Choosing legal AI tools for billing and lien work

Related: is AI accurate enough for court, HIPAA-compliant AI medical record review, and the AI-native personal injury law firm, which covers AI demand letter drafting.

Medrecords AI is medical record review software. You upload the records and bills; it drafts a cited chronology, billing ledgers and flags, every line linked to its source page. For the work in this guide, that means:

• A claims billing ledger that pulls charges from bills, statements and EOBs across the file. Each figure links to the bill page and, where one exists, the visit note that documents the service. Charges with no supporting record, the same visit billed in 2 packets, and notes that contradict a billed service are flagged.
• A medical billing summary that rolls the bills up by provider, date or category, with every total drilling down to cited line items.
• Medical bill review that compares billed lines to benchmark data and flags outliers with percentile context. It never reduces or reprices a bill.
• A cited medical chronology sorted by date of service, which lets a reviewer match each bill to the visit it charges for, and surfaces prior injuries and treatment of other body parts.
• Missing records identification that flags billed dates and providers with no records in the file, each flag cited to the evidence that implies it.
• Deduplication so the same page produced twice is not counted twice, with citations that survive.

The output feeds a medical specials ledger and the table you attach to a reduction request. See lien resolution and conditional payments.

Flags are signals, not verdicts. A "no source" flag may mean the note is in a production you have not uploaded yet. What Medrecords AI does not do: it does not compute lien amounts or reductions, decide what is related to the injury, negotiate with lienholders, file anything with Medicare, request or retrieve records from providers, or give legal advice. It works on the files you upload, under SOC 2 and HIPAA with a signed BAA (see security and HIPAA). Self-Service bills 10 cents a deduplicated page, down to 5 cents at volume, duplicates free; Enterprise On-Prem is an annual license.

What is a medical lien in a personal injury case?

A claim by a hospital, treating provider, health plan or government payer to be repaid from the settlement or judgment for care it provided or paid for. The right comes from a state lien statute, a contract such as a letter of protection, a plan document, or federal law. Each type has its own notice rules and reduction levers.

Do you have to pay Medicare back from a settlement?

Yes, for conditional payments Medicare made for injury-related care. Under 42 CFR 411.24 the recipient must reimburse Medicare within 60 days of receiving the primary payment, and interest runs if a final demand is not paid within 60 days. Unrelated claims can be disputed, and Medicare reduces its recovery by a share of fees and costs under 42 CFR 411.37.

Can Medicaid take my whole settlement?

No. Under Ahlborn (2006), a state Medicaid program can recover only from the portion of the settlement that represents medical expenses. Wos v. E.M.A. (2013) bars a fixed irrebuttable percentage, and Gallardo v. Marstiller (2022) lets the state reach the medical allocation for future as well as past care. State procedures for setting the share vary.

What does billed vs paid mean for medical damages?

Billed is the provider's full charge; paid is what was actually accepted. In Howell (Cal. 2011), an insured plaintiff could recover only amounts paid or incurred, not written-off charges. Florida's 2023 statute sets evidence rules by payment status, including 120% of the Medicare rate for some unpaid charges. Other states differ.

Can AI match medical bills to the medical records?

It can do most of the matching: extract each billed line, find the note for the date of service, and flag lines with no note, duplicates and cancelled visits, each cited to its page. It cannot decide whether treatment was related to the injury or what a lienholder should accept. A person checks every flag and makes those calls.

Is it HIPAA compliant to upload medical records and bills to AI?

It can be, if the vendor signs a business associate agreement, protects the data with controls you can verify such as a SOC 2 report, and does not use your records to train its models. A consumer chatbot with no BAA has made no HIPAA commitments. Ask for the BAA before the first upload.

Can ChatGPT calculate a lien reduction?

It can do arithmetic you give it, but it does not know your state's lien statute, your client's plan terms or what a recovery contractor accepts, and it may state a confident figure that is not on any page. Fabricated AI output has already drawn Rule 11 sanctions. Verify every number against the bill and the rule.

Does AI software reduce or calculate medical liens automatically?

It should not. Good software extracts line items, cites them, flags unsupported and duplicate charges and may benchmark amounts, but the reduction decision and the negotiation stay with the attorney. Medrecords AI flags and cites; it does not compute lien amounts or reprice bills.

Statutes, regulations, CMS guidance and case figures were checked against primary or official sources in September 2026. Quoted statutory text is verbatim. Florida's statute is paraphrased except for the definition quoted in chapter 6. Every case file, bill, page number and dollar figure in chapters 3, 8 and 9 is hypothetical. Product facts come from this site's product pages. Nothing here is legal advice.

• 42 USC 1395y(b)(2), Medicare Secondary Payer: conditional payments, reimbursement within the 60-day period, interest, and double damages under (b)(2)(B)(iii).
• 42 CFR 411.24, recovery of conditional payments: repayment within 60 days of receiving the primary payment.
• 42 CFR 411.37, reduction of Medicare's recovery for procurement costs.
• CMS, Medicare's recovery process: BCRC role, final demand, payment due within 60 days of the demand date, interest from the demand date.
• CMS, demand calculation options: self-calculated option for settlements of $25,000 or less (treatment ended 90 days before, incident 6 months before, physical trauma only); fixed percentage option ceiling raised from $5,000 to $10,000 effective October 2, 2023.
• CMS, Medicare Secondary Payer Recovery Portal.
• Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268 (2006): $550,000 settlement, $215,645.30 lien, $35,581.47 medical share.
• Wos v. E.M.A., 568 U.S. 627 (2013): North Carolina's irrebuttable 1/3 allocation preempted.
• Gallardo v. Marstiller (2022): 7 to 2; states may recover from the medical allocation, past and future.
• 42 USC 2651, Federal Medical Care Recovery Act, including (b) on military pay.
• Florida Statutes 768.0427 (chapter 2023-15): definitions, evidence of medical expenses, LOP disclosures, damages limit.
• Howell v. Hamilton Meats & Provisions, 52 Cal.4th 541 (2011): $189,978.63 billed, $59,691.73 paid; recovery limited to amounts paid or incurred.
• ERISA reimbursement cases cited by name: FMC Corp. v. Holliday (1990), Sereboff v. Mid Atlantic Medical Services (2006), US Airways v. McCutchen (2013), Montanile v. Board of Trustees (2016). Pebley v. Santa Clara Organics (Cal. Ct. App. 2018). Medicare Advantage recovery: 42 CFR 422.108. VA recovery: 38 USC 1729.
• Mata v. Avianca, Inc., 678 F. Supp. 3d 443 (S.D.N.Y. 2023): Rule 11 sanctions for fabricated AI-generated case citations.

Related guides: medical billing review, eggshell plaintiff and pre-existing conditions, how to get medical records for a lawsuit, and deduplicating medical records for personal injury.