Tort/Casualty Recovery FAQ

What is the difference between Medicaid and Medicare?

In broad, general terms Medicaid is a State administered program that provides health and long-term care coverage to certain categories of low-income individuals and families and people with severe disabilities; Medicare is a federally administered program providing health insurance for individuals age 65 and older, and for younger adults with permanent disabilities. A person may have both Medicaid and Medicare. The Florida Medicaid TPL Recovery Program is only responsible for the identification and recovery of Medicaid-paid funds. The Medicare Secondary Payor (MSP) Unit is responsible for the identification and recovery of Medicare funds. You can contact the MSP unit at (904) 791-6181.

Will Medicaid negotiate to reduce its lien amount and or give consideration for Attorneys’ fees and costs?

Florida Medicaid does not negotiate lien amounts, however, Florida Statute 409.910(11) (f) provides a formula of distribution that gives consideration for Attorney’s fees and cost.

How long does it take to get Medicaid paid claims information from the TPL Recovery Unit?

You should receive an initial lien amount within 21 days of receipt of the letter of representation or completed Tort Information Form.  You will not receive a claim itemization unless a completed HIPAA Compliant Medical Release is on file.

I issued a subpoena for medical records, what information will I receive and how long should it take to receive it?

Medicaid records do not generally include medical records, but rather paid claims data. A subpoena alone is not sufficient to obtain these records; you must submit a completed HIPAA Compliant Medical Release or obtain a court order. Once the proper documents are on file, records are generally mailed within 21 days.

Does an action by AHCA under 409.910 constitute a waiver of sovereign immunity pursuant to s. 768.14?

No, an action by the agency to recover damages in tort under section 409.910 does not constitute a waiver of sovereign immunity pursuant to s. 768.14.

Does AHCA waive its right to its claim if it fails to provide the recipient or the recipient’s attorney with a statement asserting its payment of collateral source within 30 days pursuant to Florida Statute 768.76(7)

No, pursuant to Florida Statute 768.76(2)(a)1 and (2)(b) the Medicaid program of Title XIX of the Social Security Act is not considered a collateral source.

How is payment made?

Payment can be made in the form of a personal check, money order, or cashier’s or certified check. It must be written payable to: Agency for Health Care Administration. The payment should be mailed to: Florida TPL Recovery Unit, P.O. Box 12188, Tallahassee FL 32317-2188.