Florida Medicaid Casualty Recovery Program

Section 1902(a)(25) of the Social Security Act, 42 CFR 433.135, requires that States take all reasonable measures to ascertain the legal liability of third parties to pay for medical services furnished to a Medicaid recipient. Pursuant to 1902(a)(25), Florida Statute Section 409.910 provides that the Agency for Health Care Administration (AHCA) collect all amounts determined available from liable third parties.

The subsection further requires that recipients or their legal representatives notify the Agency of the existence of any third party benefits.

Furthermore, the Agency has a statutory lien for the full amount of medical care furnished. This lien attaches and is perfected automatically when a recipient first receives treatment for which the Agency may be obligated to provide payment under the Medicaid program.

Conduent Payment Integrity Solutions (Conduent) is the Florida Agency for Health Care Administration (AHCA) approved subcontractor of Health Management Systems (HMS) contracted to identify, manage, and recover all Florida Medicaid paid funds when a Florida Medicaid recipient is involved in a tort or a casualty accident / incident. If you are an attorney with a Florida Medicaid recipient client involved in a tort accident /incident, or if you are an insurance adjuster involved in a case where a Florida Medicaid recipient was injured please do the following:

1. Complete a Tort Information Form found on this website or send a letter of representation to the Florida TPL Recovery Unit. Along with the Tort Information Form or letter of representation, please include a HIPAA-compliant Medical Release signed by the Medicaid recipient. If you send a letter of representation, please be sure to include at a minimum:

  • Recipient Name
  • Recipient SSN
  • Recipient DOB
  • Date of accident or incident
  • Details of accident or incident

2. Submit the Tort Information Form via this website. Send the letter of representation and/or HIPAA-compliant Medical Release form to the following address:

Florida Medicaid Casualty Recovery Program
Attn: HIPAA-Compliant Medical Release
P.O. Box 12188
Tallahassee, FL 32317

When the form /letter and release is received, the data will be entered into our Case Management System. The case will be assigned to a Recovery Specialist. The Recovery Specialist will analyze the case to determine what claims, if any, AHCA paid, related to the accident/incident. Once analyzed, you will receive:

  • A Notice of Lien indicating the initial lien amount. (Detailed lien information will be provided only if a HIPAA-compliant Medical Release is on file.); or
  • A letter stating the individual could not be identified as a Florida Medicaid recipient, along with a request to verify the information or provide additional information; or
  • A letter requesting the missing items – if the request is incomplete

Please note that medical providers have one year from the date of service to bill AHCA. Accordingly, you must request an updated lien amount at the time of settlement.

If you have any questions, please feel free to contact us.

Relevant Statutes and Codes

Florida Statutes Section 409.910 – Responsibility for payments on behalf of Medicaid-eligible persons when other parties are liable

Florida Statutes Section 768.76 – Collateral sources of indemnity