01.26.2018

About the Pennsylvania MA Program And Reimbursement In Personal Injury Cases

If you require legal counsel and assistance in litigating a claim for damages resulting from a personal injury, contact the Powell Law Firm. Our decades of experience make it the clear and obvious choice for representation in personal injury matters in Scranton/Wilkes-Barre and surrounding areas. If you have suffered some injury as the result of an accident, call the attorneys at Powell Law. Your consultation is free and you don’t pay unless we win your case!

The Pennsylvania Department of Human Services (DHS) administers a Medical Assistance (MA) Program to provide health insurance benefits to eligible residents of Pennsylvania. While the MA Program is jointly funded with state and federal tax dollars, the DHS must ensure that Pennsylvania and the federal government do not pay for services when other coverage is or becomes available. Thus, any funds paid by the MA program when a responsible third party is liable for health care costs must be recovered.

These “third parties” subject to the mandatory recovery provisions include: (1) self-insured plans, (2) pharmacy benefits managers, and (3) “other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service” such as workers’ compensation, automobile insurance, liability insurance plans, and managed care organizations. To comply with this mandate, DHS created the Third Party Liability (TPL) Program.

When a third party reimburses a provider in part or in full for claims paid by the MA program, the state’s MA program must be reimbursed. Because of the federal mandate, TPL identifies and pursues responsible third parties for reimbursement to the DHS.

The attorneys at Powell Law have the expertise and experience to ensure that their clients meet all applicable legal requirements when any reimbursement procedure is necessary. The attorneys at Powell Law carry on the work of a law firm that spans generations and has represented thousands of Pennsylvanians over a period of 112 years. Contact Powell Law at (570) 961-0777 or visit us online. The consultation is FREE and you don’t pay unless we win!

About the Pennsylvania MA Program And Reimbursement In Personal Injury Cases

 

 

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