Got a question for you PI guys. This is probably more geared to you defense guys. Let's say plaintiff has a premises liability claim and has a surgery at a hospital. She is Medicare eligible, but the hospital refuses to bill Medicare because they claim they have the right to bill the party responsible (in full, rather than get the reduced payment from Medicare). This is a not for profit hospital, supposedly. The plaintiff did not sign any opt out agreement. The liability insurance carrier has no med-pay. How do you go about getting the hospital to bill Medicare?
could file a dec action on it. then i guess you'd get into erisa v non erisa in terms of whether it was in federal court or not.
It's a pre-lit case so no court involvement We're going to resolve it, just trying to figure out how to get the hospital to bill Medicare like all the other providers she's treated with while they are holding out because their bill is like 110k and they want the full amount. Plaintiffs attorney is on board with them billing Medicare too, so it's not something being driven by them. It's just the hospital being dumb
I don't think he'd have standing to do that. I'm not sure that you can unless Arkansas has a unique statute on it. I think Hospitals have a year to submit it and will determine then whether they've got a better chance with Medicare or filing a lien.
It's a FL claim. Does the hospital not having an opt out agreement with the patient, knowing that she has Medicare and bypassing it, not carry any weight? Sammy Meatballs what are your thoughts on this?
did the hospital file a lien or is it just a bill floating out there? is the hospital trying to negotiate this with in-house lawyers or did they hire an outside firm? if they filed a lien and hired an outside firm, the reason they're being pains in the asses is they most likely only get paid a % on what they recover on behalf of the hospital. might not get anything if it's sent to medicare
This is beside the point, but there's case law in Alabama that says they don't have to even file it for the lien to attach. It's absurd.
I don't think there are any statewide regulations on hospital liens in FL, and they're regulated by county ordinances No counsel and no lien has been filed. Just a 110k bill out there, but their billing dept refusing to bill Medicare for the facility/surgery when the ER physician and radiology for the same dates of service did bill Medicare
I've got a letter I send that almost always busts their lien and gets them to bill Medicare. I've also talked to Medicare and the patient has a right to go through Medicare and file a grievance against the facility. That's the option if the letter doesn't work.
Do you think you could pm me the body of the letter? I've been working with our in-house counsel and outside counsel on this to draft a letter to send them but there has been some snags
In Alabama, if the hospital files the lien within 10 days or the plaintiff's attorney has actual notice of the lien (even without perfection), and you settle a case or get a judgment and don't pay the hospital out of that judgment, then the hospital has a cause of action against the plaintiff's attorney for impairment of the lien.
What county? Medicare is a secondary payor. Hosptial doesn't have to bill them if they don't want to and you can't force them to do so.
Palm Beach Co :/ Does the hospital not have to have an opt out agreement with the patient if they are going to bypass Medicare?
in texas if you dont pay a hospital lien then the release is invalid. my old boss is in the middle of a clusterfuck lawsuit for not paying a lien. he couldve got out of it by paying i think 4k on a 50k lien but he told htem to fuck off and now they are saying they wont even settle for the 50
I'm glad someone is having success these first two weeks. I've been getting fucking shit tier offers and having to be a dick to everyone thus far. It sucks.
any of you guys do admiralty stuff? Im taking a class on it now and it seems like a great racket if you can get into it.
have a sexual assault case where a 6 grader raped our 1st grader at school. school had ordered psychological testing on the 6th grader in order for him to return to school prior to all this. we don't know why. school principal admitted to our clients mom after rape happened that 6th grader had issues and was domineering to younger children and there had been an edict to seperate them. we allege 6th graders mom was supervising after school program when this happened. at the mediation they denied that. about to file suit. their whole thing is notice. they say they didn't have notice that he was sexually aggressive or a sexual deviant. at the mediation i said that doesnt matter. its negligent supervision. they had a duty to supervise. the 6th grader went up to his mom who was supervising and said can i take this 1st grader to go pee. she said yes. then they disappeared for lengthy period of time and the 6th grader takes him into the bathroom. i see it as duty, breach, damages. i don't see where notice fits into it. but they are making it all about notice.
That's because you're talking about a criminal act. In general, you can't be held liable for the criminal acts of another.
“It is the general rule in Alabama that absent special relationships or circumstances, a person has no duty to protect another from criminal acts of a third person.” Moye v. A.G. Gaston Motels, Inc., 499 So.2d 1368, 1370 (Ala.1986). See Ex parte McRae's of Alabama Inc., 703 So.2d 351 (Ala.1997); C.A. v. Wal–Mart, Inc., 683 So.2d 413 (Ala.1996); Baptist Memorial Hosp. v. Gosa, 686 So.2d 1147 (Ala.1996); Broadus v. Chevron USA, Inc., 677 So.2d 199 (Ala.1996); Habich v. Crown Cent. Petroleum Corp., 642 So.2d 699 (Ala.1994); Dailey v. Housing Auth. for the Birmingham Dist., 639 So.2d 1343 (Ala.1994); E.H. v. Overlook Mountain Lodge, 638 So.2d 781 (Ala.1994); W.L.O. v. Smith, 585 So.2d 22 (Ala.1991); Webster v. Church's Fried Chicken, Inc., 575 So.2d 1108 (Ala.1991); Douglas v. McDonald's Corp., 565 So.2d 137 (Ala.1990); Morton v. Prescott, 564 So.2d 913 (Ala.1990); Bailey v. Bruno's, Inc., 561 So.2d 509 (Ala.1990); Williams v. First Alabama Bank, 545 So.2d 26 (Ala.1989); Nail v. Jefferson County Truck Growers Ass'n, Inc., 542 So.2d 1208 (Ala.1988); O.H. v. Ballard Realty Co., 516 So.2d 519 (Ala.1987); Childers v. Winn–Dixie Stores, Inc., 514 So.2d 879 (Ala.1987); Frazier v. Laborers Int'l Union of N. America, Local No. 559, 502 So.2d 743 (Ala.1987); Petrella v. Peddler's Motor Inn Best Western, 488 So.2d 497 (Ala.1986); Simpson v. Wolf Ridge Corp., 486 So.2d 418 (Ala.1986); Law v. Omelette Shop, Inc., 481 So.2d 370 (Ala.1985); Ortell v. Spencer Cos., 477 So.2d 299 (Ala.1985); Henley v. Pizitz Realty Co., 456 So.2d 272 (Ala.1984); Stripling v. Armbrester, 451 So.2d 789 (Ala.1984); Latham v. Aronov Realty Co., 435 So.2d 209 (Ala.1983); Berdeaux v. City National Bank of Birmingham, 424 So.2d 594 (Ala.1982); Gaskin v. Republic Steel Corp., 420 So.2d 37 (Ala.1982); and Parham v. Taylor, 402 So.2d 884 (Ala.1981). I'm sure all those cases are wrong, though.
Caretaker is also a special relationship. I defended a case with similar facts. I had the local special olympics chapter and at a competition one of the atheletes sexually assaulted another in the dormitories between events. It was fucking rough.
Yeah, I've defended a few of these cases. The worst was the UAH shooting case a few years. Local counsel brought in some guy from the DC area that had success in the Virginia Tech case. They didn't get very far here. I only mentioned notice because that's what Gump asked about.
But, notice still matters. It's a part of forseeability which is a part of causation. You could have a general duty but the particular criminal act could be unforseeable without notice and therefore no liability.