A Short Primer on VA and TriCare Lien Resolution

While Medicare and private / ERISA liens are the focus of much attention and discussion in recent years, other federally-created reimbursement rights and subrogation obligations deserve attention as well. With more and more individuals serving in the United States military abroad, and their families remaining stateside, and later receiving veterans’ benefits, we thought it appropriate to share with you some tips about resolving Veterans Administration (VA) and Tricare liens, as you can expect a rise in such “liens” being asserted in the coming months.

The Federal Medical Care Recovery Act (FMCRA) at 42 U.S.C. §§ 2651-2653 governs the federal government’s right to recover medical expenses incurred for the medical care of an injured beneficiary where =there exists a liable third party. FMCRA (much like the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2)) provides the federal government with both an independent right of recovery against liable third parties as well as a right of subrogation, assignment and ability to intervene or join a beneficiary’s claim. The federal government relies on 10 U.S.C. § 1095 to recover against third-party payors and wants the beneficiary to take lead in protect its interests (see, for example, 32 C.F.R. § 757.18). In fact, the federal government requires a plaintiff attorney to sign a protection agreement to a) acknowledge the United States government’s claim and b) commit to protect the interests of the federal government.

In our experience, while federal law does not require offsets, the federal government is agreeable to compromised reductions under certain circumstances. Typically, those situations arise when it is convenient for the federal government to grant such a request or when denying that request would impose an undue hardship on the beneficiary. Just as when we resolve a Medicare conditional payment claim, GRG adheres to strict internal protocols regarding the duration of resolving a VA or Tricare lien based on our extensive experience with working with the recovery offices for each branch of the military.

Depending on the branch of the military who provided benefits in the case of Tricare (HealthNet), there may be certain thresholds in which resolution comes from the Judge Advocate General’s office, as opposed to Tricare’s regional offices.

Resolving a VA claim has its own unique set of challenges, not the least of which is obtaining a bill for services rendered. When a third party liability claim is opened, the VA facility that provided treatment must generate the bills necessary to audit for injury-relatedness. This can take an additional amount of time, so the wise practitioner screens his or her cases for all potential forms of military health care coverage, as the only way to expedite the bureaucratic process is to attack it early and often.

With the same pressures placed on the VA and military health care systems to provide better health care at lower costs, the need to find additional sources of revenue is acute, especially where third parties are responsible, if not liable for creating those medical expenses, personal injury cases involving active service members and their families, and / or veterans requires an additional level of care. Cases involving VA or Tricare beneficiaries often require specialized knowledge, experience and compliance protocols. To that end, GRG would be happy to consult with you and take the leading role in your VA or Tricare lien resolution activities. For more information or to speak with our subject matter experts, call us at (704) 559-4300.

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