Ohio Tort Recovery Unit

Frequently Asked Questions

What is the difference between Medicaid and Medicare?

In broad, general terms, Medicaid is health insurance for the indigent; Medicare is health insurance for the elderly and disabled. Medicaid is a State administered health insurance program overseen by the federal Centers for Medicaid and Medicare Services (CMS). Medicare is a federally administered program. A person may have both Medicaid and Medicare. The Ohio Tort Recovery Unit 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 (513) 852-4353.

Does the State of Ohio contribute to attorney's fees and costs for recovery in a settlement or lawsuit that involves a Medicaid recipient?

Pursuant to Ohio Revised Code Section 5160.37, the State of Ohio does not contribute to attorney's fees or costs for recovery of Medicaid funds in a settlement or lawsuit that involves a Medicaid recipient. Attorney's fees and costs are subtracted from any settlement or judgement before ODM recovers its lien amount, but ODM lien is not pro rated for any fees or costs.

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

Typically it takes two to three weeks to get paid claims information from the Tort Recovery Unit. However, each case is different. For example, if the date of the accident or incident is greater than one year, it may take longer to get claims information than if the accident or incident was six months ago. Also, Medical providers have up to one year from the date of service to bill Medicaid. If a Medicaid Manage Care Plan (MCP) provided services to the Medicaid recipient, the Tort Recovery Unit must request claim information from the MCP and the MCP has 30 days to reply.

What is a Medicaid recipient's liability to the Medical provider?

Please see Ohio Administrative Code 5160-1-13.1

If the tort or casualty involves a municipality, is the municipality immune from Medicaid's recovery under ORC 2744.05?

ORC 2744.05

ORC section 2744.05 was first enacted under HB 176 and became effective November 20, 1985. In essence ORC 2744.05 places limitations on damages awarded a person in actions against a political subdivision where the damages were the result of an act or omission of the subdivision in connection with a governmental or proprietary function. HB 350 amended ORC 2744.05 effective January 27, 1997. However, ORC 2744.05(B)(2)(b) states that the limitation to damages in an action against a political subdivision does not "prohibit the department of medicaid from recovering from the political subdivision, pursuant to section 5160.37 of the Revised Code, the cost of medical assistance provided under a medical assistance program."

What if a final settlement amount is achieved prior to obtaining a final lien amount from the Ohio Tort Recovery Unit?

Ohio Tort Recovery generally must wait until it receives all medical billing before issuing a final lien letter. However, if the medical billing already received equals or exceeds the dollar amount of what ODM would receive under the statutory formula set forth in ORC 5160.37(G)(2), Ohio Tort Recovery may be able to issue a reduction request response (approval or denial) in lieu of a final lien letter.

In order for Ohio Tort Recovery to expedite resolution, it needs for you to complete a reduction request form. A reduction request form may be obtained by calling 1-888-245-9019 and requesting a compromise form.

A completed reduction request form must include written assurance from you or your attorney that:

The dollar amount you state in the compromise request form as the settlement amount is the total settlement or judgment amount against all the parties you are seeking recovery against. (ie. Copy of the settlement statement or offer from the third party).
There are no other parties you are or will be seeking a recovery against.

What if the insurance carrier will not release the insurance proceeds until ODM's lien interest is addressed and there is not a final lien amount?

Ohio Tort Recovery may be agreeable to the insurance carrier releasing the insurance proceeds. The Ohio Tort Recovery will need the following written assurances from you or your attorney before deciding whether to agree to the release of the proceeds:

After reasonable attorney fees (as defined by ORC 5160.37(G)(2)) and costs are deducted from the insurance proceeds, one-half of the balance will be held in a lawyer's trust account until ODM's lien interest is resolved.
If you are or will be seeking recovery against one or more additional parties concerning your claim, one half of the balance of any resulting settlements or judgments, as described above, will be held in a lawyer's trust account until ODM's lien interest is resolved. In the alternative, a statement can be provided that there are no other parties you will seek a recovery against.

Phone:	888-245-9019
Fax:	614-242-1051
Email:	ohiotort@gainwelltechnologies.com