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Pafford Improper Lien with Medicaid Accident Victim Class Action

Plaintiff Karley Williams received head injuries in an accident that, according to the complaint, was not her fault. She was lucky enough to get a settlement from the insurance company of the at-fault driver, but the complaint alleges that the Pafford companies that transported her by ambulance and helicopter and billed for it placed a lien on the settlement funds, violating state and federal laws. Why the lien? Because Williams is a Medicaid patient and Pafford wants not just the Medicaid reimbursement but its “customary” charge of over $20,000 for transporting her.

The class for this action include all persons who were Arkansas Medicaid-eligible beneficiaries and received Medicaid-covered services from Pafford

  • Whose bills were not submitted to Arkansas Medicaid for payment,
  • Who received bills from Pafford for the difference between Pafford’s standard charges and the Medicaid reimbursement,
  • Who were or are being asked to make a payment that is outside of the Assignment Agreement or Provider Agreement,
  • Who were not refunded any such payments,
  • Who did not receive the benefit of collection from a source known to Pafford and most favorable to the patient,
  • Whose claim over a third party who was potentially liable was impaired by a lien in Pafford’s attempt to charge amounts over the Medicare reimbursement rate,
  • Whose claim for benefits was impaired by a lien in Pafford’s attempt to charge amounts over the Medicare reimbursement rate, and
  • Who were sent collection notices by Pafford that contained misleading statements or misrepresentations.

According to the complaint, Williams suffered various traumatic injuries in the accident, including the head injury, and was transported by a Pafford ambulance to a regional Arkansas hospital for evaluation. Then, the complaint says, she was taken by a Pafford helicopter to a level one trauma center in Tennessee for treatment. After she recovered, the complaint says, she sued the driver who was at fault and received an confidential sum as a settlement.

Williams was an Arkansas Medicaid recipient, but according to an Arkansas arrangement known as “the private option,” she received Medicaid benefits through a Qualified Health Plan (QHP) issued by QualChoice, a private company, with financial assistance from Medicaid.

According to the complaint, Pafford was supposed to bill QualChoice for its services at the Medicare rate. Instead, Pafford put a lien on the settlement for the full amount of its bill. The complaint alleges that this denies Williams her right to Medicaid benefits, in violation of Arkansas’s Medicaid laws and to avoid having their reimbursement limited to the amount they agreed to under their agreement with Medicaid and QualChoice.

According to the complaint, Arkansas Medicaid laws allow the state of Arkansas to pay providers and then seek reimbursement of Medicaid expenses from third parties; providers are forbidden from seeking payment directly from third parties. The complaint says they are also forbidden from trying to get Medicaid recipients to pay the difference between the Medicaid rate they agreed to and their “customary” higher charges; if they have an agreement with Medicaid, they must accept the Medicaid payment as payment in full.

The complaint says that Pafford’s actions in placing a lien on the settlement and trying to obtain its “customary” rate, rather than properly placing a claim with QualCare for the Medicaid rate, violates state and federal laws.

Article Type: Lawsuit
Topic: Consumer

Most Recent Case Event

Pafford Improper Lien with Medicaid Accident Victim Complaint

August 21, 2017

Plaintiff Karley Williams received head injuries in an accident for which she later got a settlement from the insurance company of the at-fault driver, but the complaint alleges that the Pafford companies that transported her by ambulance and helicopter placed a lien on the settlement funds, violating state and federal laws. Why the lien? Because Williams is a Medicaid patient and Pafford wants not just the Medicaid reimbursement but its “customary” charge of over $20,000 for transporting her. The complaint alleges that this violates state and federal laws saying that providers with cannot bill Medicaid patients or third parties directly in an attempt to get more than the Medicaid payment for services. 

improper_lien_on_settlement_complaint.pdf

Case Event History

Pafford Improper Lien with Medicaid Accident Victim Complaint

August 21, 2017

Plaintiff Karley Williams received head injuries in an accident for which she later got a settlement from the insurance company of the at-fault driver, but the complaint alleges that the Pafford companies that transported her by ambulance and helicopter placed a lien on the settlement funds, violating state and federal laws. Why the lien? Because Williams is a Medicaid patient and Pafford wants not just the Medicaid reimbursement but its “customary” charge of over $20,000 for transporting her. The complaint alleges that this violates state and federal laws saying that providers with cannot bill Medicaid patients or third parties directly in an attempt to get more than the Medicaid payment for services. 

improper_lien_on_settlement_complaint.pdf
Tags: Emergency Transportation, Medicaid, Medical Care