Utah Code 26B-3-1012. Department’s right to intervene — Department’s interests protected — Remitting funds — Disbursements — Liability and penalty for noncompliance
Current as of: 2024 | Check for updates
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(1) The department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance.
Terms Used In Utah Code 26B-3-1012
- Claim: means :(3)(a) a request or demand for payment; or(3)(b) a cause of action for money or damages arising under any law. See Utah Code 26B-3-1001
- Equal: means , with respect to biological sex, of the same value. See Utah Code 68-3-12.5
- Lien: A claim against real or personal property in satisfaction of a debt.
- Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
- Medical assistance: means :
(8)(a) all funds expended for the benefit of a recipient under this chapter or Titles XVIII and XIX, federal Social Security Act; and(8)(b) any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department. See Utah Code 26B-3-1001- Office of Recovery Services: means the Office of Recovery Services within the department. See Utah Code 26B-3-1001
- Recipient: means :
(11)(a) an individual who has applied for or received medical assistance from the state;(11)(b) the guardian, conservator, or other personal representative of an individual under Subsection (11)(a) if the individual is a minor or an incapacitated person; or(11)(c) the estate and survivors of an individual under Subsection (11)(a), if the individual is deceased. See Utah Code 26B-3-1001- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
- Third party: includes :
(15)(a) an individual, institution, corporation, public or private agency, trust, estate, insurance carrier, employee welfare benefit plan, health maintenance organization, health service organization, preferred provider organization, governmental program such as Medicare, CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by department rule; and(15)(b) a spouse or a parent who:(15)(b)(i) may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order; or(15)(b)(ii) has been ordered to maintain health, dental, or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order. See Utah Code 26B-3-1001- Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. Source: OCC
(2)(2)(a) If the recipient proceeds without complying with the provisions of Section 26B-3-1011, the department is not bound by any decision, judgment, agreement, settlement, or compromise rendered or made on the claim or in the action.(2)(b) The department:(2)(b)(i) may recover in full from the recipient, or any party to which the proceeds were made payable, all medical assistance that the department has provided; and(2)(b)(ii) retains its right to commence an independent action against the third party, subject to Subsection 26B-3-1009(3).(3) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than five business days after receipt.(4)(4)(a) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient’s attorney shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days after the funds are placed in the attorney’s trust account.(4)(b) The date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient’s attorney.(4)(c) The department’s consent to another date for remittance may not be unreasonably withheld.(4)(d) If the funds are received by the recipient’s attorney, no disbursements shall be made to the recipient or the recipient’s attorney until the department’s claim has been paid.(5) A recipient or recipient’s attorney who knowingly and intentionally fails to comply with this section is liable to the department for:(5)(a) the amount of the department’s claim or lien pursuant to Subsection (1);(5)(b) a penalty equal to 10% of the amount of the department’s claim; and(5)(c) attorney fees and litigation expenses related to recovering the department’s claim.