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New York Medicaid

a service of HMS

Who is HMS?

 Every year HMS (hms.com) saves state government agencies billions of dollars by identifying and preventing fraud, waste, and abuse; and increasing system efficiency through healthcare cost containment solutions. In New York, Health Management Systems (HMS) is both the Recovery Audit Contractor (RAC) and the Third Party Liability (TPL) contractor for the Office of the Medicaid Inspector General (OMIG).

As the Third Party Liability contractor, HMS is responsible for recovering Medicaid from personal injury settlements (casualty), real property liens and estates in order to ensure the continued financial viability of the Medicaid program, in accordance with applicable New York State Social Services Law.

Personal Injury Settlements (Casualty)

 How does HMS assist the New York State Office of the Medicaid Inspector General with Personal Injury Settlements (Casualty)?

  • HMS is contracted to recover Medicaid expenditures related to the injury.

I am represented by an attorney, can I contact HMS directly?

  • No, HMS cannot discuss your case with you because you are represented by counsel.  HMS can discuss your case with your attorney.

Why did I receive a letter from HMS?

  • Anytime an individual who is currently or has ever been on Medicaid and while they are Medicaid eligible has an accident or injury that results in an insurance claim being filed HMS receives the patient’s information to investigate.  If HMS discovers that there is a third party who should be paying claims that were paid by Medicaid, HMS makes sure that the bills are paid by the correct party.

I was not in an accident, what do I do?

  • If there was no accident, then you can just indicate that on the form and return it.
  • The State gets its information from several sources.  First, if an insurance company begins the claim process, for any reason, they are required by law to submit that information to the State.

I am not on Medicaid, what do I do?

  • If you have been eligible for benefits at any point, even if you did not actually use them or are not eligible now, there is the potential that you can appear on Medicaid’s radar.
  • Fill out the questionnaire to the best of your ability, providing as much information as possible, and return it to HMS.
  • If you have an attorney, you should give it to your attorney, as HMS will be directing all future correspondence to your attorney.

If you have questions, please contact HMS at (877) 331-1460.

Real Property Liens

 
How does HMS assist the County with Real Property Liens?

  • HMS is contracted to file liens on behalf of the County Department of Social Services.

How does this work?

  • Pursuant to New York Social Services Law Section 369, the County Department of Social Services may file a lien against real property of a Medicaid recipient currently residing in an institution in lieu of forcing the sale of said property, in order to obtain Medicaid eligibility.  Accordingly, the Medicaid recipient and personal representative/fiduciary will be served with a copy of the lien filed with the County Clerk’s Office.

If you have questions relating to Real Property Liens, please contact HMS at (866) 567-6318.

Estates

How does HMS assist the New York State Office of the Medicaid Inspector General with Estates?

  • HMS is contracted to perform asset research and conduct the estate recovery process on behalf of the Local Districts of Social Services, New York State of Health and the New York State Office of the Medicaid Inspector General.

How does this work?  How does New York State Medicaid get paid?

  • There is a hierarchy of creditors against an estate.  First, all of the funeral expenses are to be paid.  Then, all of the administrative costs of the estate are to be paid, including attorneys’ fees, accounting fees, and taxes.  The State qualifies as a preferred creditor and collects after the funeral and administrative costs have been satisfied and any Federal liens (such as Medicare) have been paid.

The Medicaid Recipient/Decedent had nothing, what do I do?

  • Fill out the questionnaire to the best of your ability.  Most of your answers will probably be “No”.  Return it to HMS in the envelope provided.  If we have questions or need clarification we will follow up.

Our family does not have any money, how are we supposed to pay this?

  • The claim is against the estate only and only pertains to assets in the Recipient’s/Decedent’s name.  You or other family members are NOT responsible for satisfying this claim out of your own pockets.

I am the Medicaid Recipient’s/Decedent’s spouse.  Are you going to take my house and my money?  Is this going to affect my Medicaid?

  • No, because you are a surviving spouse and are therefore exempt at the time of the Recipient’s passing.  Return the questionnaire with the number 2 completed along with a copy of the death certificate.  Please note that the law provides that we are allowed to recover from your estate when you pass away.

There are assets in the Medicaid Recipient’s/Decedent’s name.  What happens next?

  • Complete the questionnaire with those details.  HMS will file a claim against the estate in the Surrogate’s Court.  You will receive a copy of that claim from HMS.

If you have questions, please contact HMS at (877) 331-1460.