Military veterans and their family members may have health insurance coverage under the Veterans' Administration (VA), Tricare or ChampVA. When settling a case involving beneficiaries of one of those programs, you need to be aware of the potential recovery rights of each program. Here is a short synopsis of how those recovery rights may ripen:
VA – The Veterans Health Administration is the largest integrated health care system in the United States. The VA provides healthcare insurance to all eligible and enrolled veterans for inpatient and outpatient services at these facilities.
After rendering treatment, the VA may seek recovery pursuant to 38 U.S.C. § 1729 and/or the Federal Medical Cost Recovery Act (42 U.S.C. §§2651 - 2653) for medical care it provides that is related to a compensable claim. The VA has both a right of subrogation as well as an independent right of recovery when some responsible third party exists. While the laws are broadly written to contemplate recovery for future medicals, we have not seen the VA, in practice, later seek future medical expenses. Any such future medical claim is addressed as part of recovery for its past medical interests.
Tricare – Tricare offers healthcare insurance to active military members, families of those members and certain retirees. Coverage under Tricare extends to medical facilities outside of the VA system described above.
Similar to the VA, Tricare will seek recovery pursuant to 38 U.S.C. § 1729 and/or the Federal Medical Cost Recovery Act (42 U.S.C. §§2651 - 2653). Tricare has both a right of subrogation and an independent right of recovery when a responsible third party exists. While Tricare does not assert a right to a "set-aside" per se, 32 C.F.R. § 199.12 provides that Tricare can incorporate certain identifiable future medicals related to the compensable claim within its recovery claim. "No TriCare-related claim will be settled, compromised or waived without full consideration being given to the possible future medical payment aspects of the individual case." 32 C.F.R. § 199.12.
ChampVA – ChampVA is a VA Health care program for the spouse or child of a Veteran who is permanently disabled or deceased from a service connected disability.
Cattie has experience working with these agencies, and negotiating reasonable lien reductions based on the current statutory and regulatory environment. If you'd like to put our experience to work for you and your client, please let us know.