O.C.G.A. § 44-14-470 (2019)

Annotations

Cross references. Lien of Department of Community Health for payment of charges for medical assistance, § 49-4-149. Editor’s notes. Ga. L. 1986, p. 222, § 2, not codified by

the General Assembly, provided that that Act would apply to charges for care and treatment rendered on or after the effective date of the Act (March 20, 1986). Law reviews. For article, “An Insurer’s Duty to Settle: The Law in Georgia,” see 22 Ga. St. Bar J. 19 (Aug. 2016). For article with annual survey on torts, see 73 Mercer L. Rev. 243 (2021).

JUDICIAL DECISIONS Application of Uniform Commercial Code to creation of medical lien. - Georgia Court of Appeals held that both O.C.G.A. §§ 11-9-109(c)(2) and (d)(2) required a party asserting a medical lien to proceed under the medical lien statute, and expressly barred the creation of a medical lien through the process for creating an Article 9 security interest by agreement. Med-Care Solutions, LLC v. Bey & Assocs., LLC, 362 Ga. App. 861, 870 S.E.2d 456, 2022 Ga. App. LEXIS 107 (2022). Construction. - Georgia’s law providing for a hospital lien against a patient for services rendered, O.C.G.A. § 44-14-470 et seq., must be strictly construed. MCG Health, Inc. v. Owners Ins. Co., 302 Ga. App. 812, 692 S.E.2d 72, 2010 Ga. App. LEXIS 241 (2010), aff’d on other grounds, 288 Ga. 782, 707 S.E.2d 349, 2011 Ga. LEXIS 24 (2011). Liable party, not patient, subject to hospital lien. - Hospital’s petition fails to allege a cause arising under the hospital lien law against the defendant patient, for the reason that O.C.G.A. § 44-14-470 gives no right of action against the patient to whom hospitalization is furnished, but only against those liable to pay the patient’s damages; the right created is

analogous to the remedy provided by the garnishment laws. Hospital Auth. v. Boyd, 96 Ga. App. 705, 101 S.E.2d 207, 1957 Ga. App. LEXIS 668 (1957). Whether debt obligation of patient or other person or entity. - Court of appeals erred in holding that a debt had to be owed by a patient in order for a hospital to foreclose on a lien because it was not authorized to impose a requirement to O.C.G.A. § 44-14-470 that was not expressly stated therein; the hospital lien statute is silent as to whether the debt must be the obligation of the patient or the obligation of some other person or entity. MCG Health, Inc. v. Owners Ins. Co., 288 Ga. 782, 707 S.E.2d 349, 2011 Ga. LEXIS 24 (2011). Hospital can recover from patient merely by showing tort-feasor paid patient. - This action is purely statutory and it is only necessary to look to the terms of O.C.G.A. § 44-14-470 itself to ascertain whether the petition sets forth a cause of action. Therefore, petition need not allege more than the specific elements set forth in O.C.G.A. § 44-14-470, and where the petition shows the treatment by the hospital of an injured person, the accrual of charges pursuant thereto, the filing of the lien by the hospital, the filing

of a suit by the injured party and its subsequent dismissal on the payment of a sum of money by or on behalf of the party alleged to have been liable, and the execution of a release to such party by the injured person, all the elements of the cause of action on behalf of the hospital and against alleged to have been liable are stated, and it is unnecessary for the hospital to allege in its petition facts showing negligence or liability to the injured party, independently of the settlement and release. Dawson v. Hospital Auth., 98 Ga. App. 792, 106 S.E.2d 807, 1958 Ga. App. LEXIS 687 (1958). Hospital could assert lien for full amount of charges, even if most were written off pursuant to managed healthcare contract. - Because a patient could have sought recovery of $24,794 from a tortfeasor of a hospital’s billed charges incurred for his injuries, the hospital was entitled to assert a lien under O.C.G.A. § 44-14-471(b) for the unpaid portion of those billed charges, even though the patient’s managed care insurer was not responsible to pay these charges in full. The court held that Constantine v. MCG Health, Inc., 275 Ga. App. 128, 619 S.E.2d 718 (2005), had been implicitly overruled in part. MCG Health, Inc. v. Kight, 325 Ga. App. 349, 750 S.E.2d 813, 2013 Ga. App. LEXIS 983 (2013), cert. denied, No. S14C0603, 2014 Ga. LEXIS 363 (Ga. May 5, 2014), cert. denied, No. S14C0603, 2014 Ga. LEXIS 427 (Ga. May 19, 2014), aff’d, 296 Ga. 687, 769 S.E.2d 923, 2015 Ga. LEXIS 154 (2015). Use of chargemaster rates does not result in viable claims for fraud, negligent representation and RICO claims. - Supreme court overrules Clouthier v. Med. Center of Central Ga., Inc., 351 Ga. App. 883 (2019), and Aguila v. Kennestone Hosp., 353 Ga. App. 17 (2019), to the extent that those cases hold that viable claims for fraud, negligent representation, and violations of the Georgia Racketeer Influenced and Corrupt Organizations Act, O.C.G.A. § 16-14-1 et seq., can be maintained against hospitals that properly file liens based on standard chargemaster rates that reflect true market considerations such as hospital costs. Bowden v. Medical Ctr., Inc., 309 Ga. 188,

845 S.E.2d 555, 2020 Ga. LEXIS 464 (2020). Use of standard chargemaster rates by hospital. - Summary judgment was improperly denied to the medical center on the plaintiffs’ fraud and negligent misrepresentation claims because the center’s filing of a lien at the center’s chargemaster rate in compliance with Georgia’s lien statutes did not amount to making a false representation; and there was nothing fraudulent about the center’s using its standard chargemaster rates as the amount claimed to be due for the hospital to perfect the hopsital’s lien as the plaintiff could contest the reasonableness of the amount. Bowden v. Medical Ctr., Inc., 309 Ga. 188, 845 S.E.2d 555, 2020 Ga. LEXIS 464 (2020). Dismissal of the patient’;s complaint for fraud was upheld because it could not be said that the hospital had no basis for using its charge master rates to come up with an amount claimed to be due for purposes of securing a lien. Aguila v. Kennestone Hospital, 359 Ga. App. 419, 858 S.E.2d 241, 2021 Ga. App. LEXIS 211 (2021). Fact that the hospital’s reasonable charges initially claimed due under O.C.G.A. § 44-14-471(a)(2)(A) was significantly higher than the actual amount that the hospital could collect on the hospital’s lien did not establish fraudulent intent. Aguila v. Kennestone Hospital, 359 Ga. App. 419, 858 S.E.2d 241, 2021 Ga. App. LEXIS 211 (2021). Priority of attorney’s lien. - Where a hospital was an existing creditor at the time a settlement was obtained in an action brought by the hospital for payment of patient’s medical bills, and, in a separate suit for damages against a third party arising out of an automobile collision, the lien of the patient’s attorney on the settlement proceeds had priority over the hospital’s claims. Ramsey v. Sumner, 211 Ga. App. 202, 438 S.E.2d 676, 1993 Ga. App. LEXIS 1477 (1993). The liens established by O.C.G.A. §§ 44-14-470 and 49-4-149 are subject to any attorney’s lien. Holland v. State Farm Mut. Auto. Ins. Co., 236 Ga. App. 832, 513 S.E.2d 48, 1999 Ga. App. LEXIS 283 (1999), cert. denied, No. S99C0945, 1999

Ga. LEXIS 526 (Ga. June 4, 1999), cert. denied, No. S99C0897, 1999 Ga. LEXIS 527 (Ga. June 4, 1999). Uninsured motorist insurance. - A hospital could enforce its lien against money paid by a patient’s uninsured motorist carrier. Thomas v. McClure, 236 Ga. App. 622, 513 S.E.2d 43, 1999 Ga. App. LEXIS 273 (1999). Under O.C.G.A. §§ 33-7-11(b)(1)(D)(ii) (underinsured motorist coverage) and 4414-470(b) (hospital liens), a tortfeasor’s insurer’s payment of a hospital lien represented partial satisfaction of an injured insured’s claim; the injured insured’s UIM carrier was entitled to a credit for the payment of the lien against the insured’s coverage. State Farm Mut. Auto. Ins. Co. v. Adams, 288 Ga. 315, 702 S.E.2d 898, 2010 Ga. LEXIS 938 (2010). TRICARE coverage impacting recovery by hospital. - Trial court did not err in dismissing for failure to state a claim upon which relief could be granted a healthcare provider’s action against an insurer to collect on a hospital lien for services provided to a patient after the patient was injured in an automobile accident caused by an insured because the statutory and regulatory scheme that governed the United States Department of Defense TRICARE health insurance program did not provide any basis for allowing a contracting civilian healthcare provider to collect the provider’s treatment costs from a third-party tortfeasor/payer, and any state law that interfered with the financing of healthcare claims for TRICARE beneficiaries was preempted as a matter of federal statutory and regulatory law, 10 U.S.C. § 1103 and 32 C.F.R. § 199.17(a)(7); even if the healthcare provider was not obligated to adhere to the TRICARE statutory and regulatory scheme, by attempting to collect the provider’s lien from the patient’s settlement funds, the healthcare provider was violating the provider’s contract with a corporation, which prohibited the provider from obtaining any recourse from the TRICARE beneficiary. MCG Health, Inc. v. Owners Ins. Co., 288 Ga. 782, 707 S.E.2d 349, 2011 Ga. LEXIS 24 (2011). Hospital may put lien on damage claim of married woman not legally liable for payment. - There is nothing in O.C.G.A. § 44-14-470 which limits the

right of the hospital to the enforcement of a lien against the claim of one who would be legally liable to pay the hospital for the charges made, and the fact that the person treated in this case may have been a married woman and therefore not herself legally liable to pay for the necessary expenses of her treatment did not affect the hospital’s right to enforce its lien on her claim for damages. Dawson v. Hospital Auth., 98 Ga. App. 792, 106 S.E.2d 807, 1958 Ga. App. LEXIS 687 (1958). A hospital had a valid lien, etc. on all causes of action held by an injured party against those who allegedly caused an injury which attached at the moment the injured party received treatment. MaconBibb County Hosp. Auth. v. National Union Fire Ins. Co., 793 F. Supp. 321, 1992 U.S. Dist. LEXIS 9350 (M.D. Ga. 1992). Trial court erred by granting partial summary judgment to a patient because the hospital was not precluded from filing a hospital lien in order to collect charges associated with the patient’s treatment since the hospital’s contract with the patient’s insurer explicitly reserved the hospital’s right to collect deductibles and copays directly from the patient, irrespective of the agreement to hold the patient responsible only for a discounted price of treatment. Kight v. MCG Health, Inc., 296 Ga. 687, 769 S.E.2d 923, 2015 Ga. LEXIS 154 (2015). Hospital’s lien was invalid. - Trial court erred in denying the plaintiffs’ motion to strike a hospital’s lien under O.C.G.A. § 44-14-470(b) for the full amount of a hospital bill; the hospital did not dispute that a patient’s operation was covered by an agreement between the hospital and an insurer; thus, the hospital would be held to the terms of the bargain it struck. Constantine v. MCG Health, Inc., 275 Ga. App. 128, 619 S.E.2d 718, 2005 Ga. App. LEXIS 858 (2005), cert. denied, No. S06C0063, 2005 Ga. LEXIS 896 (Ga. Dec. 1, 2005). Although contract provisions between the U.S. Department of Defense TRICARE health insurance program and a hospital allowed the filing of a hospital lien against a tortfeasor’s insurer under O.C.G.A. § 44-14-470(b), the lien was in-

valid because other provisions of the contract negated any debt that could support it. MCG Health, Inc. v. Owners Ins. Co., 302 Ga. App. 812, 692 S.E.2d 72, 2010 Ga. App. LEXIS 241 (2010), aff’d on other grounds, 288 Ga. 782, 707 S.E.2d 349, 2011 Ga. LEXIS 24 (2011). Children’s wrongful death claims have priority over hospital’s claim of lien. - Since the decedent’s children filed a wrongful death complaint in relation to their mother’s death in a car wreck, the available insurance proceeds were then deposited into a court registry without the mother’s estate ever making a claim for medical payments, and since the available insurance proceeds were insufficient to cover both the children’s wrongful death claims and the O.C.G.A. § 44-14-470(b) medical services lien of a hospital which provided medical services to the mother after the car wreck, the trial court erred in satisfying the hospital’s lien from the limited funds instead of satisfying the children’s claims. Nash v. Allstate Ins. Co., 256 Ga. App. 143, 567 S.E.2d 748, 2002 Ga. App. LEXIS 858 (2002). Late filing of lien. - Even though a hospital was late in filing its lien 33 days after the discharge of a patient, the lien was not rendered unenforceable, particularly in light of the fact that the liable parties had actual notice of the lien and were not prejudiced by the late filing. Thomas v. McClure, 236 Ga. App. 622, 513 S.E.2d 43, 1999 Ga. App. LEXIS 273 (1999).

Inclusion of lien language did not invalidate settlement agreement. - Trial court properly awarded summary judgment to plaintiffs to enforce a settlement agreement because inclusion of the statutory healthcare-provider lien affidavit release information did not constitute a counteroffer and did not alter the fact that a meeting of the minds has occurred with regard to the terms of the settlement. Sherman v. Dickey, 322 Ga. App. 228, 744 S.E.2d 408, 2013 Ga. App. LEXIS 484 (2013). Insurer’s obligation to timely pay settlement demand did not impermissibly conflict with duty to satisfy hospital’s lien. - An injured party’s timelimited demand on an insurer to settle the injured party’s claim for policy limits, and a hospital’s assertion of a lien for the injured party’s care, did not place the insurer in the position of being required to make payments in excess of policy limits because the insurer could create a “safe harbor” from liability for a bad faith refusal to settle when (1) the hospital promptly settled a case involving clear liability and special damages exceeding policy limits, and (2) the sole reason for an inability to settle was an injured party’s unreasonable refusal to assure satisfaction of outstanding hospital liens. Southern Gen. Ins. Co. v. Wellstar Health Sys., 315 Ga. App. 26, 726 S.E.2d 488, 2012 Ga. App. LEXIS 306 (2012).

RESEARCH REFERENCES Am. Jur. 2d. 40 Am. Jur. 2d, Hospitals and Asylums, § 5. C.J.S. 41 C.J.S., Hospitals, §§ 13, 15. ALR. Liability of private noncharitable hospital or sanitarium for improper care or treatment of patient, 39 A.L.R. 1431; 124 A.L.R. 186.

Construction, operation, and effect of statute giving hospital lien against recovery from tortfeasor causing patient’s injuries, 16 A.L.R.5th 262. Physicians’ and surgeons’ liens, 39 A.L.R.5th 787. Propriety and use of balance billing in health care context, 69 A.L.R.6th 317.