38 USC 1729 - Recovery by the United States of the cost of certain care and services

U.S Code last checked for updates: Nov 23, 2024

§ 1729.

Recovery by the United States of the cost of certain care and services

(a)

(1)

Subject to the provisions of this section, in any case in which the United States is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph (2) of this subsection, the United States has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the United States.

(2)

Paragraph (1) of this subsection applies to a non-service-connected disability—

(A)

that is incurred incident to the individual’s employment and that is covered under a workers’ compensation law or plan that provides for payment for the cost of health care and services provided to the individual by reason of the disability;

(B)

that is incurred as the result of a motor vehicle accident to which applies a State law that requires the owners or operators of motor vehicles registered in that State to have in force automobile accident reparations insurance;

(C)

that is incurred as the result of a crime of personal violence that occurred in a State, or a political subdivision of a State, in which a person injured as the result of such a crime is entitled to receive health care and services at such State’s or subdivision’s expense for personal injuries suffered as the result of such crime;

(D)

that is incurred by an individual who is entitled to care (or payment of the expenses of care) under a health-plan contract; or

(E)

for which care and services are furnished under this chapter to a veteran who—

(i)

has a service-connected disability; and

(ii)

is entitled to care (or payment of the expenses of care) under a health-plan contract.

(3)

In the case of a health-plan contract that contains a requirement for payment of a deductible or copayment by the individual—

(A)

the individual’s not having paid such deductible or copayment with respect to care or services furnished under this chapter shall not preclude recovery or collection under this section; and

(B)

the amount that the United States may collect or recover under this section shall be reduced by the appropriate deductible or copayment amount, or both.

(b)

(1)

As to the right provided in subsection (a) of this section, the United States shall be subrogated to any right or claim that the individual (or the individual’s personal representative, successor, dependents, or survivors) may have against a third party.

(2)

(A)

In order to enforce any right or claim to which the United States is subrogated under paragraph (1) of this subsection, the United States may intervene or join in any action or proceeding brought by the individual (or the individual’s personal representative, successor, dependents, or survivors) against a third party.

(B)

The United States may institute and prosecute legal proceedings against the third party if—

(i)

an action or proceeding described in subparagraph (A) of this paragraph is not begun within 180 days after the first day on which care or services for which recovery is sought are furnished to the individual by the Secretary under this chapter;

(ii)

the United States has sent written notice by certified mail to the individual at the individual’s last-known address (or to the individual’s personal representative or successor) of the intention of the United States to institute such legal proceedings; and

(iii)

a period of 60 days has passed following the mailing of such notice.

(C)

A proceeding under subparagraph (B) of this paragraph may not be brought after the end of the six-year period beginning on the last day on which the care or services for which recovery is sought are furnished.

(c)

(1)

The Secretary may compromise, settle, or waive any claim which the United States has under this section.

(2)

(A)

The Secretary, after consultation with the Comptroller General of the United States, shall prescribe regulations for the purpose of determining reasonable charges for care or services under subsection (a)(1) of this section. Any determination of such charges shall be made in accordance with such regulations.

(B)

Such regulations shall provide that reasonable charges for care or services sought to be recovered or collected from a third-party liable under a health-plan contract may not exceed the amount that such third party demonstrates to the satisfaction of the Secretary it would pay for the care or services if provided by facilities (other than facilities of departments or agencies of the United States) in the same geographic area.

(C)

Not later than 45 days after the date on which the Secretary prescribes such regulations (or any amendment to such regulations), the Comptroller General shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives the Comptroller General’s comments on and recommendations regarding such regulations (or amendment).

(d)

Any contract or agreement into which the Secretary enters with a person under section 3718 of title 31 for collection services to recover indebtedness owed the United States under this section shall provide, with respect to such services, that such person is subject to sections 5701 and 7332 of this title.

(e)

An individual eligible for care or services under this chapter—

(1)

may not be denied such care or services by reason of this section; and

(2)

may not be required by reason of this section to make any copayment or deductible payment in order to receive such care.

(f)

No law of any State or of any political subdivision of a State, and no provision of any contract or other agreement, shall operate to prevent recovery or collection by the United States under this section or with respect to care or services furnished under section 1784 of this title.

[(g)

Repealed. Pub. L. 105–33, title VIII, § 8023(b)(4), Aug. 5, 1997, 111 Stat. 667.]

(h)

(1)

Subject to paragraph (3) of this subsection, the Secretary shall make available medical records of an individual described in paragraph (2) of this subsection for inspection and review by representatives of the third party concerned for the sole purposes of permitting the third party to verify—

(A)

that the care or services for which recovery or collection is sought were furnished to the individual; and

(B)

that the provision of such care or services to the individual meets criteria generally applicable under the health-plan contract involved.

(2)

An individual described in this paragraph is an individual who is a beneficiary of a health-plan contract under which recovery or collection is sought under this section from the third party concerned for the cost of the care or services furnished to the individual.

(3)

Records shall be made available under this subsection under such conditions to protect the confidentiality of such records as the Secretary shall prescribe in regulations.

(i)

For purposes of this section—

(1)

(A)

The term “health-plan contract” means an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement, under which health services for individuals are provided or the expenses of such services are paid.

(B)

Such term does not include—

(i)

an insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of such Act (42 U.S.C. 1395j);

(ii)

a State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.);

(iii)

a workers’ compensation law or plan described in subparagraph (A) of subsection (a)(2) of this section; or

(iv)

a program, plan, or policy under a law described in subparagraph (B) or (C) of such subsection.

(2)

The term “payment” includes reimbursement and indemnification.

(3)

The term “third party” means—

(A)

a State or political subdivision of a State;

(B)

an employer or an employer’s insurance carrier;

(C)

an automobile accident reparations insurance carrier; or

(D)

a person obligated to provide, or to pay the expenses of, health services under a health-plan contract.

(Added Pub. L. 97–72, title I, § 106(a)(1), Nov. 3, 1981, 95 Stat. 1050, § 629; amended Pub. L. 99–272, title XIX, § 19013(a), Apr. 7, 1986, 100 Stat. 382; Pub. L. 100–322, title II, § 202, May 20, 1988, 102 Stat. 509; Pub. L. 101–508, title VIII, § 8011(a)–(c), Nov. 5, 1990, 104 Stat. 1388–344; Pub. L. 102–40, title IV, § 402(d)(1), May 7, 1991, 105 Stat. 239; renumbered § 1729 and amended Pub. L. 102–83, §§ 4(b)(1), (2)(E), 5(a), (c)(1), Aug. 6, 1991, 105 Stat. 404–406; Pub. L. 102–568, title VI, § 604, Oct. 29, 1992, 106 Stat. 4343; Pub. L. 103–66, title XII, § 12003, Aug. 10, 1993, 107 Stat. 414; Pub. L. 104–262, title I, § 101(d)(10), Oct. 9, 1996, 110 Stat. 3180; Pub. L. 105–33, title VIII, §§ 8022, 8023(b)(4), (d), Aug. 5, 1997, 111 Stat. 665, 667; Pub. L. 107–135, title II, §§ 208(e)(4), 209(b), Jan. 23, 2002, 115 Stat. 2463, 2464; Pub. L. 110–161, div. I, title II, § 232, Dec. 26, 2007, 121 Stat. 2273; Pub. L. 110–329, div. E, title II, § 225, Sept. 30, 2008, 122 Stat. 3713; Pub. L. 110–387, title VIII, § 804(b), Oct. 10, 2008, 122 Stat. 4141; Pub. L. 111–163, title V, § 518, May 5, 2010, 124 Stat. 1167; Pub. L. 112–154, title I, § 113, Aug. 6, 2012, 126 Stat. 1176; Pub. L. 113–37, § 2(d), Sept. 30, 2013, 127 Stat. 524; Pub. L. 113–175, title I, § 108, Sept. 26, 2014, 128 Stat. 1903; Pub. L. 114–58, title I, § 104, Sept. 30, 2015, 129 Stat. 532; Pub. L. 114–228, title I, § 104, Sept. 29, 2016, 130 Stat. 937; Pub. L. 115–62, title I, § 104, Sept. 29, 2017, 131 Stat. 1161; Pub. L. 115–182, title I, § 113, June 6, 2018, 132 Stat. 1421; Pub. L. 115–251, title I, § 104, title II, § 211(a)(8), Sept. 29, 2018, 132 Stat. 3168, 3175.)

cite as: 38 USC 1729