Detailed Answer — overview and step‑by‑step process

When you settle a personal injury claim in Maryland, medical providers and public programs may have a right to be repaid from your recovery. Identifying and resolving those liens before you disburse settlement funds protects you, your attorney, and the settlement proceeds. Below is a clear, practical process to follow.

1) Gather all medical and billing records

Collect every medical record, itemized bill, explanation of benefits (EOB), and bill collection notice that relates to the injury. This includes hospital bills, doctor bills, ambulance bills, physical therapy, imaging, and pharmacy charges. These documents show which providers treated you and how much they billed.

2) Ask each provider in writing whether it has or will assert a lien

Send a short written request (email or certified letter) to each provider asking whether it claims a lien on any settlement or judgment. Request an itemized, current statement of charges and any statutory or contractual basis for the lien. Keep copies of all communications.

3) Check public and insurer subrogation or repayment interests

Check for:

• Private health insurance subrogation — insurers sometimes have contractual subrogation rights and will want repayment for amounts they paid on your behalf.
• Medicare conditional payments — if Medicare paid for injury‑related care, it may seek repayment. The federal Medicare Secondary Payer rules apply; see Medicare’s recovery guidance (federal law) for conditional payment claims: 42 U.S.C. § 1395y.
• Maryland Medicaid (Medical Assistance) — Maryland’s Medicaid program has a recovery interest in certain settlements. Contact the Maryland Department of Health’s Medicaid unit to get a statement of claim: Maryland Department of Health.
• Worker’s compensation or other governmental payors — if workers’ comp or another program paid medical bills, it may have lien or subrogation rights.

4) Identify the legal basis and priority of each lien

Different liens have different legal bases and priorities. For example, private contractual subrogation claims differ from statutory Medicaid claims, and federal Medicare interests are governed by federal law. Search Maryland statutes and regulations or consult the Maryland General Assembly website for the code sections that govern provider claims and public program recovery: Maryland General Assembly (Code search). Also review Maryland court rules at mdcourts.gov.

5) Demand written lien statements or proof of assignment

Request that any provider or insurer asserting a lien give you a written statement showing (a) the amount claimed, (b) items covered, (c) the dates of service, and (d) the legal basis for the claim (statute, contract, assignment, or court‑filed lien). If a bill was sold to a third‑party debt buyer, ask for proof of assignment.

6) Verify amounts and challenge inaccurate claims

Compare claimed lien amounts to itemized bills and EOBs. Typical reductions include:

• Billed charges vs. allowed amounts (insurers/Medicare usually pay a reduced “allowed” amount).
• Duplicate or unrelated charges.
• Charges discharged by insurance that still appear on a bill.

Ask providers to accept negotiated payoffs or to reduce claims for prompt payment. Many providers will accept substantially less than the billed amount, particularly for cash settlements.

7) Negotiate lien resolutions before final disbursement

Negotiate settlement allocations with lienholders. For public programs (Medicaid), submit a formal demand for a payoff figure and use the program’s procedures to obtain a final claim amount. For Medicare, obtain a conditional payment report and a demand letter amount from CMS before settling. Consider placing disputed funds in escrow until claims are resolved.

8) Obtain releases or lien satisfaction documents in writing

Before distributing settlement proceeds, obtain signed releases, lien waivers, or satisfaction statements from every party asserting a lien. For public payors, get the official letter or form that shows the amount paid or the amount due. If a provider refuses to provide a release, get a signed written agreement describing the reduced amount they will accept and proof of payment.

9) Use escrow or court approval when necessary

If lienholders cannot be located, will not cooperate, or multiple claims remain in dispute, consider placing funds in escrow or asking a Maryland court to approve a structured distribution or allocation of the settlement. Escrow or court approval protects you from later claims for paid amounts.

10) Keep full documentation of every step

Retain copies of medical records, bills, correspondence, payoff letters, releases, settlement agreements, escrow records, and proof of disbursement. If a later dispute arises, that documentation shows that you and your attorney took reasonable steps to identify and resolve liens.

Hypothetical example

Jane is injured in a Maryland car crash. She has $30,000 in hospital bills, private insurance paid $18,000, leaving $12,000 billed to Jane. Insurer offers Jane $50,000 to settle. Jane’s attorney requests written lien statements from the hospital and the insurer. The hospital agrees to a $6,000 payoff if paid at closing. Maryland Medicaid reports no claim. Jane obtains a Medicare conditional payment check and a CMS demand letter (no Medicare claim here). After negotiation, the parties sign releases and the settlement pays the negotiated hospital amount from the settlement proceeds; Jane receives the net balance after attorney fees and costs.

Relevant Maryland resources

• Maryland Department of Health (Medicaid and program contacts): health.maryland.gov
• Maryland General Assembly — search Maryland Code for statutes affecting medical provider claims and Medicaid recovery: mgaleg.maryland.gov
• Maryland Courts (court rules, forms, and procedures): mdcourts.gov
• Medicare Secondary Payer rules (federal law governing Medicare conditional payments): 42 U.S.C. § 1395y

Important: State statute sections and program rules can change. Use the Maryland General Assembly site to find current statutory language or consult the Maryland Department of Health for program‑specific procedures.

When to consult a lawyer

If lien amounts are large, multiple lienholders disagree, a public program asserts a claim (Medicaid/Medicare), or a provider refuses to provide written payoff figures, you should involve an attorney experienced in Maryland personal injury settlements and lien resolution. An attorney can negotiate payoffs, place funds in escrow, or ask a court to allocate settlement proceeds to avoid future personal liability.

Disclaimer

This article explains general steps to identify and resolve medical liens in Maryland and cites authoritative government resources. It does not provide legal advice, create an attorney‑client relationship, or substitute for professional legal counsel. Laws and procedures change; contact a qualified Maryland attorney to discuss specific facts and deadlines.

Helpful Hints

• Start lien checks early—do not wait until the settlement conference or closing.
• Request written payoff amounts from Medicaid and Medicare well before settlement.
• Get itemized bills and EOBs to spot duplicate or unrelated charges.
• Negotiate aggressively—many providers accept reduced payoffs for prompt payment.
• Don’t disburse funds until you have written releases or a court order; escrow disputed funds if necessary.
• Keep a clear paper trail: letters, timestamps, certified mail receipts, emails, settlement accounting, and receipts.
• If you have Medicare or Medicaid involvement, follow their formal demand and appeals processes to prevent repayment claims later.
• Consider professional help (attorney or lien resolution company) if multiple or complex claims exist.