2021 Georgia Code
Title 44 - Property
Chapter 14 - Mortgages, Conveyances to Secure Debt, and Liens
Article 8 - Liens
Part 8 - Hospitals and Nursing Homes
§ 44-14-470. Lien on Causes of Action Accruing to Injured Person for Costs of Care and Treatment of Injuries Arising Out of Such Causes of Action

1. Except where the context otherwise requires in subsection (b) of this Code section, as used in this part, the term:
   1. "Hospital" means any hospital or nursing home subject to regulation and licensure by the Department of Community Health.
   2. "Hospital care, treatment, or services" means care, treatment, or services furnished by a hospital or nursing home.
   3. "Nursing home" means any intermediate care home, skilled nursing home, or intermingled home.
   4. "Physician practice" means any medical practice that includes one or more physicians licensed to practice medicine in this state.
   5. "Traumatic burn care medical practice" means care, treatment, or services rendered by a medical practice with respect to a patient whose burn care, treatment, or services resulted in charges in excess of $50,000.00, arising out of a single accident or occurrence.
2. Any person, firm, hospital authority, or corporation operating a hospital, nursing home, or physician practice or providing traumatic burn care medical practice in this state shall have a lien for the reasonable charges for hospital, nursing home, physician practice, or traumatic burn care medical practice care and treatment of an injured person, which lien shall be upon any and all causes of action accruing to the person to whom the care was furnished or to the legal representative of such person on account of injuries giving rise to the causes of action and which necessitated the hospital, nursing home, physician practice, or provider of traumatic burn care medical practice care, subject, however, to any attorney's lien. The lien provided for in this subsection is only a lien against such causes of action and shall not be a lien against such injured person, such legal representative, or any other property or assets of such persons and shall not be evidence of such person's failure to pay a debt. This subsection shall not be construed to interfere with the exemption from this part provided by Code Section 44-14-474.

(Ga. L. 1953, Nov.-Dec. Sess., p. 105, § 1; Ga. L. 1983, p. 548, § 1; Ga. L. 1986, p. 222, § 1; Ga. L. 2002, p. 1141, § 1; Ga. L. 2002, p. 1429, § 1; Ga. L. 2004, p. 394, § 1; Ga. L. 2008, p. 12, § 2-36/SB 433.)

The 2002 amendments. The first 2002 amendment, effective July 1, 2002, added paragraph (a)(4); and, in the first sentence of subsection (b), inserted "or providing traumatic burn care medical practice", substituted "hospital, nursing home, or traumatic burn care medical practice" for "hospital or nursing home" and substituted "hospital, nursing home, or provider of traumatic burn care medical practice" for "hospital or nursing home" near the end. The second 2002 amendment, effective July 1, 2002, added the second sentence in subsection (b).

The 2004 amendment, effective July 1, 2004, added present paragraph (a)(4); redesignated former paragraph (a)(4) as present paragraph (a)(5); and, in subsection (b), substituted "hospital, nursing home, or physician practice" for "hospital or nursing home" and inserted "physician practice," twice.

The 2008 amendment, effective July 1, 2009, substituted "Department of Community Health" for "Department of Human Resources" in paragraph (a)(1).

- Lien of Department of Community Health for payment of charges for medical assistance, § 49-4-149.

- 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).

- For article, "An Insurer's Duty to Settle: The Law in Georgia," see 22 Ga. St. Bar J. 19 (Aug. 2016).

JUDICIAL DECISIONS

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).

- 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).

- 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).

- 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).

- 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), aff'd, 296 Ga. 687, 769 S.E.2d 923 (2015).

- 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).

- 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).

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, Ga. App. , S.E.2d (May 7, 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, Ga. App. , S.E.2d (May 7, 2021).

- 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).

The liens established by O.C.G.A. §§ 44-14-470 and49-4-149 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).

- 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).

Under O.C.G.A. §§ 33-7-11(b)(1)(D)(ii) (underinsured motorist coverage) and44-14-470(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).

- 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).

- 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).

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. Macon-Bibb County Hosp. Auth. v. National Union Fire Ins. Co., 793 F. Supp. 321 (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 co-pays 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).

- 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).

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 invalid 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).

- 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).

- 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).

- 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).

- An injured party's time-limited 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).

Cited in Spengler v. Employers Com. Union Ins. Co., 131 Ga. App. 443, 206 S.E.2d 693 (1974); Integon Indem. Corp. v. Henry Medical Ctr., Inc., 235 Ga. App. 97, 508 S.E.2d 476 (1998); Watts v. Promina Gwinnett Health Sys., Inc., 242 Ga. App. 377, 530 S.E.2d 14 (2000).

RESEARCH REFERENCES

Am. Jur. 2d.

- 40 Am. Jur. 2d, Hospitals and Asylums, § 5.

- 41 C.J.S., Hospitals, §§ 13, 15.

- 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.