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Financial Responsibility of Law Enforcement for Hospital Bills

on Thursday, 6 September 2018 in Health Law Advisory: Zachary J. Buxton, Editor

On August 14, 2018, in Chase County v. City of Imperial, the Nebraska Court of Appeals decided a case that is helpful to hospitals and medical providers. The Court held that a law enforcement agency can be held financially liable for medical services provided to an arrested person even if the law enforcement agency has not completed the booking process or placed the person in jail.

Under the facts of the case, an Imperial police officer arrested a man for disturbing the peace and took him to the Chase County jail, where the jail employees began the booking process. Based on the arrestee’s condition, noncompliance and refusal to answer medical questions, a jail employee asked the police officer to take the arrestee to a hospital for medical clearance. The man was taken to the hospital and was medically cleared. He was then returned to the county jail. Because the arrestee did not have health insurance, the hospital billed both Chase County and the City of Imperial $436 for the medical evaluation. Each claimed the other was liable for the hospital bill. The county then filed an action in district court for a judgment as to whether the county or the city was liable for the hospital bill.

Both the city and county agreed that the case was to be decided by Neb. Rev. Stat. §§ 47-701 to 47-703, which “govern responsibility for payment of the costs of medical services for any person ill, wounded, injured, or otherwise in need of such services at the time such person is arrested, detained, taken into custody, or incarcerated.” This case is the first in which these statutes have been interpreted by a Nebraska appellate court.

Under section 47-702, the person who receives the medical care has primary responsibility for payment for the medical services, if the person has health insurance or other third party coverage. Medical providers should not deny services on the basis that the person presented by law enforcement is without insurance, as section 47-705 directs that any person denying services on that basis is guilty of nonfeasance, must be removed from employment and is answerable in civil damages. Because health insurance was not in place for the arrestee, the hospital in Chase County billed both the city and the county. The case then turned on the interpretation of section 47-703.

If the medical care is necessitated by injuries or wounds that occur during the course of apprehension or arrest, section 47-703 directs that the apprehending or arresting agency is financially responsible. In all other cases, the statute places liability on the agency responsible for operation of the institution or facility in which the recipient of the services is lodged. In this case, the arrestee had not been injured during the course of arrest or apprehension. Nevertheless, the county argued that because the booking process had not been completed and the person had not yet become an inmate of the jail, it was not financially responsible for the hospital bill. The Court of Appeals disagreed and held the county, not the city, liable for the hospital bill.

There are several takeaways from this case and the applicable statutes when a hospital seeks reimbursement for services provided to persons brought in by law enforcement. The hospital should first determine whether the patient has insurance or other third party coverage for the medical services provided and, if so, seek reimbursement from that source. Section 47-703 directs the law enforcement agency requesting medical services to notify the medical provider of all information possessed by the agency concerning potential sources of third party payment. If there is no third party liability, then section 47-703 permits the medical provider to bill the appropriate governmental agency, if the medical provider signs an affidavit stating that (1) denial of payment has been issued by a third party payer or (2) efforts have been made to identify sources and to collect from those sources and more than 180 days have passed or the normal collection efforts are exhausted since the medical services were rendered but full payment has not been received.

Based on the language in the case itself and the statutes cited, Chase County may be helpful to hospitals which have had law enforcement deny liability on the basis that the person was not formally arrested or placed in jail. In Chase County, the Court rejected the county’s argument that liability for medical care cannot arise prior to completion of the booking process. The Court stated: “We view the phrase ‘facility in which the recipient of the services is lodged’ to describe the governmental agency that operates the facility rather than to limit its responsibility for payment.” Sections 47-701 to 47-703 do not require formal arrest, completion of the booking process, or placement in jail. The statutes assign financial responsibility to a law enforcement agency if the person has been “detained” or “taken into custody.” If the person brought to the hospital has no insurance and no injuries or wounds arose from apprehension, then the hospital may seek reimbursement for services provided from the law enforcement agency that detained the person or took the person into custody, regardless of whether the person was arrested or placed in jail.

We will follow the case and alert readers of any appeal to the Nebraska Supreme Court and of any subsequent decision by that Court.

Barbara E. Person

Joseph P. Loudon

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