Nevada Medical Liens: A PI Staff Guide to NRS 108.585–108.660, Medicaid and LOPs

When a Nevada personal injury case resolves, the settlement check is rarely the client's alone. Hospitals, Medicaid, Medicare, health plans, treating providers on letters of protection, and prior counsel may all claim a share. This guide walks PI paralegals and case managers through the main Nevada lien types, what the statutes actually say, and a practical tracking workflow.

1. Hospital liens under NRS 108.585 to 108.660

What it attaches to. When a person receives hospitalization for an injury and claims damages from the person responsible, the hospital has a lien on any sum awarded by judgment or obtained by settlement or compromise, "to the extent of the amount due the hospital for the reasonable value of the hospitalization rendered before the date of judgment, settlement or compromise" (NRS 108.590(1)). The lien does not reach care rendered after settlement (NRS 108.600(1)).

Attorney's fees and costs come off the top. No hospital lien applies against the sums the injured party incurred for necessary attorney's fees, costs and expenses in securing the recovery (NRS 108.600(2)).

Workers' compensation carve-out. The lien is not valid against anyone covered by NRS chapters 616A to 616D or chapter 617 (Nevada's industrial insurance and occupational disease laws) (NRS 108.590(2)(a)).

How a hospital perfects the lien (NRS 108.610)

1. Record a notice of lien, substantially in the statutory form (NRS 108.620) with an itemized statement, before any money is paid to the injured person or their representative. It is filed with the county recorder where the hospital is located and, if different, where the injury occurred.
2. Serve a certified copy by registered or certified mail on the person alleged to be responsible, before the date of judgment, settlement or compromise.
3. Serve a certified copy by registered or certified mail on that person's liability insurer, if known, before the date of judgment, settlement or compromise.

The statutory form recites that "90 days have not elapsed since the termination of hospitalization" (NRS 108.620), so check timing when you receive a notice.

In-network hospitals: notice of intent (NRS 108.605)

If the patient has health insurance and the hospital has a contract with that insurer, a hospital that wants to perfect a lien must, within 90 days after hospitalization ends, send a notice of intent to file a lien by registered or certified mail to the liability carrier (if known) and to the injured person and their legal representative. Within 30 days after sending it, the hospital must pursue collection under NRS 449A.159. If it does not, the notice of intent is void from the start (NRS 108.605(2), (4)). If a judgment or settlement follows, anyone who received the notice must tell the hospital in writing (NRS 108.605(3)). This section does not apply to Medicaid, Medicare, CHIP or other public programs (NRS 108.605(5)).

The 55% cap for public-program patients (NRS 108.655)

If the injured person may be eligible for Medicaid, Medicare, the Children's Health Insurance Program or another public program that may pay all or part of the bill, the hospital may not receive more than 55 percent of its billed charges under the statutory lien. Flag this on intake whenever a client has, or may qualify for, public coverage.

What happens if a carrier pays around the lien (NRS 108.650)

A person or insurer that receives a certified copy of the notice and then pays the injured person, heirs, representatives or attorney without paying the hospital (after attorney's fees, costs, expenses and prior liens) is liable to the hospital for 180 days after that payment. Payments to publicly owned or nonprofit hospitals must be made by separate check or, where NRS 353.1467 applies, by electronic transfer. Liable parties may also examine and copy the hospital's records for that stay (NRS 108.640). The lien can be foreclosed in district court, and the court awards filing and recording costs and reasonable attorney's fees to a prevailing hospital (NRS 108.660).

Separately, NRS 108.662 to 108.668 give certain county and district hospitals a lien on real property. That is a different lien from the settlement lien above.

2. Nevada Medicaid and CHIP (NRS 422.293)

When Medicaid or Nevada CHIP pays for injury-related care, the state agency is subrogated to the recipient's rights and has a lien on the proceeds of any recovery, whether by judgment, settlement or otherwise (NRS 422.293(1), (3)). The lien must be satisfied in full, unless reduced, when proceeds are distributed. The agency may reduce the lien in consideration of the attorney's services if it received notice under NRS 422.293001 (NRS 422.293(4)). The recipient's attorney must give written notice to the agency on agreeing to represent the recipient (NRS 422.293001). Nevada also has a separate Medicaid lien scheme in NRS 108.850 to 108.870.

3. Medicare conditional payments

Medicare's recovery right is federal (Medicare Secondary Payer law) and is handled through the CMS Benefits Coordination & Recovery Center. It is not a Nevada statutory lien. See our full guide: Medicare conditional payments and the BCRC.

4. Provider "liens" and letters of protection

Many Nevada PI clients treat with chiropractors, physical therapists, imaging centers, pain management and surgical providers who agree to wait for payment until the case resolves. Outside the hospital statute, these arrangements are generally contractual, created by a lien agreement or letter of protection (LOP) the client signs. The terms of each document control. Track every one separately, and have the supervising attorney review any reduction request or dispute.

5. Prior-attorney liens (NRS 18.015)

An attorney has a lien on a claim placed in their hands for suit or collection. The lien is for the agreed fee or, without an agreement, a reasonable fee (NRS 18.015(1)–(2)). It is perfected by written notice served in person or by certified mail, return receipt requested, on the client and, if applicable, on the opposing party (NRS 18.015(3)). It attaches to any verdict, judgment, decree and money recovered (NRS 18.015(4)). On a substitution of counsel, request the prior firm's lien notice early.

6. Health plan reimbursement and subrogation

Private health plans, including self-funded ERISA plans, often claim reimbursement under the plan documents. Their rights depend on the plan language and on federal versus state law, so request the governing plan documents and an itemized payment ledger for every plan that paid injury-related charges.

7. A lien-tracking workflow that holds up at disbursement

Want this done for you? Our Health Insurance Lien Setup service helps, and lien tracking is part of the All Inclusive plan.