Claims Filing: Health Centers
For more information on the claims process for free clinics, go to Claims Filing for Free Clinics and read Policy Information Notice 2011-02 (PDF - 224 KB): Free Clinics Federal Tort Claims Act (FTCA) Program Policy Guide, Section VI: Claims Process.
Under the FTCA, all claims must be filed with the Public Health Service (PHS) Claims Office before a Federal suit may be filed. Should a plaintiff’s attorney file actions against a deemed health center in state court, the health center should take the following steps:
All state court complaints and notices of intent should be sent immediately upon receipt by fax or email to:
U.S. Department of Health and Human Services
Office of the General Counsel
General Law Division
Claims and Employment Law Branch
330 C Street, SW
Switzer Building, Suite 2600
Washington, DC 20201
Fax No.: 202-619-2922
If a plaintiff or plaintiff’s attorney contacts the health center regarding this issue, the health center should instruct a plaintiff or plaintiff’s attorney to submit the FTCA (SF-95) filing by mail to the above address.
After an initial review, the Office of General Counsel may instruct the health center to send three copies of the following documents to the above address.
- Deeming Letters.
- Wage and Tax Forms: W-2 forms for each individual involved in the incident who was working for the health center at the time of the alleged negligence. If the individual was a contractor, please send the 1099 form and an employment contract covering the period of the alleged negligence. If the health center does not store W-2 or 1099 forms, then the health center must retrieve and provide them to verify the status of the individual.
- Declaration: A declaration signed by the practitioner that the practitioner is licensed to practice medicine and that the practitioner was not billing privately. It should include the statement, "I certify this is true under penalty of perjury," but it need not be notarized. A separate declaration must be signed by each practitioner named in the complaint or in the notice of intent to file suit. If the employee is no longer working at a health center, then the health center must provide a separate statement that (a) it has made a good faith attempt to locate the employee, (b) they are unable to do so, and (c) that to the best of the health center's knowledge, the employee did not bill privately for treatment.
- Medical Records: All of the plaintiff's medical records from the health center and any private facility that might be involved.
- Insurance Policies: The declaration page of any professional (including "gap" or "wrap-around"), general, and directors and officers liability insurance policies. If the health center does not have any of these policies please provide a separate statement to that effect.
- Narrative Statement: A narrative statement regarding the facts of the alleged incident, by the practitioner or the medical director.