Harrell, the plaintiffs filed suit against a hospital arising from an infant’s
oxygen deprivation at birth, which caused catastrophic permanent harm.
Following a confidential settlement, AHCA asserted a lien against the
settlement proceeds in an amount greater than $360,000, which amount was
the totality of the medical expenses paid by Medicaid. The plaintiffs
filed a motion to determine the amount of the Medicaid lien, arguing that
the statutory formula in Fla. Stat. 409.910(11)(f) was effectively overruled by
Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268 (2006), which barred states from asserting a lien on a settlement
in excess of the portion of settlement proceeds recovered for medical
expenses. The trial court agreed with AHCA, which relied upon
Russel v. Agency for Health Care Administration, 23 So. 3d 1266 (Fla. 2d DCA 2010), to argue that the statutory formula
in Fla. Stat. 409.910 is mandatory.
On appeal, the First DCA noted that at the time the trial court made its
ruling, the United States Supreme Court was reviewing
Wos v. E.M.A., 133 S. Ct. 1391 (2013). In
Wos, the Supreme Court ruled that a North Carolina statute which established
a set proportion as the amount of the state’s reclamation from a
beneficiary’s tort recovery, was pre-empted by the Medicaid Act
to the extent it required payment beyond that shown to be for medical
expenses. The First DCA found that
Wos undermined the reasoning of those cases AHCA and the trial court relied
upon. The First DCA further noted that three districts (the Second, Fourth
and Fifth) had all issued opinions consistent with
Wos. The First DCA found that its jurisprudence was outdated in light of
Wos and the decisions of the Second, Fourth and Fifth districts.
Accordingly, the First DCA receded from prior First DCA precedent, and
ruled that a plaintiff must be given the opportunity to seek reduction
of the amount of a Medicaid lien established by the statutory formula
outlined in Fla. Stat. 409.910(11)(f) by demonstrating, with evidence,
that the lien amount exceeds the amount recovered for medical expenses.