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AHCA v. Elsa Parnu Hunt, et al., Case No. 1D14-3916 (1st DCA)

In Hunt, the First District reversed an administrative order entered by the Division of Administrative Hearings that excused the plaintiffs from repaying Medicaid-covered medical expenses following settlement of their wrongful death suit. The plaintiffs’ son experienced neurological injuries and severe disabilities from birth complications, and received medical care paid by AHCA through the Medicaid program as a result. He later passed away. AHCA recorded a Medicaid lien in 2005. The plaintiffs filed a wrongful death action arising out of their son’s death, which ultimately settled for a substantial sum.

After the settlement, the parties disputed the amount that AHCA should be reimbursed for Medicaid-provided medical assistance. The plaintiffs filed a petition with DOAH to have the disputed amount determined under Fla. Stat. 409.910. The plaintiffs argued that AHCA was not entitled to the entirety of its $315,000 Medicaid lien because the Estate’s settlement amount was $162,000 settlement amount and costs incurred by the Estate. At the final hearing, however, the plaintiffs altered their argument. They did not argue that AHCA’s recovery should be limited. Rather, they argued that AHCA should not be permitted to recover anything at all because the lien had expired under Fla. Stat. 409.910(11)(h), which provides that AHCA’s enforcement of rights shall commence within five years after the date a cause of action accrues. The DOAH judge agreed, and entered an order excusing the plaintiffs from making any payment to AHCA. This appeal followed.

The First District reversed, finding that the administrative law judge was responsible under the statute for resolving the amount of medical expenses reimbursable to AHCA, regardless of the “unalleged” statute of limitations defense the plaintiffs may assert in an enforcement proceeding. The First District noted that when the plaintiffs invoked DOAH’s jurisdiction many months before the statute of limitations deadline, they did not attack AHCA’s right to reimbursement. Instead, they conceded an obligation to reimburse AHCA out of the settlement funds, that the settlement funds included some amount to cover medical expenses incurred, and they placed funds in an interest bearing account for AHCA’s benefit. The First District further noted that under the plaintiff’s petition, all that was to be determined by the DOAH judge was the correct reimbursement amount. The Hunt court additionally noted that the statute itself states that DOAH is the exclusive method for challenging the amount of third party benefits payable to the agency, suggesting that the plaintiffs may dispute the statute of limitations argument in a separate, enforcement proceeding.

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