Reale, Humana appealed a final judgment determining its right to reimbursement
of conditional Medicare payments under Florida subrogation law, including
Florida’s collateral sources of indemnity statute, section 768.76,
Florida Statutes. The Third District ruled that the trial court did not
have subject-matter jurisdiction to review the dispute and that Florida’s
collateral sources of indemnity statute is on its face inapplicable.
In about 2009, Humana paid conditional Medicare benefits for the plaintiff’s
medical treatment in the amount of $19,155.41, the result of a third party’s
liability. Humana provided benefits under a Part C Medicare advantage
program. The plaintiff filed suit, and later recovered a settlement of
$135,000. The trial court applied section 768.76, Florida Statutes, and
determined that Humana was entitled to approximately $3,000 as reimbursement.
The Third District ruled that the trial court lacked subject-matter jurisdiction
because the plaintiff failed to exhaust mandatory administrative remedies
and, even if exhaustion had occurred, the plaintiff’s claim was
subject to exclusive federal jurisdiction. The Third District noted that
under the Medicare Act, the Social Security program’s judicial review
process is the sole avenue for judicial review of all claims arising under
the Medicare Act. The statutory provisions additionally limit jurisdiction
of claims arising under the Medicare Act to the federal courts but only
after exhaustion of administrative remedies. Accordingly, 42 U.S.C. 405(h)
and 405(g), when read together, “create an exclusive review process
for all claims arising under the Medicare Act, including claims brought
in the context of the Medicare Advantage program.”
The Third District additionally ruled that Florida’s subrogation
law is expressly preempted by Part C’s broad and unambiguous preemption
provision, 42 U.S.C. 1395w-26(b)(3). The Third District ruled that on
its face, Fla. Stat. 768.76 provides that benefits received under Medicare
are not collateral sources. The plaintiff argued that Humana did not provide
Medicare conditional benefits and Humana is not Medicare. The Third District
ruled, however, that Humana is a Medicare advantage organization that
provides Medicare benefits. Therefore, the benefits paid are indisputably
benefits received under Medicare, and Fla. Stat. 768.76 makes clear that
such benefits shall not be considered a collateral source. As such, Fla.
Stat. 768.76 was inapplicable to the benefits paid in this case.
The Third District also noted that even if Fla. Stat. 768.76 may be applicable
to determine Humana’s right to reimbursement, Fla. Stat. 768.76
is preempted by the broad, express preemption clause in Part C of the
Accordingly, the Third District ruled that the trial court erred in its
finding of subject-matter jurisdiction and its determination of Humana’s
reimbursement rights pursuant to Florida’s subrogation law.