A recent review of a birth injury lawsuit, Florida’s First District Court of Appeal reversed the course on past case law to fall in line with new federal standards regarding state agency medical bill reimbursement from injured parties’ previously-established judgments or settlement agreements.
Essentially, the court held in Harrell v. Florida AHCA that Florida’s Agency for Health Care Administration couldn’t collect anything more than medical expenses from a family’s personal injury fund. Our Tampa birth injury lawyers understand that prior to the 2013 U.S. Supreme Court ruling in Wos v. E.M.A., the determination for a state agency’s medical care reimbursements from a personal injury fund were determined by Florida Statute 409.910(11)(f).
However, in the Harrell case, the state was attempting to collect more from the settlement fund than what the family had recovered in damages for past medical expenses.
According to court records, the case started in 2002 when the couple’s daughter was deprived of oxygen during birth. This resulted in severe, catastrophic injuries. Those included cerebral palsy, mental retardation and quadriplegia. These are conditions from which the girl will never recover, and she will require intensive care for the rest of her life.
The family sued the hospital for damages. In the end, plaintiffs reached a confidential settlement agreement with the hospital. Because it’s confidential, we don’t know exactly how much they accepted or other terms of the agreement.
We do know the family needed help covering all of the girl’s medical expenses prior to reaching the settlement. Florida’s Medicaid program, which is overseen by the AHCA, covered medical expenses for the girl’s care in the amount of $361,000.
After the family reached a settlement, the state’s AHCA asserted a lien against the settlement for the full amount of medical expenses.
The family filed a petition with the court to determine the amount of the lien, asserting the formula set forth in Florida statutes should be set aside per the 2006 U.S. Supreme Court ruling of Arkansas DHHS v. Ahlborn. That ruling indicated states were barred from asserting liens on settlements in excess of medical expenses. The family argued that because the amount it recovered in the settlement for past medical expenses was less than what the ACHA was asserting in its lien, the ACHA should only be able to recover a proportionate share.
ACHA countered that the formula used to determine its recovery was mandatory, and it was entitled to the full amount.
The trial court decided in ACHA’s favor, finding the family had to reimburse the state the full amount. However, at the time of the decision, the court noted the pending Wos case. In that case, the court held that state statutes in North Carolina that set the state’s recovery from tort injury beneficiary’s at one-third was preempted by the Medicaid Act in so far as it required payment beyond what the injured party might have received for medical expenses. The court was clear in its indication that the Medicaid Act does not allow a state to demand a greater portion of the beneficiary’s recovery beyond what is specifically attributed to medical expenses.
Likewise, several other Florida appellate courts have reversed course on these matters. The 1st DCA determined it was time to do so as well. The trial court’s ruling was reversed, and the case remanded for further consideration in light of the Wos ruling.
If you have been a victim of medical malpractice in Tampa, contact Chalik & Chalik at (954) 476-1000 or 1 (800) 873-9040.
Harrell v. Florida AHCA , July 28, 2014, Florida’s First District Court of Appeal
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