Reducing Substantial Florida Personal Injury & Workers’ Compensation Medicaid Liens — Our Recent (June, 2013) Court Experience

scales.jpgA few months ago our law firm, working with the Domnick & Shevin, PL law firm, settled a difficult liability case against an insurance agency arising out of a catastrophic motorcycle crash.

Our client had been hospitalized for two months. Medicaid paid his substantial hospital bill. After the case settled, Medicaid came to us demanding to be repaid in full from the settlement proceeds.

We disputed Medicaid’s claim to be repaid in full. Instead, we offered the agency a small portion of the settlement to go away. Medicaid rejected the offer. Unwilling to give in, we filed a Motion to Reduce Medicaid Lien with the court that handled the underlying liability case. (We reserved jurisdiction with this court by including language In the Order of Voluntary Dismissal that it retained jurisdiction “to determine liens and reductions of liens based on equity or any other basis, including, but not limited to, Medicaid’s interest in any recovery.”)

Medicaid countered with a number of arguments. Among them: The court did not have jurisdiction to entertain the dispute. In its view, the Plaintiff was required to file a separate lawsuit, a dec action, against Medicaid; and Florida Statute 409.910 authorized a full recovery.

Medicaid is a federal-state cooperative program that provides medical assistance to individuals who cannot afford to pay their own medical costs. 42 U.S.C. ยงยง1396, et seq. While the federal law requires the various states to have laws in place to take portions of a Medicaid beneficiary’s tort judgment or settlement, the anti-lien provision of the federal law pre-empts a State’s effort to take any portion of a Medicaid beneficiary’s tort judgment or settlement not “designated as payments for medical care.” Wos v. E. M. A., 568 U.S. (2013), we persuaded the court that F.S. 409.910 violated the federal anti-lien statute, and, therefor, should be disregarded in favor of a formula based on fairness and equity. We proposed that fairness and equity called for Medicaid to recover on its lien in the same ratio percentage as our client’s net recovery, after reducing for attorney’s fees and costs, compared to the total value of his damages. This was 5%. The court agreed.

Hence, instead of recovering 100% of its lien, which would have left our client with very little of the overall settlement, Medicaid was awarded 5%.

CAVEAT: Effective July 1, 2013, Medicaid lien reduction hearings will be handled by administrative law judges in Florida. This should not prevent trial courts from making findings on the reasonableness of settlement allocations and determining damages. While the findings are not dispositive, they can have a persuasive effect on the administrative law judges.

(It should be noted that Medicaid uses a private company (ACS Recoveries/Xerox) to collect its liens.)

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Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

While prompt resolution of your legal matter is our goal, our approach is fundamentally different. Our clients are “people” and not “cases” or “files.” We take the time to build a relationship with our clients, realizing that only through meaningful interaction can we best serve their needs. In this manner, we have been able to best help those requiring legal representation.