Medicaid programs to shift liability for costs to third parties by “tak[ing] all reasonable measures to ascertain the legal liability of third parties ... to pay for the care and services available under the [Medicaid State] plan,” 42 U.S.C. § 1306a(a)(25)(A); see also 42 C.F.R. § 433.136. It requires beneficiaries to assign to the States their right to such recovery, and to agree to cooperate with same. Id., § 1396k(a). State Medicaid programs are required to seek to recover from personal injury settlements what it has paid for the cost of medical care provided by the program, and Maryland does so. Maryland Health-General Code, § 15-120. The services for which Medicaid may
seek recovery must have been caused by the tort that gave rise to the plaintiff ’s claim. Medicaid as a subrogee has no greater right to recover for the cost of the
medical care it paid for than the plaintiff does. The clarity of this limitation is re- flected in the unanimity of the Supreme Court’s decision in Arkansas Dept. of Health and Human Services v. Ahlborn, 547 U.S. 268, 164 L.Ed.2d 459, 126 S.Ct. 1752 (2006). The Court rejected the ar- gument that a State Medicaid program had the right “to more than the portion of [a beneficiary’s] settlement than rep- resents medical expenses” for which it, Medicaid, had paid. 126 S.Ct. at 1760. The facts were largely stipulated. Plain- tiff, a young woman, 19 years old, was permanently injured in an automobile accident; her claim was ultimately settled for $550,000. The State stipulated that her claim could be reasonably valued at $3,040,708.18. Medicaid’s outlay was $215,645.30. The parties also stipulated that $35,581.47 of the settlement was at- tributable to reimbursement for medical
payments made. The Court noted the Federal statute
limiting States to enforcing “rights ... to payment for medical care from any third party,” id., at 1761, quoting 42 U.S.C. § 1396k(a)(1)(A)(emphasis added), and on the flip side the general limitation on Medicaid recovery except as otherwise provided – from real property or from a probate estate after death. In light of this, it concluded, Medicaid subroga- tion claims are “limited to payments for medical care,” and may not attach or encumber “the remainder of the settlement.”Id. at 1763. The Court spoke disapprovingly of older cases that re- jected “equitable subrogation principles such as the ‘made whole’ rule,” and while its approach was to avoid rather than reject them, the effect is to strike off in a parallel direction. To be sure, the Court appears to say that to the extent there is
Network Support, Systems Integration, Hardware, Software, Managed Services
Authorized/Certified resellers for:
Tabs/PracticeMaster (Time & Billing/Practice Management Software) Amicus Attorney (Practice Management Software) Worldox GX (Document Management Systems) Symantec Dell
Hewlett Packard
Phillips Dictation Equipment Olympus Dictation Equipment
One Call, Many Solutions!
www.byterightsupport.com 410-347-2983
Lower Level 343 North Charles Street Baltimore, MD 21201 1840 Snydersburg Road Westminster, MD 21157 410.347.2983
www.byterightsupport.com
Summer 2007 Trial Reporter 55
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76