Justia Medical Malpractice Opinion Summaries

The Medicaid statute’s anti-lien provision, 42 U. S. C. 1396p(a)(1), pre-empts state efforts to take any portion of a tort judgment or settlement not “designated as payments for medical care.” A North Carolina statute requires that up to one-third of damages recovered by a beneficiary for a tortious injury be paid to the state to reimburse it for payments made for medical treatment on account of the injury. E. M. A. suffered serious birth injuries that require her to receive 12 to 18 hours of skilled nursing care per day and that will prevent her from working or living independently. North Carolina’s Medicaid program pays part of the cost of her ongoing care. E. M. A. and her parents filed a medical malpractice suit against the physician who delivered her and the hospital where she was born and settled for $2.8 million, due to insurance policy limits. The settlement did not allocate money among medical and nonmedical claims. The state court placed one-third of the recovery into escrow pending a judicial determination of the amount owed by E. M. A. to the state. While that litigation was pending, the North Carolina Supreme Court held in another case that the irrebuttable statutory one-third presumption was a reasonable method for determining the amount due the state for medical expenses. The federal district court, in E.M.A.’s case, agreed. The Fourth Circuit vacated. The Supreme Court affirmed. The federal anti-lien provision pre-empts North Carolina’s irrebuttable statutory presumption that one-third of a tort recovery is attributable to medical expenses. North Carolina’s irrebuttable, one-size-fits-all statutory presumption is incompatible with the Medicaid Act’s clear mandate View "Wos v. E. M. A." on Justia Law

Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded. View "In re E.B." on Justia Law

This appeal involved a putative class action filed by three Pennsylvania Medicaid beneficiaries subject to the Pennsylvania Department of Public Welfare's (DPW) liens against future settlements or judgments. At issue was whether state agencies responsible for administering the Medicaid program have the authority to assert such liens and, if so, whether Pennsylvania's statutory framework was consistent with the Supreme Court's decision in Arkansas Department of Health and Human Services v. Ahlborn. The court examined the text, structure, history, and purpose of the Social Security Act, 42 U.S.C. 301 et seq., and held that liens limited to medical costs were not prohibited by the anti-lien and anti-recovery provisions of the Act, 42 U.S.C. 1396p(a)-(b). Accordingly, the court upheld Pennsylvania's longstanding practice of imposing such liens. The court also held that Pennsylvania's current statutory framework, which afforded Medicaid recipients a right of appeal from the default allocation, was a permissible default apportionment scheme. View "Tristani, et al. v. Richman, et al." on Justia Law