The Center for Constitutional Litigation (CCL) recently won a landmark decision that will affect many of our clients and their families!
A Florida nursing home resident died from complications of bed sores and received a settlement of $50,000. Since Medicare had paid for the deceased’s medical expenses, the 11 surviving children, who sued for loss of consortium, invited Medicare to participate in an allotment of the settlement. Medicare claimed the entire amount citing its manual and later refused to take part in a probate hearing to allot the settlement.
The family’s trial lawyer went to federal court seeking recognition of the probate court’s decision. The court deferred to Medicare’s interpretation of the 1980 Medicare Secondary Payer Act.
The family (through their trial lawyer and CCL) filed an appeal, briefed the issue, and then argued it last April.
The U.S. Court of Appeals for the Eleventh Circuit reversed the probate court’s decision on September 30, 2010. The Court of Appeals emphatically rebuked Medicare over the way the agency treats settlements and held that Medicare does not have the right to claim full reimbursement from an undifferentiated settlement, as it has for years. Instead, Medicare must participate in any state-authorized process to prorate its lien claim or accept the result when it refuses to participate. The decision is the first by a federal circuit court on the issue.
The result: Having chosen not to participate in the allocation; Medicare must accept the probate court’s decision that Medicare’s proportionate share of the settlement was only $787.50.
Congratulations and thanks to a family that has made a difference to patients and other families throughout the nation! Congratulations as well to the entire CCL team. The full decision can be found at: http://www.ca11.uscourts.gov/opinions/ops/200913765.pdf
Clients should not fear Medicare. Briggs & Wholey has a team that scours every item in a Medicare claim. We repay Medicare (and the American taxpayer) every cent they are owed. No more, no less. That means we give our Clients and their Families every cent they are owed as well.