Dillard v. Agency for Health Care Administration
127 So. 3d 820
Fla. Dist. Ct. App.2013Background
- Reuben Fife, Jr. was catastrophically injured by a cocaine overdose after being taken into a juvenile detention center.
- Candy Dillard, on Fife's behalf, sued the Sheriff of Collier County, the Department of Juvenile Justice, and Prison Health Services for denial of medical care.
- The case settled, and Medicaid benefits continued to cover Fife's medical costs.
- AHCA sought reimbursement from the settlement using the formula in section 409.910(ll)(f).
- Dillard argued the formula applied only to the portion allocated to past medical expenses due to the anti-lien provision.
- The trial court applied pre-Wos/Riley case law, applying the formula to the entire settlement; on appeal, the court remanded for reconsideration consistent with Wos and Riley.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Should the 409.910(ll)(f) formula apply to the entire settlement or only past medical expenses? | Dillard: only past medical expenses under 1396p(a)(1). | AHCA: formula applies to the entire settlement. | Remanded for new hearing guided by Wos and Riley. |
| Does Wos/Riley require rebutting the default allocation before reducing the lien? | Dillard should be allowed to prove lien exceeds medical expense recovery. | AHCA should rely on the statutory default allocation unless rebutted. | Remanded for supplemental proceedings applying Wos and Riley. |
| May the trial court consider both prior record evidence and new evidence on remand to determine allocation? | Not explicitly stated, but should be guided by Wos/Riley. | May rely on prior record; further evidence permissible as needed. | Remand for further proceedings consistent with Wos and Riley. |
Key Cases Cited
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (Medicaid recoveries limited to medical expenses, no presumptive full recovery)
- Agency for Health Care Admin. v. Riley, 119 So.3d 514 (Fla. 2d DCA 2013) (overruled Russell; requires reconsideration under Wos framework)
- Wos v. E.M.A. ex rel. Johnson, 133 S. Ct. 1391 (S. Ct. 2013) (Medicaid lien not subject to an irrebuttable default; must align with medical expense attribution)
- Roberts v. Albertson’s Inc., 119 So.3d 457 (Fla. 4th DCA 2012) (court acknowledged rebuttal possibility to default allocations)
- Russell v. Agency for Health Care Administration, 23 So.3d 1266 (Fla. 2d DCA 2010) (previous framework permitting statutory allocation absent evidence of medical-damages-only recovery)