Goheagan v. Perkins
197 So. 3d 112
Fla. Dist. Ct. App.2016Background
- Molly Swaby was severely injured in a 2007 car accident, incurred $970,179.97 in medical bills, and died; Medicaid paid $95,476.60.
- The Estate obtained a $1,000,000 recovery from a third-party bad-faith settlement against the tortfeasor’s insurer.
- AHCA asserted a Medicaid lien for the full $95,476.60 against the settlement under Fla. Stat. § 409.910(11)(f).
- The Estate moved for equitable distribution, arguing federal Medicaid anti-lien law preempted § 409.910(11)(f) and that the lien should be reduced to the portion of the recovery allocable to past medical expenses (about 3.5% of net proceeds).
- The trial court applied § 409.910(11)(f), denied reduction, and ordered full reimbursement to AHCA; the Estate appealed.
- The district court reviewed statutory interpretation and preemption de novo and affirmed, holding the federal anti-lien provision does not preempt Florida’s statute in wrongful death actions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether 42 U.S.C. § 1396p(a)(1) (Medicaid anti-lien) preempts Fla. § 409.910(11)(f) so AHCA cannot recover more than the portion of a tort recovery attributable to medical expenses in a wrongful death settlement | Estate: Ahlborn/Wos require that states may only take the portion of a recovery attributable to medical expenses; § 409.910(11)(f) is preempted because it can reach non-medical portions | AHCA: Anti-lien statute by its terms protects only living recipients; Congress did not intend to forbid state recovery from wrongful death settlements under state Medicaid lien law | Held: Anti-lien statute applies to recoveries of living recipients and does not preempt Fla. § 409.910(11)(f) in wrongful death actions; AHCA entitled to full reimbursement of Medicaid payments |
Key Cases Cited
- Ark. Dep’t of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (held federal anti-lien bars state from asserting lien on portions of tort recovery not designated as payment for medical care)
- Wos v. E.M.A. ex rel. Johnson, 133 S. Ct. 1391 (U.S. 2013) (held irrebuttable statutory apportionment that claims nonmedical portions is preempted; formulae are rebuttable but one-size-fits-all presumptions may conflict with anti-lien)
- Englich v. Agency for Healthcare Admin., 916 So.2d 994 (Fla. 4th DCA 2005) (upheld Florida Medicaid Act lien application to wrongful death settlement; denied pro rata allocation)
- Strafford v. Agency for Health Care Admin., 915 So.2d 643 (Fla. 2d DCA 2005) (applied § 409.910(11)(f) to wrongful death settlement and required full payment subject to statutory formula)
- Ross v. Agency for Health Care Administration, 947 So.2d 457 (Fla. 3d DCA 2006) (reaffirmed that personal representative cannot allocate to reduce AHCA’s lien under Florida law)
- Estate of Hernandez v. Agency for Health Care Administration, 190 So.3d 139 (Fla. 3d DCA 2016) (held federal anti-lien provision does not apply to wrongful death settlements and does not preempt Florida Medicaid lien law)