SCOTUS Rules Florida Medicaid Recoups PI Settlement
LEE COUNTY, FL – In 2008, a 13 year old Gianinna Gallardo was stepping off the bus when a truck struck her at a high speed. Immediately, she was medevacked to the closest hospital and her parents were informed that she would be completely dependent on them.
The Case
Because of the severity of the accident, medical expenses were reached at least $862,000, which was the amount Florida Medicaid paid on behalf of the Gallardos. As any good parent would, the Gallardos sought compensation for the trouble they and their daughter have and will face because of the accident. Within a few years, the family would be awarded $800,000 for past and future expenses in the settlement.
After being made aware of the settlement, Florida Medicaid requested a $300,000 reimbursement. Florida law allows reimbursement from settlement payments for medical care; specifically, they are entitled to half of the total recovery amount after attorney’s fees and costs are subtracted. Even federal Medicaid law says that states should make a reasonable effort to recoup costs.
The Decision
The States’ Medicaid reimbursement pursuit lead to a lawsuit that would be presented in the Supreme Court. The Supreme Court released the 7-2 decision in June in favor of Florida Medicaid. Justice Clarence Thomas wrote the opinion referencing existing laws as shown above, which upheld the decision made by the 11th US Circuit Court of Appeals.
The Dissent
Justice Sotomayor was part of the dissent where she wrote “the reading of the law is inconsistent with the structure of the Medicaid program and will cause needless unfairness and disruption.” She argued that Medicaid cannot recoup payments allocated for future care of accident victims.
Because of the decision, the Gallardo will owe Florida Medicaid about half of the settlement amount and possibly the opposing attorney’s fees as well.
References:
Gallardo v. Dudek. Legal Research Tools From Casetext. (2017, April 18). Retrieved June 15, 2022, from https://casetext.com/case/gallardo-v-dudek-1
Saunders, J. (2022, June 7). U.S. Supreme Court Decides Florida Medicaid Can Recoup From Injury Settlement. WLRN. Retrieved June 14, 2022, from https://www.wlrn.org/news/2022-06-07/u-s-supreme-court-decides-florida-medicaid-can-recoup-from-injury-settlement
Weiss, D. C. (2022, June 6). Kagan Joins Majority as Supreme Court Allows State to Recoup Medicaid Costs from Injury Settlement. ABA Journal. Retrieved June 14, 2022, from https://www.abajournal.com/web/article/kagan-joins-majority-as-supreme-court-allows-state-to-recoup-medicaid-costs-from-injury-settlement#:~:text=The%20U.S.%20Supreme%20Court%20ruled,Thomas%20wrote%20the%20majority%20opinion.
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