K.H. v. Agency for Health Care Administration

Appellant settled a lawsuit for more than $350,000 after being seriously injured by a criminal act committed at a commercial property. By the time of the settlement, AHCA had paid over $120,000 for Appellant’s medical care under the Medicaid program. ACHA then asserted a statutory lien to recoup the $120,000. There is a statutory formula for this under section 409.910(11)(f), Fla. Stat., though a recipient can show reasons why a lesser amount should be paid if he or she can satisfy the standard under section 409.910(17)(b). The recipient did that, but an Administrative Law Judge denied the petition and applied the normal statutory formula. She appealed.

Her first argument was that a “Letter of Understanding” between herself and the commercial property she sued limited the lien to 5% of the settlement, which would just be $13,000. The agreement was between the parties to the civil suit, not the State, though. Medicaid and AHCA never agreed to a 5% limitation. Thus, the letter did not rob ACHA of its right to seek full reimbursement.