14-001380MTR Clark Chamberlin, A Minor, By And Through His Parents And Natural Guardians, Kelli Chamberlin And Todd Chamberlin vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Thursday, April 15, 2021.

Summary: Petitioner proved by a preponderance of the evidence that AHCA should be reimbursed for its Medicaid lien in a lesser amount than that calculated under section 409.910(11)(f).

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

C LARK C HAMBERLIN , A M INOR , B Y A ND

T HROUGH H IS P ARENTS A ND N ATURAL

G UARDIANS , K ELLI C HAMBERLIN A ND

T ODD C HAMBERLIN ,

Petitioners ,

vs. Case No. 14 - 1380MTR

A GENCY F OR H EALTH C ARE

A DMINISTRATION ,

Respondent .

/

F INAL O RDER

Pursuant to notice, a final hearing was conducted in this case on

January 28, 2021, via Zoom teleconference, before Lawrence P. Stevenson, a

duly - des ignated Administrative Law Judge (ÑALJÒ) of the Division of

Administrative Hearings (ÑDOAHÒ).

A PPEARANCES

For Petitioner: Floyd B. Faglie, Esquire

Staunton & Faglie, PL

189 East Walnut Street

Monticello, Florida 3 2344

For Respondent: Alexander R. Boler, Esquire

2073 Summit Lake Drive, Suite 300

Tallahassee, Florida 32317

S TATEMENT OF T HE I SSUE

The issue in this proceeding is how much of PetitionerÔs settlement

proceeds should be paid to Respondent, A gency for Health Care

Administration (ÑAHCAÒ), to satisfy AHCA's Medicaid lien under section

409.910, Florida Statutes .

P RELIMINARY S TATEMENT

On March 24, 2014, Petitioner Clark Chamberlin, a minor, by and

through his parents and natural guardians, Kelli Chamberlin and Todd

Chamberlin, filed with DOAH a pleading styled ÑPetition to Determine

Amount Payable to Agency for Health Care Administration in Satisfaction of

Medicaid Lien.Ò

The case was scheduled for hearing on May 21, 2014. On April 4, 2014,

Pet itioner filed a Motion to Stay the Proceedings due to pending litigation

against additional defendants in the underlying medical malpractice case. By

O rder of April 24, 2014, the case was placed in abeyance pending resolution

of the underlying medical malp ractice action. On March 3, 2015, the case was

transferred to the undersigned due to a reassignment of the ALJ originally

assigned to the case. Numerous status reports were filed and 13 O rders

continuing the case in abeyance were entered over the course of the next six

years. By notice dated October 28, 2020, Petitioner notified the undersigned

that the final defendants had settled and Petitioner was ready to proceed to

hearing. The abeyance was lifted by O rder dated November 10, 2020, and the

final hearing was set for January 28, 2021.

On January 14, 2021, Petitioner filed an unopposed Motion for Leave to

Amend the Petition. By Order dated January 19, 2021, leave was granted to

file the Amended Petition, which thereby became the operative initial

pleading in this case. On January 20, 2021, the parties filed a Joint Pre -

hearing Stipulation that included numerous stipulated and admitted issues

of law and fact. Those stipulated issues of law and fact have been

incorporated herein as appropriate.

At the hearin g, Petitioner presented the testimony of two attorneys,

Thomas H. Leeder and R. Vinson Barrett, both of whom were accepted

without objection as experts in the evaluation of damages for medical

malpractice and wrongful death cases. PetitionerÔs Exhibits 1 t hrough 11

were accepted into evidence. AHCA presented no witnesses. AHCAÔs

Exhibit 1 was admitted into evidence under seal .

The one - volume T ranscript of the hearing was filed at DOAH on March 5,

2021. The partiesÔ joint motion for extension of the time fo r filing p roposed

f inal o rders was granted by Order dated March 11, 2021, and a filing

deadline of March 23, 2021, was established. In keeping with the Order

granting extension, Petitioner filed his Proposed Final Order on March 23,

2021. AHCAÔs Proposed F inal Order was logged in at DOAH at 8:00 a.m. on

March 24, 2021, which indicates it was filed on March 23, 2021, but after

5:00 p.m. Petitioner has not objected to AHCAÔs late filing. The undersigned

finds the filing was so near the deadline that no unfair advantage could have

accrued to AHCA. Both Proposed Final Orders have been considered in the

writing of this Final Order.

All references to the Florida Statutes are to the 2020 edition, unless

otherwise noted.

F INDINGS OF F ACT

Based on the evidence add uced at hearing, and the record as a whole, the

following Findings of Fact are made:

1. On November 5, 2008, Kelli Chamberlin gave birth to Clark

Chamberlin and his twin brother Sawyer at St. MaryÔs Medical Center in

Palm Beach County. The boys were born p rematurely, at 29 weeks gestation.

Clark and Sawyer were admitted to the hospitalÔs Neonatal Intensive Care

Unit. While ClarkÔs mother had tested positive for Group B Streptococcus

prior to giving birth, the medical staff responsible for ClarkÔs care faile d to

timely treat Clark with the proper antibiotics. Clark developed meningitis

and resulting hydrocephalus. As a result, Clark suffered catastrophic

neurological injury and was left permanently disabled. Clark is unable to

walk, talk, eat, toilet , or care for himself in any manner. He is dependent on

the care of his parents for every aspect of his daily life.

2. ClarkÔs medical expenses related to his injury were partly paid through

his fatherÔs employer, which maintained a self - funded employee benefit pla n

governed by the Employee Retirement Income Security Act of 1974, or

ERISA. The Medicaid program administered by AHCA paid for the

remainder of ClarkÔs medical expenses. The employerÔs ERISA plan provided

$280,318.94 in benefits related to ClarkÔs injurie s, and asserted a subrogation

and reimbursement claim in this amount. The Medicaid program provided

$1,409,615.94 in benefits related to ClarkÔs injuries. The sum of these

benefits, $1,689,934.88 , constituted ClarkÔs entire claim for past medical

expenses.

3. ClarkÔs parents brought a medical malpractice action against the

medical providers responsible for his care (ÑDefendantsÒ) to recover all of

ClarkÔs damages, as well as their own individual damages associated with

their sonÔs injuries.

4. The medical malpractice action was settled through a series of

unallocated confidential settlements totaling a gross amount of $9,449,500.

5. As a condition of ClarkÔs eligibility for Medicaid, Clark assigned to

AHCA his right to recover from liable third parties' me dical expenses paid by

Medicaid. See 42 U.S.C. § 1396a(a)(25)(H) and § 409.910(6)(b), Fla. Stat.

6. During the pendency of ClarkÔs medical malpractice action, AHCA was

notified of the action and AHCA asserted a $1,409,615.94 Medicaid lien

against ClarkÔs cause of action and settlement of that action.

7. AHCA did not commence a civil action to enforce its rights under

section 409.910 or intervene or join in ClarkÔs action against the Defendants.

8. By letter, AHCA was notified of ClarkÔs settlement.

9. AHC A has not filed a motion to set aside, void, or otherwise dispute

ClarkÔs settlement.

10. The Medicaid program through AHCA spent $1,409,615.94 on behalf

of Clark, all of which represents expenditures paid for ClarkÔs past medical

expenses.

11. The parties stipulated that application of the formula provided by

section 409.910(11)(f) to ClarkÔs $9,449,500 settlement would require

payment to AHCA of the full $1,409,615.94 Medicaid lien.

12. Petitioner has deposited the Medicaid lien amount in an interest -

bear ing account for the benefit of AHCA pending an administrative

determination of AHCAÔs rights, which constitutes Ñfinal agency actionÒ for

purposes of chapter 120, Florida Statutes, pursuant to section 409.910(17)(b).

13. Thomas H. Leeder is a trial attorne y and a partner with the Leeder

Law Firm in Plantation. Mr. Leeder practices exclusively plaintiffÔs personal

injury law and handles catastrophic injury cases, including cases involving

children. Mr. Leeder testified that he handles jury trials and is fami liar with

building a case for trial by reviewing medical records, reviewing accident

reports, speaking with doctors, and meeting with clients. Mr. Leeder stays

abreast of jury verdicts by reviewing jury verdict reports and discussing cases

with other attor neys, including some who defend personal injury suits.

14. Mr. Leeder is a member of a number of trial attorney associations,

including the Florida Justice Association, the American Association for

Justice (ÑAAJÒ), and the AAJÔs Birth Trauma Litigation Gr oup. Mr. Leeder

testified that as a routine part of his practice , he makes assessments

concerning the value of damages suffered by injured clients. Mr. Leeder

explained in detail his process for making these determinations. Mr. Leeder

testified that he is familiar with, and routinely participates in, the allocation

of settlements in the context of health insurance liens, workersÔ compensation

liens , and Medicare set - asides, as well as post - verdict allocations of

judgments by trial judges.

15. Mr. Leeder and his partner , Scott Newmark , represented Clark and

his parents in ClarkÔs medical malpractice suit. Mr. Newmark began the suit

in 2009. Mr. Leeder got involved in 2016 to depose the defense experts on

liability and damages. Mr. Leeder testified that he rev iewed ClarkÔs medical

records, deposed the DefendantsÔ expert witnesses, reviewed expert reports ,

and met with Clark and his family many times.

16. Mr. Leeder testified as to the facts of the case. Due to their premature

birth and low birth weight, Clark and Sawyer were more than usually

susceptible to infection. Mr. Leeder testified that 19 days after birth and

while still in the hospital, Clark and Sawyer developed infections and became

septic.

17. Mr. Leeder explained that both sepsis and meningitis are treated with

antibiotics, but that meningitis must be treated with three times the amount

of antibiotics because the drugs must penetrate the blood - brain barrier to be

effective. Both boys were treated for sepsis, but ClarkÔs infection had

progressed into meningitis before it was diagnosed. By the time the diagnosis

was made, ClarkÔs brain had been catastrophically damaged. Defense and

plaintiffÔs radiologists described holes throughout the childÔs brain that were

visible on scans.

18. Mr. Leeder testified that hydrocephalus is a known complication of

meningitis. Clark developed hydrocephalus and required a series of shunts to

release the pressure on his brain caused by obstructive hydrocephalus.

ClarkÔs brain damage was catastrophic and irreversible.

19. M r. Leeder testified that ClarkÔs catastrophic brain damage has had a

devastating effect on Clark and his family. Clark is unable to walk, talk, or

toilet. He requires a feeding tube for most of his nutrients, though he can

take some pureed foods by mouth. He requires 24 - hour nursing care. Kelli

Chamberlin had to quit her job as a dental radiologist to care for Clark.

Mr. Leeder testified that it is especially heartbreaking for ClarkÔs parents to

see a healthy twin brother and realize how Clark likely would have

progressed but for the medical malpractice.

20. Mr. Leeder testified that, based on his professional training and

experience, Clark and his parentsÔ damages have a value well in excess of

$45 million. Mr. Leeder described the steps that his law firm t ook during the

litigation to arrive at a valuation of damages.

21. Mr. LeederÔs firm retained Stephanie Chalfin, an expert in vocational

analysis and life care planning, to prepare a life care plan for Clark.

Ms. Chalfin performed a vocational analysis. C larkÔs loss of earnings was

estimated conservatively, based on his parentsÔ educational level and

earnings. As noted above, Kelli Chamberlin is trained as a dental radiologist.

Todd Chamberlin is an ultrasound technician. ClarkÔs lost future earnings

were , therefore , premised on his attainment of a bachelorÔs degree or some

level of technical education.

22. Ms. Chalfin consulted with ClarkÔs physicians to determine the nature

and level of care he would require going forward. Her written report on the

life c are plan was supplemented by an evaluation from an independent

physiatrist. The total economic losses in the case were then reviewed by

economist Oscar Padron, who reduced them to present value.

23. Mr. Leeder testified that ClarkÔs claim for economic dama ges had a

low - end value of $29.6 million and a high - end value of $38.4 million.

Mr. Leeder explained that the difference in the low - end value and the high -

end value revolved around different projections as to ClarkÔs life expectancy

prepared by his physici ans.

24. Mr. Leeder testified that the familyÔs claim for non - economic damages

would be added to the $29.6 to $38.4 million in economic damages and the

roughly $1.6 million claim for past medical expenses to determine the full

value of their damages. Mr. L eeder opined that the claim for non - economic

damages would have a very high value in light of jury verdicts in comparable

cases involving children with brain damage. Mr. Leeder noted a 2004 case in

Palm Beach County in which the child was brain damaged at birth by

improper use of forceps during delivery and the jury awarded the child and

parents $63 million, with $17 million in pain and suffering for the child and

$7 million in pain and suffering for each parent.

25. Mr. Leeder testified that in a total of nine comparable jury verdicts ,

the average award for non - economic damages was $19.4 million. If this

$19.4 million were added to the low - end $28.4 million value of the

ChamberlinsÔ economic damages, the total would more than exceed

Mr. LeederÔs conservati ve $45 million valuation of all the damages in the

instant case. Mr. Leeder concluded that the $45 million valuation was Ñextra

conservativeÒ because it did not even include the parentsÔ pain and suffering.

26. Mr. Leeder testified that he extensively disc ussed the case with

Mr. Newmark and appellate co - counsel , Phil Burrington , numerous times. He

also discussed the case with several defense attorneys with whom he

routinely works. Mr. Leeder testified that the attorneys with whom he

discussed the case unani mously agreed that the damages had a value in

excess of $45 million.

27. Mr. Leeder testified that the medical malpractice claim was pursued

against the hospital and various medical staff and medical providers who

cared for Clark during and after birth. A number of the Defendants, including

the hospital, the OB/GYN, the neurologists, and a pediatric group, settled

early for their insurance policy limits. Ultimately, the only remaining

Defendants were the treating neonatology group and its individual doctors .

28. Mr. Leeder testified the theory of liability was that the Defendants

failed to prevent or properly treat the meningitis. Proof was difficult because

there was medical literature supporting both sidesÔ arguments concerning the

standard of care. The ca se against the neonatology group eventually focused

on whether the plaintiffs could gain access to a data base kept by the group

that was arguably protected by a statutory equivalent of the work - product

privilege. Mr. Leeder testified that he believed the information from this data

base could have been used to refute and impeach the deposition testimony of

the doctors.

29. The access question was litigated up to the Fourth District Court of

Appeal, which finally issued an opinion in favor of the plaintiffs. Rather than

turn over the data base to the plaintiffs, the neonatology group settled the

case on the day following the courtÔs opinion.

30. The total settlement from all Defendants was $9,449,500. Mr. Leeder

testified that the settlement did not come clos e to compensating Clark for the

full value of his damages. Based on the conservative $45 million value of all

damages, Clark recovered only 21 percent of the value of his damages from

the settlement. Using a pro rata methodology, Mr. Leeder concluded that the

appropriate share of ClarkÔs past medical expenses to be applied to satisfy

AHCAÔs medical lien should be 21 percent of the $1,689,934.88 total past

medical expenses, or $354,886.32. 1 Mr. LeederÔs testimony was

uncontradicted and persuasive as to the m ethodology to be used in

calculating AHCAÔs share of the recovery.

31. R. Vinson Barrett testified on behalf of Petitioner as an expert in the

evaluation of damages for medical malpractice and wrongful death cases,

without objection from AHCA. Mr. Barrett has been a trial attorney for over

40 years and is a partner with the law firm of Barrett, Nonni and Homola,

PA , in Tallahassee. For at least 30 years, Mr. BarrettÔs practice has been

focused on plaintiffsÔ medical malpractice and wrongful death cases and has

routinely conducted jury trials. He has handled cases involving catastrophic

injury, including brain injury to children. He is a member of the Florida

Justice Association and the Capital City Justice Association.

1 Con trary to Mr. LeederÔs testimony, AHCAÔs Medicaid lien was only $1,409,615.94. The

number used by Mr. Leeder, $1,689,934.88, included past medical expenses paid by the

ChamberlinsÔ s private insurance, which should not be used to calculate AHCAÔs recovery.

32. Mr. Barrett is familiar with revie wing medical records, reviewing life

care plans, reviewing economist reports , and preparing cases for trial. As a

routine part of his practice, Mr. Barrett stays abreast of jury verdicts by

reviewing jury verdict reports and discussing cases with other tri al attorneys.

Another routine part of his practice is to make assessments of the value of

damages suffered by injured parties.

33. Mr. Barrett testified that he is familiar with settlement allocation in

the context of health insurance liens, Medicare set - a sides , and workersÔ

compensation liens. He further testified that he is familiar with the process of

allocating settlements in the context of Medicaid liens. Mr. Barrett has been

accepted as an expert in the valuation of damages in federal court and in

man y Medicaid lien hearings at DOAH.

34. Mr. Barrett testified that he was familiar with the instant case. He

reviewed all exhibits filed in this proceeding and was present for Mr. LeederÔs

testimony. Mr. Barrett testified that ClarkÔs life care plan was simi lar to

many life care plans he had reviewed in cases involving catastrophic brain

damage to children. Mr. Barrett described ClarkÔs injury and the impact it

had on Clark and his family:

ItÔs catastrophic. This is about the worst thing that

could possibly ever happen to a family. His injury,

of course, has obliterated his life. And itÔs been Ï

you know, I can tell from what IÔve reviewed that

itÔs been a tremendous stress on his family. ItÔs

changed their ability to work and earn a living. ItÔs

a 24/7 oblig ation that they have, and a sad

situation, because they can see what Clark

probably would have been, had it not been for this

injury, because of his twinÔs progress. This family

has been referred to family counselingÈ ThereÔs

just a lot of psychological an d practical reasons that

this has been a huge, huge dark cloud over the

familyÔs existence ever since it happened.

35. Mr. Barrett testified, based on his professional training and

experience, that the conservative value of the damages is more than

$45 million. He observed that the life care plan and the economistÔs report

presented several options regarding the present value of ClarkÔs future

medical expenses depending on his life expectancy. Those options, as also

described by Mr. Leeder, ran from a lo w - end of $27,951,967 to a high - end of

$36,752,806 for ClarkÔs lost future earnings and future medical expenses.

Mr. Barrett noted that these numbers would need to be added to the

$1.6 million claim for past medical expenses to determine the total value of

the economic damage claim. Accordingly, the claim for economic damages

would be in the $29.6 to $38.4 million range.

36. Mr. Barrett testified that the ChamberlinsÔ s claim for non - economic

damages would be added to this $29.6 to $38.4 million economic dama ge

claim. Mr. Barrett stated that the rule of thumb for trial lawyers is that non -

economic damages tend to equal about three times the amount of economic

damages. He opined that the claim for non - economic damages would have a

high value in this case.

37. Mr. Barrett reviewed the jury verdicts presented by Mr. Leeder. He

agreed that they were comparable and supportive of a high value for non -

economic damages given that the average non - economic award for the

children in those cases was $19.4 million. Mr. Bar rett testified that the jury

verdicts supported the conclusion that his valuation of the ChamberlinsÔ s

damages at $45 million was very conservative.

38. Mr. Barrett agreed with Mr. Leeder that the $9,449,500 settlement

would not fully compensate Clark and his parents for all the damages they

had suffered. Mr. Barrett testified that if the conservative $45 million value

of all damages was the basis for comparison, then the $9,449,500 settlement

represents 21 percent of the value of the damages. Mr. Barrett t estified that

because only 21 percent of the damages were recovered in the settlement,

only 21 percent of the $1,689,934.88 claim for past medical expenses was

recovered, or $354,886.32. Mr. Barrett testified that it would be reasonable to

allocate $354,88 6.32 of the settlement to past medical expenses, as a pro rata

share of the actual settlement versus the value of the damages. Mr. Barrett

testified that his testimony and the method of making the $354,886.32

allocation to past medical expenses in this cas e were consistent with his

testimony in other Medicaid lien cases at DOAH. 2

39. AHCA did not offer any witnesses or documentary evidence to

question the credentials or opinions of either Mr. Leeder or Mr. Barrett.

AHCA did not offer testimony or documentar y evidence to rebut the

testimony of Mr. Leeder and Mr. Barrett as to valuation or the pro rata

reduction ratio. AHCA did not offer alternative opinions on the damage

valuation or allocation method suggested by either Mr. Leeder or Mr. Barrett,

both of who m testified knowledgably and credibly as experienced

practitioners.

40. The testimony of Petitioner's two experts regarding the total value of

damages was credible, unimpeached, and unrebutted. Petitioner proved that

the settlement of $9,449,500 does not b egin to fully compensate Clark, Kelli ,

and Todd Chamberlin for the full value of their damages. PetitionerÔs

recovery represents only 21 percent of a conservative valuation of the

ChamberlinsÔ s claims.

41. The undersigned finds that Petitioner has proven b y a preponderance

of the evidence that 21 percent (the ratio that $9,449,500 bears to $45

million) is the appropriate pro rata share of Clark ChamberlinÔs medical

expenses to be applied to determine the amount recoverable by AHCA in

satisfaction of its Med icaid lien.

42. ACHAÔs lien for past medical expenses is $1,409,615.94. Applying the

21 percent pro rata ratio to this total yields $296,019.35, which is the portion

2 Like Mr. Leeder, Mr. Barrett used the total amount of past medical expenses,

$1,689,934.88, to calculate AHCAÔs proportional recovery of its Medicaid lien. The correct

amount of the AHCA Medicaid lien was $1,409,615.94. Twenty - one percent of $1,409,615.94

is $296,019.35.

of the settlement representing reimbursement for past medical expenses and

the amount reco verable by AHCA for its lien. 3

C ONCLUSIONS OF L AW

43. The Division of Administrative Hearings has jurisdiction of the subject

matter of and the parties to this proceeding. §§ 120.569, 120.57(1), and

409.910(17), Fla. Stat.

44. AHCA is the agency authoriz ed to administer FloridaÔs Medicaid

program. § 409.902, Fla. Stat.

45. As a condition for receipt of federal Medicaid funds, states are

required to seek reimbursement for medical expenses from Medicaid

recipients who later recover from legally liable third parties.

46. By accepting Medicaid benefits, Medicaid recipients automatically

subrogate their rights to any third - party benefits for the full amount of

Medicaid assistance provided by Medicaid and automatically assign to AHCA

the right, title, and intere st to those benefits, other than those excluded by

federal law. Section 409.910(6)(c) creates an automatic lien on any such

judgment or settlement with a third party for the full amount of medical

expenses paid to the Medicaid recipient. However, AHCA's re covery is limited

to those proceeds allocable to past medical expenses. See Giraldo v. Ag. for

Health Care Admin , 248 So. 3d 53 (Fla. 2018)(under federal law AHCA may

only reach the past medical expenses portion of a Medicaid recipient's tort

recovery to s atisfy its Medicaid lien).

47. Section 409.910(11)(f) limits AHCA's recovery for a Medicaid lien to

the lesser of its full lien or one - half of the total award, after deducting

attorney's fees of 25 percent of the recovery and all taxable costs, not to

3 I n keeping with the testimony of his experts, Petitioner , in his Proposed Final Order,

contended that the amount allocable to AHCA was $354,886.32 , or 21 percent of all past

medical expenses, including the $280,318.94 paid by private ins urance. The undersigned has

corrected this number to include only 21 percent of the expenses covered by AHCAÔs

Medicaid lien.

exce ed the total amount actually paid by Medicaid on the recipient's behalf.

In this case, application of the formula would result in AHCA recovering the

full amount of the lien.

48. However, section 409.910(17)(f) provides a method by which a

Medicaid recipie nt may contest the amount designated as recovered Medicaid

expenses payable under section 409.910(11)(f). To successfully challenge the

amount payable to AHCA, the recipient must prove, by a preponderance of

the evidence, that a lesser portion of the total recovery should be allocated as

reimbursement for past medical expenses than the amount calculated by

AHCA pursuant to the formula.

49. The pro rata approach has been accepted in Florida cases where the

Medicaid recipient has presented competent, substan tial evidence to support

the allocation of a smaller portion of a settlement for past medical expenses

than the portion claimed by AHCA. Ag. for Health Care Admin . v. Rodriguez ,

294 So. 3d 441 (Fla. 1st DCA 2020); Bryan v. Ag. for Health Care Admin . ,

291 S o. 3d 1033 (Fla. 1st DCA 2020); Mojica v. Ag. for Health Care Admin . ,

285 So. 3d 393 (Fla. 1st DCA 2019); Eady v. State , 279 So. 3d 1249 (Fla. 1st

DCA 2019).

50. Where uncontradicted testimony is presented by the recipient, the

factfinder must have a "rea sonable basis in the record" to reject it. Giraldo ,

248 So. 3d at 56, quoting Wald v. Grainger , 64 So. 3d 1201, 1205 - 06

(Fla. 2011) . In the instant case, AHCA has provided no reasonable basis to

reject the testimony of Mr. Leeder and Mr. Barrett.

51 . Petit ioner proved by a preponderance of the evidence that the

settlement proceeds of $9,449,500 represent only 21 percent of PetitionerÔs

claim valued at $45 million, which both testifying attorneys reasonably

believed was a very conservative valuation. Therefo re, it is concluded that

AHCA's full Medicaid lien amount should be reduced by the percentage that

Petitioner's recovery represents of the total value of Petitioner's claim.

52 . The application of the 21 percent ratio to the Medicaid lien amount of

$1,409, 615.94 results in $296,019.35 . This amount represents that share of

the settlement proceeds fairly and proportionately attributable to

expenditures that were actually paid by AHCA for Petitioner's past medical

expenses.

O RDER

Based on the foregoing Findin gs of Fact and Conclusions of Law, it is

hereby

O RDERED that:

The Agency for Health Care Administration is entitled to $296,019.35 in

satisfaction of its Medicaid lien.

D ONE A ND O RDERED this 15th day of April , 2021 , in Tallahassee, Leon

County, Florida.

S

L AWRENCE P. S TEVENSON

Administrative Law Judge

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 15th day of April , 2021 .

C OPIES F URNISHED :

Floyd B. Faglie, Esquire John Cofield, Client Services Sr. Man ager

Staunton & Faglie, PL Conduent Payment Integrity Solutions

189 East Walnut Street Suite 300

Monticello, Florida 32344 2073 Summit Lake Drive

Tallahassee, Florida 32317

Frank Dichio Alexander R. Boler, Esquire

Agency for Health Care Administration Suite 300

Mail Stop 19 2073 Summit Lake Drive

2727 Mahan Drive Tallahassee, Florida 32317

Tallahassee, Florida 32308

Elizabeth A. Teegen, Esquire

Ashley E. D avis, Esquire Office of the Attorney General

Florida Department of State Th e Capitol, Plaza Level 01

500 S outh Bronough S treet Tallahassee, Florida 32399

Tallahassee, Florida 32399

Simone Marstiller, Secretary

Richard Shoop, Agency Clerk Agency for Health Care Administration

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 1

2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308

Tallahassee, Florida 32308

Shena L. Grantham, Esquire

James D. Varnado, General Counsel Agency for Health Care Administration

Agency for Health Care Administration Building 3 , Room 3407B

2727 Mahan Drive, Mail Stop 3 2727 Mahan Drive

Tallahassee, Florida 32308 Tallahassee, Florida 32308

Thomas M. Hoeler, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

N OTICE O F R IGHT T O J UDICIAL R EVIEW

A party who is adversely affected by this Final Order is entitled to judicial

review pursuant to section 120.68, Florida Statutes. Review proceedings are

governe d by the Florida Rules of Appellate Procedure. Such proceedings are

commenced by filing the original notice of administrative appeal with the

agency clerk of the Division of Administrative Hearings within 30 days of

rendition of the order to be reviewed, a nd a copy of the notice, accompanied

by any filing fees prescribed by law, with the clerk of the d istrict c ourt of

a ppeal in the appellate district where the agency maintains its headquarters

or where a party resides or as otherwise provided by law.