17-005417MTR Joseph Pinto Domingo, A Minor, By And Through His Parents And Natural Guardians, Aurileia Dos Reis Pinto And Nilton Pinto vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Friday, January 15, 2021.

Summary: Petitioners proved that reimbursement of Medicaid expenses in an amount less than the full amount set by the (11)(f) formula was appropriate.

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

J OSEPH P INTO D OMINGO , A M INOR , B Y

A ND T HROUGH H IS P ARENTS A ND

N ATURAL G UARDIANS , A URILEIA D OS

R EIS P INTO A ND N ILTON P INTO ,

Petitioners ,

vs. Case No. 17 - 5417MTR

A GENCY F OR H EALTH C ARE

A DMINISTRATION ,

Respond ent .

/

A MENDED F INAL O RDER O N R EMAND

On November 18, 2020 , the First District Court of Appeal issued its

opinion in Joseph Pinto Domingo, a minor, by and throu gh his parents and

natural guardians, Aurileia Dos Reis Pinto and Nilton Pinto v. State of

Florida, Agency for Health Care Administration , Case No. 1D1 8 - 2573 , in

which the Court reversed the Final Order entered in this case on May 22,

2018 . In the Final Or der, the then presiding Administrative Law Judge

ordered Petitioner to reimburse AHCA for the full amount of its Medicaid

expenditures for h is past medical expenses in the amount of $ 641,174.03, in

satisfaction of AHCAÔs Medicaid lien.

The O pinion is dis positive as to the amount Petitioner s are required to

reimburse AHCA in satisfaction of its Medicaid lien, stating that:

In this case, the appellant presented competent,

substantial, and uncontradicted evidence to

support the reduction of his Medicaid lien by using

a pro rata method. AHCA failed to present any

evidence that the appellantÔs proposed pro rata

methodology was inaccurate or that another

method would be more appropriate to apply. As a

result, the ALJ erred as a matter of law by

concluding that t he appellant failed to prove that

his Medicaid lien should have been reduced. See

Mojica , 285 So. 3d at 396Č98. We note that the

appellantÔs proposed amount that AHCA should

recover for its Medicaid lien was mathematically

incorrect; however, the appellant presented

competent, substantial evidence that the Medicaid

lien should be reduced by one - third. Accordingly,

we reverse and remand the cause to the

Department of Administrative Hearings for the

ALJ to reduce AHCAÔs Medicaid lien to

$213,724.68.

The Cour t remanded the case to DOAH for further proceedings consistent

with its O opinion. Mandate was entered on December 9, 2020 . The presiding

Administrative Law Judge having retired since the entry of the Final Order,

the case was assigned to the undersigned.

On January 11, 2021 , an Order for Requiring Status Report was entered

that required the parties to confer and jointly advise the undersigned of the

amount each of them believed to be the correct amount to be reimbursed by

Petitioner s in satisfaction of the M edicaid lien. On January 13, 2021 , the

parties filed a joint response in which they agreed that the sum of

$213,724.68 is sufficient , and required, to satisfy the Medicaid lien . Furt her

evidentiary proceedings are not necessary to carry out the direction o f the

Court.

Based on the foregoing, it is hereby O RDERED that Petitioner s , Joseph

Pinto Domingo, a minor, by and through his parents and natural guardians,

Aurileia Dos Reis Pinto and Nilton Pinto , shall pay to Respondent, Agency for

Health Care Administr ation, the sum of $213,724.68 , in satisfaction of the

Medicaid Lien.

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

County, Florida.

S

E. G ARY E ARLY

Administrative Law Judge

Division of Administra tive Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 15th day of January , 2021 .

C OPIE S F URNISHED :

Alexander R. Boler, Esquire

Suite 330

2073 Summit Lake Drive

Tallahassee, Florida 32317

(eServed)

Floyd B. Faglie, Esquire

Staunton & Faglie, PL

189 East Walnut Street

Monticello, Florida 32344

(eServed)

Kim Annette Kellum, Esquire

Ag ency for Health Care Administration

Mail Stop 3

2727 Mahan Drive

Tallahassee, Florida 32308

(eServed)

Shena L. Grantham, Esquire

Agency for Healthcare Administration

Building 3, Room 3407B

2727 Mahan Drive

Tallahassee, Florida 32308

(eServed)

Thomas M. Hoeler, Esquire

Agency for Health Care Administration

Mail Stop 3

2727 Mahan Drive

Tallahassee, Florida 32308

(eServed)

Richard Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Shevaun L. Harris, Acting Secretary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308

Bill Roberts, Acting General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Flo rida 32308

(eServed)

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

governed by the Florida Rules of Appellate P rocedure. 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, and 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.