17-005454MTR Jared Bruno Ramella vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Thursday, February 15, 2018.

Summary: Pet. proved by a preponderance of the evidence that $10,324 of the total third-party recovery represents the share of the settlement proceeds fairly attributable to past medical expenditures & that amount is available to satisfy AHCA's Medicaid lien.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

JARED BRUNO RAMELLA,

Petitioner,

vs. Case No. 17 - 5454MTR

AGENCY FOR HEALTH CARE

ADMINISTRATION,

Respondent.

_______________________________/

FINAL ORDER

O n November 14 , 2017, Ad ministrative Law Judge Hetal Desai

of the Division of Administrative Hearings conducted t he final

hearing in this matter by video teleconference with sites in

Tallahassee and Tampa, Florida.

APPEARANCES

For Petitioner: John W. Staunton, Esquire

Staunton & Faglie, PL

3000 Gulf to Bay Boulevard

Clearwater, Florida 33759

For Respondent: Alexander R. Boler, Esquire

2073 Summit Lake Drive , Suite 300

Tallahassee, Florida 323 17

STATEMENT OF THE ISSUE S

The issue for determination is the amount of money

Petitioner, Jared Bruno Ramella, must pay to Respondent, Agency

for Health Care Administration (ÐAHCAÑ or Ðthe AgencyÑ), out of

his settlement proceeds as reimbursement for past Medicaid

expenditures pursuant to section 409.910, Florida

Statutes (2017 ). 1/ More specifically, it must be determined

whether Petitioner must pay the default amount of the Medicaid

lien , $121,065 , pursuant to section 409.910(11)(f) ; and , if not,

what p ortion of his $775,000 settlement proceeds is due to AHCA.

PRELIMINARY STATEMENT

On September 29, 2017, Petitioner, a Medicaid recipient,

filed a ÐPetition to Determine Amount Payable to Agency for

Health Care Administration in Satisfaction of Medicaid Lie nÑ

(ÐPetitionÑ) with the Division of Administrative Hearings

(ÐDOAHÑ). Upon receiving the Petition, DOAH notified the Agency

of the Petition and assigned it to an Administrative Law Judge

(ÐALJÑ) .

The Petition challenged the Agency Ó s Medicaid lien on

Pet itioner Ó s set tlement and recovery from third parties.

Pursuant to section 409.910(11)(f) , t he Agency seeks full

reimbursement of Medicaid expenditures paid on Petitioner Ó s

behalf with Medicaid funds. The Petition asserts reimbursement

of a lesser portion of Petitioner Ó s recovery is appropriate

pursuant to section 409.910(17)(b).

After proper notice, the ALJ held a telephonic pre - hearing

conference on November 9, 2017, to determine the scope of the

hearing and discuss the exhibits and witnesses. During t his

conference, the parties Ó stipulat ion to a number of facts was

discussed; these stipulated facts are incorporated below.

The final hearing was held on November 14, 2017. Petitioner

offered the testimony of two witnesses: Weldon Earl Brennan,

Esquire, Petitioner Ó s personal injury attorney and an expert

witness in valuation of personal injury damages; and Ralph Vi nson

Barrett, Esquire , who was also accepted as an expert in valuation

of damages in personal injury cases. Moreover, Petitioner Ó s

Exhibits 1 through 22 were admitted into evidence without

objection. The Agency did not offer any witnesses or evidence.

A T ranscript of the proceeding was filed on December 19,

2017. The parties were granted an extension to file post - hearing

submittals. Both par ties filed proposed final orders (ÐPFOÑ) ,

but Petitioner Ó s submittal was untimely. As the Recommended

Order had not been finalized and there was no objection to the

late - filed PFO , both P F Os have been considered.

FINDING S OF FACT

Underlying Accident and Injuries

1. Petitioner, at age 29, was involved in a catastrophic

motorcycle accident leaving him paralyzed from his waist down,

and with only limited use of his right arm. On the night of

November 21, 2014, Petitioner Ó s motorcycle collided with an

oncom ing vehicle that had turned left in front of Petitioner.

The driver of the oncoming vehicle (ÐDriverÑ) did not see

Petitioner riding toward her in traffic and Petitioner was unable

to stop. Upon impact Petitioner was thrown off his motorcycle

and landed approximately 64 feet away .

2. At the scene of the accident, Petitioner had no

sensation from his mid - abdomen down. Later, it was determined he

suffered a number of injuries including fractures of several of

his cervical vertebrae, a broken right leg, severe nerve damage

in his right arm, and a brain bleed.

3. Petitioner is permanently paralyzed from the ribs down,

has no control over his bowel and urinary functions, and suffers

from chronic depression and an anxiety disorder. The injuries

have impac ted not only his physical abilities, but have also

affected his ability to maintain normal family, social and work

relationships.

4. Petitioner received extensive medical care for his

injuries. In total, as of September 2017, Petitioner Ó s unpaid

past m edical expenses (ÐPMEÑ) related to his injuries totaled

$159,818, of which $121,065 was provided by Medicaid. 2/ N o

portion of the PME was incurred for future medical care.

Petitioner Ó s Sources of Recovery

5. As a result of the accident, Petitioner filed a claim

for damages with his mother Ó s insurance policy and received the

policy limits, $150,000.

6. Petitioner filed a similar claim against the Driver Ó s

personal insurance policy and received the policy limits,

$25,000.

7. Personally, the Driver had no collectable assets. She

and her family business, however, maintained a number of

insurance policies with Auto Owners Insurance Co . (ÐAuto

OwnersÑ) , with a total coverage limit of $100,000. Petitioner

made a claim against these policies, but Auto Owners declined to

tender the policy limits to him.

8. In 2015, Petitioner filed a lawsuit against the Driver

in circuit court. Ultimately, Auto Owners settled with

Petitioner for $600,000. In exchange for the settlement funds,

Petitioner agreed to dismiss th e lawsuit, and execute a full

release of the Driver for the accident and Auto Owners for a

potential bad faith claim.

9 . In total, Petitioner received $775,000 in gross

settlement proceeds (ÐGSPÑ) from the following sources:

25,000 USAA (Driver Ó s perso nal policy)

150,000 Allstate ( Petitioner Ó s mother Ó s policy)

100,000 Auto Owners (Driver Ó s self - employment policy)

500,000 Auto Owners (bad faith settlement)

$775,000 Gross Settlement Proceeds

10 . Mr. Brennan testified that even though t he Driver would

have been found liable had the matter gone to trial, the $100,000

policy limit was the best Petitioner could hope to recover even

with a favorable jury verdict because the Driver was Ð judgment

proof. Ñ Based on Auto Owner Ó s refusal to tende r the policy

limits, Petitioner was able to recover $500,000 in settlement

proceeds above the policy limits.

11 . Had Petitioner not pursued litigation, the most

Petitioner would be able to recover would be $275,000.

12 . On September 21, 2017, Petitione r notified AHCA of the

Auto Owner Ó s settlement and asked AHCA what amount it would

accept in satisfaction of its $121,065 Medicaid lien. AHCA did

not reply to Petitioner Ó s inquiry.

1 3 . Petitioner deposited $121,065 in an interest - bearing

account for the benefit of AHCA pending an administrative

determination of AHCA Ó s rights by DOAH.

Allocation of Past Medica l Expenditures

14 . The parties stipulated that under the default formula

found in section 409.910(11)(f), Petitioner is required to pay

the Agenc y the full amount of the $121,065 Medicaid lien from the

$775,000 total settlement proceeds.

15 . The settlement agreement with Auto Owners contained a

paragraph titled ÐAllocation of Settlement.Ñ This paragraph

stated Petitioner Ó s damages were valued as more than $12 million,

and $7,973.71 of the $600,000 was allocated for past medical

bills.

Allocation of Settlement . Although it is

acknowledged that this settlement does not

fully compensate Plaintiff for all of the

damages he has allegedly suffered, this

settlement shall operate as a full and

complete Release as to Releasees (as more

fully described . . . below) without regard

to this settlement only compensating

Plaintiff for a fraction of the total

monetary value of his alleged damages. The

parties agree that Plaintiff Ó s alleged

damages have a value in excess of

$12,000,000, of which $159,474.11 [ 3/ ]

represents Plaintiff Ó s claim for past medical

expenses. Given the facts, circumstances, and

nature of Plaintiff Ó s alleged injuries and

this settlement, the parties have agreed to

allocate $7,973.71 of this settlement to

Plaintiff Ó s claim for past medical expenses

and allocate the remainder of the settlement

towards the satisfaction of claims other than

past medical expenses. This allocation is a

reasonab le and proportionate allocation based

on the same ratio this settlement bears to

the total monetary value of all Plaintiff Ó s

alleged damages.

The settlement agreement between Petitioner and Auto Owners was

fully executed on September 22, 2017.

16 . AHCA w as not a party to the settlement agreement or

release.

17 . Although the parties stipulated to a number of facts and

figures, they did not stipulate to the total provable damages

(ÐTPDÑ). Regardless, Petitioner proved by the preponderance of

the evidenc e that TPD was equivalent to $12 million.

18 . More precisely, Petitioner established through

unrebutted evidence and testimony of his trial attorney and his

expert witness that personal injury actions can be broken down

into the following categories:

(A ) past lost wages ;

(B) future lost income ;

(C) pas t medical amounts billed ;

(D) future medical expenses ; and

(E) non economic damages such as pain and suffering.

This is consistent with terminology used in other administrative

proceedings defining TP D as Ðall components of a plaintiff Ó s

recoverable damages, such as medical expenses, lost wages, and

noneconomic damages ( e.g. , pain and suffering).Ñ See Smathers v.

Ag . for Health Care Admin. , Case No. 16 - 3590MTR, 2017 Fla. Div.

Adm. Hear. LEXIS 540, at * 7 (Fla. DOAH Sept. 13, 2017).

19 . According to the testimony, jury awards -- which are one

manifestation of a TPD determination -- in similar personal injury

cases can be estimated to be approximately 2.85 times the first

fo ur categories, or TPD = 2.85 x ( A B C D ) .

20 . Petitioner proved that his past economic damages

(A C) Î - which include the total amount bill ed for medical

services and lost income as of the date of the settlement -- were

approximately $1,058,159. 4/

21 . Petitioner also offered into evidence an economi c

report projecting future lost income assuming Petitioner Ó s loss

of total earning capacity; and a Ðfuture life care planÑ report

that projected future medical expenses . Together , these reports

establish ed PetitionerÓs future economic d amages (B D) would be

conservatively estimated at $3,576,376. The present day value of

these future damages would be $3,892,550.

22 . Based on these figures, Petitioner Ó s TPD can be

calculated to be approximately $12 million: TPD = ($1,058,159

$3,8 92,550) x 2.85 = $12,151,926.

23 . Mr. Brennan testified that based on his experience and

the research he conducted in connection with filing Petitioner Ó s

lawsuit, he believed the total value of the lawsuit was in a

range between $12 and $16 million.

24. Mr. Barrett testified that based on his familiarity

with jury trials involving similar injuries, in his expert

opinion, a jury verdict would have been between $12 and $18

million, noting Ð12 million is certainly a very conservative

figure for his pure dam ages.Ñ

25. Both witnesses also testified the $775,000 settlement

amount did not fully compensate Petitioner. There was no dispute

at the hearing that the GSP is a fraction of the cost for future

medical expenses, and does not begin to cover Petitioner Ó s future

loss of earning potential or his non economic damages.

26. The portion of Petitioner Ó s GSP that can be allocated

as PME paid by the Agency remains to be determined. Under a

Ðsettlement - to - valueÑ formula , AHCA would recover the same

portion of its lien as the portion of GSP in relation to his TPD,

or equal to GSP/TPD x (PME). See Smathers , 2017 Fla. Div. Adm.

Hear. LEXIS 540, at *8.

27 . Here, the GSP represented approximately 6.46 percent of

the TPD. Applying this percentage to the PME using the

Ðsettlement - to - valueÑ formula , the Agency could only recover

$ 10,324 . In other words, the amount of settlement funds

attributable to medical expenditures can be determined as:

$ 775,000 (GSP ) X $ 159,818 (PME )

$12,000,000 (TPD)

28 . In support of this formula , Petitioner submitted -- again

without an objection from AHCA -- orders from various Florida

circuit courts reducing Medicaid liens by applying this formula.

Mr. Barrett Ó s unrebutted testimony corroborated this evidence

that the Ð settlement - to - va lue Ñ formula should be applied to

Petitioner Ó s PME , noting this method was Ðlogic al, and that is

how it is done. That Ó s the trade practice.Ñ

29 . Given that Petitioner Ó s witnesses were the only

witnesses, these witnesses were knowledgeable and credible, a nd

there was no contrary testimony or evidence, Petitioner has

proved by a preponderance of the evidence that $ 10,324

constitutes the portion of the GSP that can fairly be allocated

toward Petitioner Ó s PME.

CONCLUSIONS OF LAW

30 . The Division of Administ rative Hearings has jurisdiction

over the subject matter and parties in this case pursuant to

sections 120.569, 120.57, and 409.910, Florida Statutes, the

Medicaid Third - Party Liability Act . Delgado v. Ag. for Health

Care Admin. , 43 Fla. L. Weekly D245 , 2 018 Fla. App. LEXIS 1012 , at

*11 - 12 (Fla. 1st DCA Jan . 26, 2018) (concluding DOAH has subject

matter jurisdiction to resolve dispute s brought under section

409.910(17)(b); Ð In his final order, the ALJ initially concluded

as a matter of law that DOAH had Ò j urisdiction over the subject

matter . . . pursuant to sections 120.569, 120.57(1) and

409.910(17), Florida Statutes. Ó The ALJ did not err in reaching

that conclusion .Ñ ).

31 . Medicaid is a joint federal - state program designed to

help participating states provide medical treatment for their

residents that cannot afford to pay. Moore ex rel. Moore v.

Reese , 637 F.3d 1220, 1232 (11th Cir. 2011). Although

participation in Medicaid is voluntary, all states take advantage

of this funding source for the medica l needs of its citizens.

See Ark. Dep Ó t of Health & Human Servs. v. Ahlborn , 547 U.S. 268,

275 (2006) (Ð States are not required to participate in Medicaid,

but all of them do. The program is a cooperative one; the

Federal Government pays between 50% and 83% of the costs the

State incurs for patient care, and, in return, the State pays its

portion of the costs and complies with certain statutory

requirements for making eligibility determinations, collecting

and maintaining information, and administering t he program.Ñ);

see also Gallardo v. Dudek , 263 F. Supp. 3d 1247, 1250 (N.D. Fla.

2017) , amended on rehearing , 2017 U.S. Dist. LEXIS 112448 (N.D.

Fla. 2017) ; rev. granted , C ase N o. 17 - 13693 (11th Cir. 2017); and

see also Estate o f Hernandez v. Ag. for Healt h Care Admin. , 190

So. 3d 139, 141 - 142 (Fla. 3d DCA 2016) (describing interplay

between Federal and Florida law regarding Medicaid program and

lien recovery) .

32 . In order for the state of Florida to take advantage of

Medicaid funds for patient care costs , it must comply with the

federal regulations requiring it to recover its expenditures for

the medical expenses from third - party sources such as settlement

agreements . 42 U.S.C. § 1396a(a)(25)(B); Ahlborn , 547 U.S. at

284 - 85. At the same time, the Medica id statute limits a state Ó s

right to collect reimbursement of expended funds to only those

third - party monies that can be allocated for medical care.

42 U.S.C. § 1396p(a)(1) ; Ahlborn , 547 U.S. at 285 - 86.

33. The parties have stipulated : (1) the Agency has the

right to recover payment; (2) Petitioner has the opportunity to

prove that the portion of the settlement that represents medical

expenses is less than the amount due under the default formula ;

(3) the Agency can only seek recovery from that portio n of the

settlement that represents PME ; and (4) Petitioner Ó s burden of

proof is the Ðpreponderance of the evidenceÑ standard. What

remains to be determined is whether Petitioner proved that less

than $121,065 of the $775,000 represents the PME ; and , if s o, what

portion of the $775,000 can be allocated for the PME .

34 . T he L egislature set forth a Ðdefault formula Ñ to

determine the amount the Agency may recover for past Medicaid

payments from a judgment, award, o r settlement from a third - party.

S ection 409.910(11)(f) establishes the Agency Ó s default recovery

amount for a Medicaid lien is limited to one - half of the total

award, after deducting attorney Ó s fees of 25 percent of the

recovery and all taxable costs, up to, but not to exceed, the

total amount a ctually paid by Medicaid on the recipient Ó s behalf.

Here, the parties stipulated that under this statutory formula,

the Agency would be entitled to its full lien amount of $121,065.

35 . The statute, however, provides Medicaid r ecipients with

a method fo r challenging this default amount by initiating an

administrative proceeding through DOAH. Section 409.910(17)(b)

provides the procedure by which a Medicaid recipient may contest

the amount designated as recovered medical expenses payable under

section 40 9.910(11)(f). Due to recent federal and state court

decision s striking down portions of section 409.910(17)(b) , this

section currently is interpreted as follows:

This procedure is the exclusive method for

challenging the amount of third - party benefits

pay able to the agency. In order to

successfully challenge the amount payable to

the agency, the recipient must prove, by

[ a preponderance of the evidence ] clear and

convincing evidence , that a lesser portion of

the total recovery should be allocated as

reim bursement for past and future medical

expenses than the amount calculated by the

agency pursuant to the formula set forth in

paragraph (11)(f) or that Medicaid provided a

lesser amount of medical assistance than that

asserted by the agency. ( s trikethrough and

underline added) .

See Gallardo , 263 F. Supp. 3d at 1260 (holding Florida Ó s Ð clear

and convincing Ñ burden in section 409.910(17)(b) is preempted by

federal law) ; Museguez v. Ag. for Health Care Admin . , Case

No. 16 - 7379MTR, 2017 Fla. Div. Adm. Hear. L EXIS 561 , *36 - 37 (Fla.

DOAH Sept. 19, 2017) (explaining the default burden of proof after

Gallardo pursuant to section 120.57(1)(j) is preponderance of the

evidence); Lamendola v. Ag. for Health Care Admin. , Case

No. 17 - 3908MTR, 2018 Fla. Div. Adm. Hear. LEXIS 6, *14 - 15 ( Fla.

DOAH Jan. 5, 2018) (ÐNotwithstanding the language of section

409.910(17)(b), because of rulings in Gallardo . . . PetitionerÓs

burden in this case is a preponderance of the evidence .Ñ) . See

also Gallardo , 263 F. Supp. 3d at 1253 (Ð Ga llardo contends that

§ 409.910 conflicts with federal law and is therefore preempted to

the extent that it allows AHCA to satisfy its lien from a Medicaid

reci pientÓ s recovery for future medical expenses. This Court

agrees. Ñ); Willoughby v. Ag. for Healt h Care Admin. , 212 So. 3d

516, 518 ( Fla. 2d DCA 2017) (holding third - party proceeds

representing future medical expenses cannot be attached for

purposes of Medicaid lien ) , vol untarily dismissed Case No. SC17 -

660 (Fla. S. Ct. Sept. 13, 2017) ; Lamendola , 201 8 Fla. Div. Adm.

Hear. LEXIS 6, at * 15) (noting Ð any settlement proceeds attributed

to future medical expenses shall not be considered in calculation

of AHCAÓs lienÑ) . But see Giraldo v. Ag. for Health Care Admin. ,

208 So. 3d 244 (Fla. 1st DCA 2016) (conf licting with Willoughby ,

finding AHCA may recover proceeds allocated toward future medical

expenses to satisfy Medicaid lien) , rev . granted , Case No. SC17 -

297 (Fla. S. Ct. Sept. 6, 2017 ) .

36 . Here, the Agency has agreed t o the burden of proof and

that do es not seek reimbursement from any portion of the

settlement for future medical damages. It simply asserts that

Petitioner has not met his burden to show Ð that a lesser portion

of the total recovery should be allocated as reimbursement for

past medical ex penses.Ñ

37 . Again, the burden wa s on Petitioner as the Medicaid

recipient to prove by a preponderance of the evidence that a

lesser portion of the total recovery should be allocated as

re imbursement for PME than the amount the Agency calculated. The

Ð pr eponderance of the evidence Ñ standard is a lower bar than the

Ðclear and convincingÑ standard formerly applied and currently

stated in section 409.910(17)(b). It is defined as evidence that

more likely than not tends to prove a proposition. See Gross v.

Lyons , 763 So. 2d 276, 280 n.1 (Fla. 2000). Citing Black Ó s Law

Dictionary , the Florida Supreme Court defines Ðpreponderance of

the evidenceÑ as follows:

Th e greater weight of the evidence, not

necessarily established by the greater number

of witnesses tes tifying to a fact but by

evidence that has the most convincing force;

superior evidentiary weight that, though not

sufficient to free the mind wholly from all

reasonable doubt, is still sufficient to

incline a fair and impartial mind to one side

of the iss ue rather than the other .

S. Fla. Water Mgmt. v. RLI Live Oak, LLC , 139 So. 3d 869, 872 n.1

(Fla. 2014) .

38 . Although it is true the statute provides little guidance

as to what standard should be used in determining whether and to

what extent a Medicaid recipient can satisfy the Ðshould be

allocatedÑ requirement, here Petitioner has proven that to allow

the Agency to recover the entire default amount would not be fair

or reasonable. See Smathers 2017 Fla. Div. Adm. Hear LEXIS 540,

at *16 n.7.

39 . It sho uld be noted that Petitioner Ó s settlement

agreement in and of itself cannot establish the allocation to be

used in determining what portion of the settlement proceeds can be

allocated for PME . Sec t ion 409.9 1 0 (13) provides that a settlement

agreement canno t i mpair a Medicaid lien:

No action of the recipient shall prejudice the

rights of the agency under this section.

No . . . Ð settlement agreement, Ñ entered into

or consented to by the recipient or his or her

legal representative shall impair the agency Ó s

rights.

See also Deyam paret v. Ag. for Health Care Adm in . , Case No. 17 -

4560MTR, 2018 Fla. Div. Adm. Hear. LEXIS 2, *16 - 17 ( Fla. DOAH

Jan. 3, 2018). Here, the numbers in the settlement a greement are

not correct, nor were they agreed to by AHCA.

40 . Rega rdless of the explicit language in the settlement

agreement, all of the testimony and other evidence offered by

Petitioner proved that the Ð settlement - to - value Ñ formula was an

appropriate method to determin e what portion of the allocation was

attributable to PME .

41. Petitioner also asserts that the $ 10,324 amo unt that

results from using the Ðsettlement - to - valueÑ formula should be

further reduced to reflect the percentage that the Medicaid

expenditure ($121,065) makes up the total PME ($159,818) , which i s

approximately 7 6 percent. This formula would make only $7,8 46

available to AHCA for satisfaction of the Medicaid lien. There is

no authority for such a red uction. Se ction 409.910(17)(b)

explicitly allows only one method for a Medicaid recipient to

cha llenge the default amount : by establish i ng Ð that a lesser

portion of the total recovery should be allocated as reimbursement

for past [] medical expenses .Ñ The statute does not use the term

Ð past Medicaid expenditures . Ñ

42 . Although t he Agency did not have the burden of proof, it

could have put on testimony or evidence that brought into question

Petitioner Ó s underlying propositions relating to the TPD, or that

another method should be used to calculate what portion of the

proceeds are attributable to PM E and should be available to AHCA .

It chose not to do so. There was nothing in the record

contradicting the testimony and evidence put on by Petitioner that

a Ð settlement - to - value Ñ ratio of GSP to PME constitutes a fair,

reasonable and accurate share of the total settlement available

for recovery on the Medicaid lien.

43 . Petitioner p rove d by a preponderance of the evidence,

$ 10,324 represents th e amount of the GSP that can be fairly

attributable to PME and are available to the Agency for repayment

on i ts Medicaid lien.

ORDER

Based on the foregoing Findings of Fact and Conclusions of

Law, it is hereby

ORDERED that the Agency for Health Care Administration may

recover $ 10,324 from Petitioner Ó s settlement proceeds at issue in

this matter in satisfaction o f its Medicaid lien.

DONE AND ORDERED this 15 th day of February , 2018 , in

Tallahassee, Leon County, Florida.

S

HETAL DESAI

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee P arkway

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 1 5 th day of February , 2018 .

ENDNOTE S

1/ Unless referenced otherwise, all citatio ns to state and

federal statutes , rules and regulations are to the 2017 versions

which were effect at the time of Petitioner Ó s settlement

agreement . See Cabrera v. Ag. f or Health Care Admin. , Case

No. 17 - 4557MTR, 2018 Fla. Div. Adm. Hear. LEXIS 43, n.1 ( Fla.

DOAH Jan. 23, 2018) (citing Suarez v. Port Charlotte HMA , 171 So.

3d 740 (Fla. 2 d DCA 2015) ).

2/ Although the evidence establishes the total medical costs from

the date of the accident to the time of the expert report were

approximately $1 million ( see supra , n.4) , the parties stipulated

for Medicaid lien purposes the Ðpast medical expensesÑ amount is

$159,818 based on the outstanding lien amounts , which are broken

down as follows:

Lien Amount Source

$ 121,065 Medicaid

15,618 Florida Brain an d Spinal Cord Injury Program

20,120 Prestige Health

2,610 AETNA Medicare Prescription Drug Program

405 Medicare

$ 159,818 PME

All monetary figures are rounded to the nearest dollar.

3/ The discr epancy between the PME ($159,818) and the amount in

the Settlement Agreement ($159,474) was due to a subsequent

billing adjustment.

4/ Although this figure seems excessive for these components,

AHCA did not dispute the amounts provided by Petitioner for

either the past lost wages or total past medical expenses which

include both the PME and other expenses not subject to liens .

According to the economic report these figures were as follows:

$83,327 Loss of Income/ Earning Capacity

974,832 Total B illing for me dical expenses as of Sept. 2016

$1,058,159 Past Economic Damages as of September 2016

COPIES FURNISHED:

Alexander R. Boler, Esquire

2073 Summit Lake Drive , Suite 300

Tallahassee, Florida 32317

(eServed)

Kim Annette Kellum, Esquire

Agency for Health Care Administration

2727 Mahan Drive , Mail Stop 3

Tallahassee, Florida 32308

(eServed)

John W. Staunton, Esquire

Staunton & Faglie, PL

3000 Gulf to Bay Boulevard

Clearwater, Florida 33759

(eServed)

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Stefan Grow, General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Justin Senior, Secretary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308

(eServed)

Thomas M. Hoeler, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

NOTICE OF RIGH T TO JUDICIAL REVIEW

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

Procedure. Such proceedings are com menced 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 l aw, with the clerk

of the District Court of Appeal in the appellate district where

the agency maintains its headquarters or where a party resides or

as otherwise provided by law.