In at least two prior posts, I have discussed issues surrounding Medicare’s rights to be reimbursed for medical payments from settlements or judgments in personal injury claims. As I stated in the past, dealing with Medicare can be an extremely frustrating experience. So, I am happy to report a recent court decision that, to some degree, requires Medicare to play by rules that apply to the rest of us.
On September 29, the United States Court of Appeals for the 11th Circuit issued a decision in Bradley v. Sebelius. The case involved reimbursement claims by Medicare arising out of a wrongful death settlement in Florida. This case is a welcome decision for attorneys frustrated by the experience of dealing with Medicare. On his blog, Tennessee attorney John Day wrote a great analysis of this decision. I agree with John after reading the facts of the case that it involved some great lawyering on the part of plaintiffs’ counsel to document and position the case in an effort to achieve this great result.
In the case, the Federal Court rejected Medicare’s far-reaching argument that its own field manual was basically entitled to the force of law. In rejecting those claims, the Federal Court actually stated:
The Secretary’s ipse dixit contained in the field manual does not control the law.
If you want to understand the Latin phrase ipse dixit, here is one definition as to its meaning:
The master said it so it must be true! That pretty much sums up Medicare’s prior attitude in dealing with its beneficiaries. Here, Medicare created its own manual and has attempted to enforce it against beneficiaries as if it were a validly enacted statute.
Additionally, according to this case, Medicare must account for underlying state law concerning substantive recovery rights. Under Florida’s wrongful death law, the claim of an estate is separate and distinct from the claims of the survivors. Both the estate and survivors of a deceased can sue the party responsible for causing the death in Florida. However, under Florida law, only the estate can claim medical expenses as part of its damages. Thus, only the estate’s share of any settlement is subject to Medicare reimbursement claims.
This decision is a welcome limitation upon Medicare’s actions. Now, if Congress would only pass legislation requiring Medicare to respond in a timely manner to efforts by private parties to reimburse medical payments.