STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

ASHTON HAYWOOD, A MINOR, BY AND THROUGH HIS PARENTS AND NATURAL GUARDIANS, ASHLEY WILLIAMCEAU AND JAMAL HAYWOOD,

vs.

Petitioner,

Case No. 15-6106MTR

AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

/

FINAL ORDER

A duly-noticed final hearing was held in this case on May 9, 2016, via video teleconference in Tallahassee and

West Palm Beach, Florida, before W. David Watkins, a designated Administrative Law Judge of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Floyd B. Faglie, Esquire

Staunton and Faglie, P.L.

189 East Walnut Street Monticello, Florida 32344

For Respondent: Alexander R. Boler, Esquire Suite 300

2073 Summit Lake Drive Tallahassee, Florida 32317

STATEMENT OF THE ISSUE

The issue to be determined is the amount to be reimbursed to Respondent, Agency for Health Care Administration (AHCA), for medical expenses paid on behalf of Petitioner, Ashton Haywood, from personal injury settlements received by Petitioner from

third parties.

PRELIMINARY STATEMENT

On October 27, 2015, Petitioner filed with the Division of Administrative Hearings (Division) a Petition to Determine Amount Payable to Agency for Health Care Administration in Satisfaction of Medicaid Lien (Petition), by which he challenged Respondent’s lien for recovery of medical expenses paid by Medicaid in the amount of $464,302.93. The basis for the challenge was the assertion that the application of section 409.910(17)(b), Florida Statutes, warranted reimbursement of a lesser portion of the total third-party settlement proceeds than the amount calculated by Respondent pursuant to the formula established in section 409.910(11)(f).

The Division notified Respondent of the Petition on the date it was filed. The final hearing was initially scheduled for February 24, 2016, but was continued at the request of the parties. The final hearing was rescheduled for May 9, 2016, and was held on that date.

At the final hearing, Petitioner presented the testimony of Darryl L. Lewis and R. Vinson Barrett, each of whom was accepted as an expert in valuation of damages (in personal injury cases). Petitioner’s Exhibits 1 through 12 were received in evidence.

Respondent called one witness, James H.K. Bruner, who was accepted as an expert in case and settlement valuation.

Respondent’s Exhibits A and B were received in evidence.

A one-volume Transcript of the proceedings was filed on June 14, 2016. Petitioner and Respondent timely filed Proposed Final Orders. Both parties’ Proposed Final Orders were considered by the undersigned in the preparation of this Final Order.

All references to the Florida Statutes are to the 2015 version, unless otherwise noted.

FINDINGS OF FACT

1. On August 18, 2011, Ashley Williamceau, then 32 weeks pregnant, presented to the emergency room with lower abdominal pain. She was taken to the labor and delivery unit where the nurses had difficulty obtaining a fetal heart beat and failed to note signs and symptoms of a placental abruption. An emergency C-section was performed and Ashton Haywood (“Ashton”) was born without a heart rate and required resuscitation. Ashton’s heart rate remained below 60 until three minutes of life. As a result of the delay in performing the C-section, Ashton suffered a

   
   

   severe hypoxic ischemic brain injury resulting in permanent and irreversible catastrophic brain damage. Ashton is unable to speak, ambulate, eat, toilet or care for himself in any manner. He is dependent on others for every aspect of his daily care.

2. Ashton’s parents and natural guardians,

   
   

   Ashley Williamceau and Jamal Haywood, brought a medical malpractice action in Palm Beach County, Florida, to recover all of Ashton’s damages, as well as their individual claim for damages associated with their son’s injury, against Ashton’s medical providers (“Defendants”).

3. Ashton’s past medical expenses related to his injuries were paid in part by Medicaid, and Medicaid provided $464,302.93 in benefits. This $464,302.93 paid by Medicaid, combined with

   $23,386.52 in medical bills not paid by Medicaid, constituted Ashton’s entire claim for past medical expenses. Accordingly, Ashton’s claim for past medical expenses was $487,689.45.

4. Ashton, or others on his behalf, did not make payments in the past or in advance for Ashton’s future medical care, and no claim for damages was made for reimbursement, repayment, restitution, indemnification, or to be made whole for payments made in the past or in advance for future medical care.

5. Ashton’s parents and natural guardians,

   
   

   Ashley Williamceau and Jamal Haywood compromised and settled the medical malpractice lawsuit for $5,000,000. In making this

   
   

   settlement, the settling parties agreed that: 1) the settlement did not fully compensate Ashton for all his damages; 2) Ashton’s damages had a value in excess of $35,000,000, of which

   $487,689.45 represented his claim for past medical expenses; and

   
   

   3) allocation of $69,642.05 of the settlement to Ashton’s claim for past medical expenses was reasonable and proportionate.

6. The Settlement Agreement and Release memorializing the settlement between Petitioner and Defendants provided, in part, as follows:

   Although it is acknowledged that this settlement does not fully compensate Ashton Haywood for all of the damages he has allegedly suffered, this settlement shall operate as a full and complete Release as to RELEASEES without regard to this settlement only compensating Ashton Haywood for a fraction of the total monetary value of his alleged damages. The parties agree that Ashton Haywood’s alleged damages have a value in excess of $35,000,000, of which

   $487,689.45 represents Ashton Haywood’s claim for past medical expenses. Given the facts, circumstances, and nature of Ashton Haywood’s injuries and this settlement, the parties have agreed to allocate $69,642.05 of this settlement to Ashton Haywood’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 reasonable and proportionate allocation based on the same ratio this settlement bears to the total monetary value of all Ashton Haywood’s damages.

   
   

   Further, the parties acknowledge that Ashton Haywood may need future medical care related to his injuries, and some portion of this

   
   

   settlement may represent compensation for future medical expenses Ashton Haywood will incur in the future. However, the parties acknowledge that Ashton Haywood, or others on his behalf, have not made payments in the past or in advance for Ashton Haywood’s future medical care and Ashton Haywood has not made a claim for reimbursement, repayment, restitution, indemnification, or to be made whole for payments made in the past or in advance for future medical care. Accordingly, no portion of this settlement represents reimbursement for future medical expenses

   
   

7. Because Ashton was a minor, his settlement required Court approval. Accordingly, by Order on Plaintiffs’ Amended Petition for Court Approval of Minor’s Settlement dated August 12, 2015 (“Order Approving Settlement”), the Circuit Court Judge, Honorable Meenu T. Sasser, approved Ashton’s settlement.

8. As a condition of Ashton’s eligibility for Medicaid, Ashton assigned to AHCA his right to recover from liable third- parties medical expenses paid by Medicaid. See 42 U.S.C.

   §§ 1396a(a)(25)(H) and 409.910(6)(b), Fla. Stat.

   
   

9. AHCA was not a party to the settlement between Petitioner and Defendants.

10. By letter of September 24, 2015, Ashton’s medical malpractice attorney notified AHCA of the settlement and provided AHCA with a copy of the executed Release, copy of the Order Approving Settlement, and itemization of $396,334.04 in

    
    

    litigation costs. This letter explained that Ashton’s damages had a value in excess of $35,000,000 and the settlement represented only a 14.28-percent recovery of Ashton’s

    $487,689.45 claim for past medical expenses, or $69,642.05. This letter requested AHCA to advise as to the amount AHCA would accept in satisfaction of the Medicaid lien.

11. AHCA did not file an action to set aside, void, or otherwise dispute Ashton’s settlement with the Defendants.

12. The Medicaid program spent $464,302.93 on behalf of Ashton, all of which represents expenditures paid for Ashton’s past medical expenses. No portion of the $464,302.93 paid by the Medicaid program on behalf of Ashton represent expenditures for future medical expenses, and AHCA did not make payments in advance for medical care.

13. Section 409.910(11)(f) provides, in pertinent part, as

follows:

(f) [I]n the event of an action in tort against a third party in which the recipient or his or her legal representative is a party which results in a judgment, award, or settlement from a third party, the amount recovered shall be distributed as follows:

1. After attorney’s fees and taxable costs . . . one-half of the remaining recovery shall be paid to the agency up to the total amount of medical assistance provided by Medicaid.

   
   

2. The remaining amount of the recovery shall be paid to the recipient.

   
   

3. For purposes of calculating the agency’s recovery of medical assistance benefits paid, the fee for services of an attorney retained by the recipient . . . shall be calculated at

25 percent of the judgement, award, or settlement.

1. Ashton and AHCA agree that application of the formula at section 409.910(11)(f) to Ashton’s settlement requires payment to AHCA of the full $464,302.93 Medicaid lien. The full Medicaid lien amount has been deposited into an interest-bearing account pending an administrative determination of AHCA’s rights, and this constitutes “final agency action” for purposes of chapter 120, Florida Statutes, pursuant to section 409.910(17).

2. Pursuant to the formula set forth in 409.910(11)(f), Respondent should be reimbursed $464,302.93, the full amount of its lien.

3. However, the statute provides a method by which a recipient may contest the amount designated as recovered medical expense damages payable to the agency pursuant to the formula set forth in paragraph (11)(f). “In order to successfully challenge the amount payable to the agency, the recipient must prove, by clear and convincing evidence, that a lesser portion of the total recovery should be allocated as reimbursement for past and future medical expenses than the amount calculated by the agency” pursuant to the formula. § 409.910(17)(b), Fla. Stat.

   
   

4. Darryl L. Lewis has been an attorney for 27 years and is a partner with Searcy, Denny, Scarola, Barnhart & Shipley,

   P.A. The focus of his practice is plaintiffs’ personal injury and medical malpractice, and he has handled cases throughout Florida and multiple states involving catastrophic injury and death. He testified that over the last 27 years he has handled well over 50 to 75 jury trials, including cases involving catastrophic injury to children. Mr. Lewis has served in executive leadership positions of a number of trial attorney organizations, including the Florida Justice Association, the American Association for Justice, and the Attorney Information Exchange Group, and he is currently on the executive committee of the Trial Lawyers Section of the Florida Bar. He is also a member of the Kentucky Justice Association, the T.J. Reddick Bar Association, and the Malcolm Cunningham Bar Association.

5. Mr. Lewis testified that as a routine and daily part of his practice, he makes assessments concerning the value of damages suffered by injured parties. He explained this process which includes extensive meetings with the client, review of medical records and life care plans, review of jury verdicts and settlements secured by his firm, use of focus groups, and “round-tabling” the case with members of his law firm, which “specializes in catastrophic injury cases and is known across the country for getting some of the biggest results for lawyers

   
   

   that do that type of work.” Mr. Lewis was proffered and accepted as an expert in the valuation of damages suffered by injured parties.

6. Mr. Lewis represented Ashton and his family relative to Ashton’s medical malpractice action. He explained that as part of his representation, he spent countless hours with Ashton and his parents in their home, in the car, and at doctor visits. Further, Mr. Lewis testified that every medical record for Ashton was reviewed, and he reviewed the life care plan, met with the life care planner, traveled to Kentucky and spent hours discussing Ashton’s case with Dr. Ronald Missum (the Economist), and took 70 to 100 depositions of experts and doctors.

7. Mr. Lewis gave a detailed explanation of the circumstances giving rise to Ashton’s premature birth via C-section at 32 weeks’ gestation, and the nature of his

   catastrophic brain damage. He explained that Ashton’s mother had abdominal pain and was instructed by her obstetrician’s office to go to the emergency room. Once a doctor became involved at the emergency room, it was determined that Ashton’s mother had suffered a placental abruption and she underwent an emergency C-section. Ashton was born with a catastrophic brain injury. Mr. Lewis testified that Ashton’s brain injury is “irreversible and permanent. He’s of the children who are the most injured that you will ever see. He is catastrophically

   
   

   brain injured, and those brain cells don’t grow back. Ashton will never be able to walk. Ashton will never be able to talk. Ashton will never be able to feed himself, so he’s as injured as any human being can be.” Ashton receives his nutrition through a G-tube and he will need 24 hour care for the rest of his life. Mr. Lewis explained that this injury has not only had a devastating impact on Ashton’s life, but also had a profound impact on the life of Ashton’s parents, whose “whole life has changed and they understand that, but they’re dedicated to taking care of Ashton.”

8. Mr. Lewis testified that through his representation of Ashton and his parents, review of Ashton’s file, and based on his training and experience, he had developed the opinion that the value of Ashton and his parents’ damages was between $39 and

   $53 million. In relation to economic damages, Mr. Lewis outlined his review of the life care plan and the report of the Economist, who was deposed during the litigation. Mr. Lewis testified that the Economist placed the present value of Ashton’s lost ability to earn money at $1,770,057 to $3,300,000 and the present value of Ashton’s future life care needs at

   $18.6 to $27 million. Accordingly, the present value of Ashton’s lost earnings, future life care needs, and $487,689.45 past medical claim would be between $20,857,746 and $30,787,689.

   
   

9. Mr. Lewis then turned to the non-economic damages of Ashton and his parents and noted that “the biggest damages in a case are the non-economic damages.” Mr. Lewis explained that he was “very conservative” in valuing the non-economic damages. He placed the value of Ashton’s non-economic damages at $13 million and noted that this was “very, very low considering his life expectancy as testified by Dr. Lichtblau and Dr. Cullen.”

   Mr. Lewis opined that Ashton’s parents’ non-economic damages had a conservative value of between $3 and $5 million each.

10. Based on the valuation of Ashton’s economic damages and the non-economic damages of Ashton and his parents,

    Mr. Lewis testified that the value of Ashton and his parent’s damages was between $39 and $53 million. He testified that the valuation of Ashton’s damages as used by the settling parties, of $35 million was very conservative. In further support of his valuation of the damages, Mr. Lewis explained that he took into consideration jury verdicts and his firm’s experience handling similar cases. He testified that the nine verdicts in Petitioner’s Exhibit 12 involved injuries comparable to Ashton’s injury. Mr. Lewis’s professional opinion regarding the valuation of Ashton’s damages is credited.

11. Mr. Lewis testified that the settlement did not fully compensate Ashton for the full value of his damages. Mr. Lewis testified that based on the conservative valuation of all

    
    

    Ashton’s damages of $35,000,000, the settlement represented a recovery of 14.28 percent of the value of Ashton’s damages.

    Mr. Lewis testified that because Ashton only recovered

    
    

    14.28 percent of the value of his damages in the settlement, he only recovered 14.28 percent of his $487,689.45 claim for past medical expenses, or $69,642.05.

12. Vince Barrett also testified on behalf of Petitioner.

    
    

    Mr. Barrett is a trial attorney with almost 40 years’ experience in personal injury, medical malpractice, and medical products liability cases. Mr. Barrett was accepted as an expert in valuation of damages suffered by injured persons.

13. Mr. Barrett testified that he was familiar with Ashton’s injuries and had reviewed the hospital birth records, pediatric neurologist medical records, pediatric pulmonologist medical records, the Defense’s Independent Medical Examination Report of Dr. Cullen, Dr. Lichtblau’s Life Care Plan, the Economist Report, the Complaint, the Release, the Guardian ad Litem Report, a Day-in-the-Life Video, and had spoken to Ashton’s mother concerning Ashton’s medical condition.

    Mr. Barrett testified that based on his review of the file and “years and years of experience in doing those cases,” the valuation of Ashton’s damages at $35 million was very conservative. Mr. Barrett noted that the Economist had projected the present value of Ashton’s lost earning capacity at

    
    

    between $1,707,057 to $3,300,000 and his future life care needs at $18,657,867 to $27,036,808, and these numbers were in keeping with what he had seen in other catastrophic injury cases.

    Mr. Barrett testified that the valuation of Ashton’s non- economic damages at $13 million was “extremely conservative” and he believed Ashton’s non-economic damages would be in the range of $15 to $20 million. Further, Ashton’s parents’ non-economic damages had a value of $3 million each. Mr. Barrett testified that his valuation of the non-economic damages was based on “that sort of feeling I just develop over years and years of looking at these and seeing how they come up and also based on jury verdict reports.”

14. Mr. Barrett testified that he was aware that the parties to the settlement had agreed that the damages had a value in excess of $35 million and that because Ashton had only recovered 14.28 percent of his damages in the settlement, the parties had agreed to allocate $69,642.05 of the settlement to past medical expenses. Mr. Barrett testified that the settling parties’ valuation of Ashton’s damages at $35 million was conservative, and the allocation of $69,642.05 to past medical expenses was reasonable, rational, fair, and conservative.

15. AHCA called James H.K. Bruner as a witness.

    
    

    Mr. Bruner has been an attorney for 33 years and a member of the Florida Bar since 2004. Since coming to Florida in 2003, he has

    
    

    worked for the Department of Children and Families, the Department of Health, and AHCA, and he was employed for

    five years by Xerox Recovery Services in relation to collection of Medicaid liens, with such employment ending in April 2013.

    In 2013, Mr. Bruner became a solo practitioner, and he lists on the Florida Bar website 75 areas of law in which he practices. He testified that he is a general practitioner and he practices “door law,” taking whatever comes in the door. Mr. Bruner testified that 70 percent of his practice is plaintiff personal injury. He testified that over the last two years he has only filed two personal injury lawsuits. He has never filed a medical malpractice lawsuit nor a personal injury lawsuit involving catastrophic, permanent and irreversible brain damage. Mr. Bruner testified that over the last 20 years he has not handled a personal injury jury trial.

16. AHCA tendered Mr. Bruner as an expert in case and settlement valuation, and over Petitioner’s objection, he was accepted as an expert as tendered.

17. Mr. Bruner’s testimony involved a review of the jury verdicts in Petitioner’s Exhibit 12, and his assertion that cases settle for the full value of the damages. In regard to the jury verdicts in Exhibit 12, Mr. Bruner criticized the verdicts, claiming that while the verdicts involved catastrophic brain injury to children, there were factual differences in the

    
    

    mechanism of injury; thus, making the verdicts irrelevant. Further, while the juries had determined the value of the damages, Mr. Bruner criticized the verdicts because he asserted it was possible that the cases may have settled post-verdict for less or the injured parties may have received less due to reductions for comparative negligence. Finally, Mr. Bruner testified that only verdicts from Palm Beach should be considered, and he would exclude consideration of verdicts from adjoining counties.

18. Mr. Bruner’s testimony is not helpful or persuasive because it did not provide, nor was it offered for the purpose of providing, an alternative value of the damages suffered by Petitioner. AHCA made no attempt to provide an alternative valuation of Petitioner’s damages or contest the value of Petitioner’s damages as testified to by Mr. Lewis and

    Mr. Barrett. Ultimately, the credible testimony and evidence presented by Petitioner concerning the value of Petitioner’s damages was unrebutted by AHCA.

    CONCLUSIONS OF LAW

    
    

19. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties in this case pursuant to sections 120.569, 120.57(1), and 409.910(17), Florida Statutes.

    
    

20. Respondent is the agency authorized to administer Florida’s Medicaid program. See § 409.902, Fla. Stat.

21. The Medicaid program “provide[s] federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons.” Harris v. McRae, 448 U.S.

    297, 301 (1980). Though participation is optional, once a state elects to participate in the Medicaid program, it must comply with federal requirements governing the same. Id.

22. As a condition for receipt of federal Medicaid funds, states are required to seek reimbursement for medical expenses incurred on behalf of Medicaid recipients who later recover from legally-liable third parties. See Arkansas Dep't of Health &

    Human Servs. v. Ahlborn, 547 U.S. 268, 276 (2006).

    
    

23. Consistent with this federal requirement, the Florida Legislature has enacted section 409.910, which authorizes and requires the State to be reimbursed for Medicaid funds paid for a recipient's medical care when that recipient later receives a personal injury judgment or settlement from a third party. Smith v. Ag. for Health Care Admin., 24 So. 3d 590 (Fla. 5th DCA

    2009). The statute creates an automatic lien on any such judgment or settlement for the medical assistance provided by Medicaid. See § 409.910(6)(c), Fla. Stat.

24. The amount to be recovered for Medicaid medical expenses from a judgment, award, or settlement from a third

    
    

    party is determined by the formula in section 409.910(11)(f), which sets that amount at one-half of the total recovery, after deducting attorney’s fees of 25 percent of the recovery and all taxable costs, up to, but not to exceed, the total amount actually paid by Medicaid on the recipient’s behalf. Ag. For

    Health Care Admin. v. Riley, 119 So. 3d 514, 515 n.3 (Fla. 2d DCA 2013).

25. Respondent correctly asserts that it is not automatically bound by any allocation of damages set forth in a settlement between a Medicaid recipient and a third party that may be contrary to the formulaic amount, citing

    section 409.910(13). See also § 409.910(6)(c)7., Fla. Stat.

    
    

    (“No release or satisfaction of any . . . settlement agreement shall be valid or effectual as against a lien created under this paragraph, unless the agency joins in the release or satisfaction or executes a release of the lien.”). Rather, in cases such as this, where Respondent has not participated in or approved the settlement, the administrative procedure created by section 409.910(17)(b) is the means for determining whether a lesser portion of a total recovery should be allocated as reimbursement for medical expenses in lieu of the amount calculated by application of the formula in section 409.910(11)(f).

    
    

26. Section 409.910(17)(b) provides that:

    
    

    A recipient may contest the amount designated as recovered medical expense damages payable to the agency pursuant to the formula specified in paragraph (11)(f) by filing a petition under chapter 120 within 21 days after the date of payment of funds to the agency or after the date of placing the full amount of the third-party benefits in the trust account for the benefit of the agency pursuant to

    paragraph (a). The petition shall be filed with the Division of Administrative Hearings. For purposes of chapter 120, the payment of funds to the agency or the placement of the full amount of the third- party benefits in the trust account for the benefit of the agency constitutes final agency action and notice thereof. Final order authority for the proceedings specified in this subsection rests with the Division of Administrative Hearings. This procedure is the exclusive method for challenging the amount of third-party benefits payable to the agency. In order to successfully challenge the amount payable to the agency, the recipient must prove, by clear and convincing evidence, that a lesser portion of the total recovery should be allocated as reimbursement 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.

27. Section 409.910(17)(b) thus makes clear that the formula set forth in subsection (11) constitutes a default allocation of the amount of a settlement that is attributable to medical costs, and sets forth an administrative procedure for adversarial testing of that allocation. See Harrell v. State,

    
    

    143 So. 3d 478, 480 (Fla. 1st DCA 2014)(adopting the holding in Riley that petitioner “should be afforded an opportunity to seek the reduction of a Medicaid lien amount established by the statutory default allocation by demonstrating, with evidence, that the lien amount exceeds the amount recovered for medical expenses”)(quoting Roberts v. Albertson’s, Inc., 119 So. 3d 457, 465-466 (Fla. 4th DCA 2012), reh’g and reh’g en banc denied sub

    nom. Giorgione v. Albertson’s, Inc., 2013 Fla. App. LEXIS 10067

    
    

    (Fla. 4th DCA June 26, 2013)).

    
    

28. Clear and convincing evidence “requires more proof than a ‘preponderance of the evidence’ but less than ‘beyond and to the exclusion of a reasonable doubt.’” In re Graziano,

    696 So. 2d 744, 753 (Fla. 1997). The clear and convincing evidence level of proof:

    [E]ntails both a qualitative and quantitative standard. The evidence must be credible; the memories of the witnesses must be clear and without confusion; and the sum total of the evidence must be of sufficient weight to convince the trier of fact without hesitancy.

    
    

    Clear and convincing evidence requires that the evidence must be found to be credible; the facts to which the witnesses testify must be distinctly remembered; the testimony must be precise and explicit and the witnesses must be lacking in confusion as to the facts in issue. The evidence must be of such weight that it produces in the mind of the trier of fact a

    
    

    firm belief or conviction, without hesitancy, as to the truth of the allegations sought to be established.

    
    

    In re Davey, 645 So. 2d 398, 404 (Fla. 1994)(quoting, with

    
    

    approval, Slomowitz v. Walker, 429 So. 2d 797, 800 (Fla. 4th DCA

    
    

    1983)); see also In re Henson, 913 So. 2d 579, 590 (Fla. 2005). “Although [the clear and convincing] standard of proof may be met where the evidence is in conflict, it seems to preclude evidence that is ambiguous.” Westinghouse Elec. Corp. v. Shuler

    Bros., 590 So. 2d 986, 989 (Fla. 1st DCA 1991).

    
    

29. The evidence in this case is clear and convincing that the allocation for Petitioner’s past medical expenses in the amount of $69,642.05 constitutes a fair, reasonable, and accurate share of the total recovery for those past medical expenses actually paid by Medicaid.

30. Petitioner has proven, by clear and convincing evidence, that $69,642.05 of the total third-party recovery represents that share of the settlement proceeds fairly attributable to expenditures that were actually paid by Respondent for Petitioner’s medical expenses.

ORDER

Upon consideration of the above Findings of Fact and Conclusions of Law, it is hereby

ORDERED that:

The Agency for Health Care Administration is entitled to

$69,642.05 in satisfaction of its Medicaid lien.

DONE AND ORDERED this 28th day of July, 2016, in Tallahassee, Leon County, Florida.

S

W. DAVID WATKINS Administrative Law Judge

Division of Administrative 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 28th day of July, 2016.

COPIES FURNISHED:

Alexander R. Boler, Esquire Suite 300

2073 Summit Lake Drive Tallahassee, Florida 32317 (eServed)

Floyd B. Faglie, Esquire Staunton and Faglie, P.L.

189 East Walnut Street Monticello, Florida 32344 (eServed)

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 (eServed)

Elizabeth Dudek, Secretary

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

Tallahassee, Florida 32308 (eServed)

Stuart Williams, General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 (eServed)

NOTICE OF RIGHT 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 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 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.

Docket for Case No: 15-006106MTR

Orders for Case No: 15-006106MTR