Synergy Blog

From Roger Baron: Supreme Court grants Cert in Medicaid Case which Challenges the Application of Ahlborn’s “pro rata” loss sharing formula

Reprinted with Permission from Roger Baron

The Supreme Court granted Cert yesterday in E.M.A. ex rel. Plyler v. Cansler, 674 F.3d 290 (4th Cir.2012).  In this case, the 4th Circuit upheld the application of Ahlborn’s pro rata loss sharing formula for a Medicaid reimbursement claim.  The North Carolina Attorney General filed a Petition for Writ of Certiorari which was granted in DELIA, SEC., NC DEPT. OF H&HS V. E. M. A., ET AL., — S.Ct. —-, 2012 WL 4343865 (Mem), U.S.,2012. September 25, 2012.

With the pendency of the McCutchen case and the granting of cert in this Medicaid case, it appears that the Supreme Court is interesting in examining the details of “reimbursement” claims.

The Questions presented in the Petition for Writ of Cert are as follows:

  1. The Medicaid Act requires participating States to seek reimbursement from third-party tortfeasors for health-care expenditures they made to Medicaid recipients who are tort victims. 42 U.S.C. §§ 1396a(a)(25)1396k(a) (2006). To enforce that requirement when the recipient and a third-party resolve their tort dispute through judgment or settlement, North Carolina law provides that the State has a subrogation right to, and may assert a lien upon, the lesser of one-third of the recipient’s recovery or the State’s actual medical expenditures. N.C. Gen. Stat. § 108A-57 (2011).
  2. The question presented is whether N.C. Gen. Stat. § 108A-57 is preempted by the Medicaid Act’s anti-lien provision as it was construed in Arkansas Department of Health & Human Services v. Ahlborn, 547 U.S. 268 (2006), an issue on which the North Carolina Supreme Court and the United States Court of Appeals for the Fourth Circuit are in conflict.

TESTIMONIALS

"I just want to thank Synergy for their great work in getting a health insurance lien resolved. The health insurance company refused to reduce their lien a penny from a motorcycle accident involving my client who was not wearing a helmet, a fact that would have hurt our award in front of a jury. Synergy put tremendous pressure on this company, and after months of bombarding this insurance company with statutory requests and threats, they were able to get them to give in and reduce the lien significantly. The cost was minimal in relation to the hard work they put in, and the savings my client received. Client was very happy, and it allowed me to close out a case that I had resolved over 6 months before. Keep them in mind if you are dealing with a smug insurance adjuster who felt confident he would not have to reduce a lien, like I was dealing with. Thank you very much Synergy."

Jeffrey A. Adelman, Esq.
Adelman & Adelman, P.A.

“This service is tremendous, and Synergy Lien Resolution Services is fantastic to work with. All of our cases will be sent through this process.”

David Eaton, Esq.
Eaton & Tirella

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