Opinion
No. 1D19-4407
05-17-2021
Robert MATHERS, Appellant, v. AGENCY FOR HEALTHCARE ADMINISTRATION, Appellee.
Sean C. Domnick of Domnick Cunningham & Whalen, West Palm Beach, for Appellant. Alexander R. Boler of Boler Legal, PLLC, Tallahassee, for Appellee.
Sean C. Domnick of Domnick Cunningham & Whalen, West Palm Beach, for Appellant.
Alexander R. Boler of Boler Legal, PLLC, Tallahassee, for Appellee.
Ray, C.J.
Robert Mathers appeals the dismissal of his amended petition to determine the Medicaid lien amount that the Agency for Healthcare Administration ("AHCA") may recover from his personal injury settlement. Because the Administrative Law Judge ("ALJ") correctly interpreted the law in dismissing the petition as untimely, we affirm.
In May 2013, Mathers was seriously injured in an automobile accident. He suffered catastrophic damage to his spinal cord that left him disabled and dependent on others for daily living. Florida's Medicaid program paid $221,862.52 for his medical care.
Mathers sued the alleged tortfeasors to recover his damages from the accident. The parties eventually reached a confidential settlement and in February 2016, Mathers deposited the proceeds in a trust account for the benefit of AHCA. AHCA had asserted a lien against Mathers’ settlement proceeds for the full amount of the Medicaid benefits paid related to his injuries from the accident.
More than three years later, in May 2019, Mathers filed a petition with the Division of Administrative Hearings ("DOAH") contesting the amount that AHCA could recover from his personal injury settlement to satisfy its lien. The ALJ dismissed the petition as untimely because Mathers did not file it within twenty-one days after he placed his settlement proceeds in a trust account, as required by section 409.910(17)(b), Florida Statutes (2015).
On appeal, Mathers claims the ALJ erred by dismissing his petition as untimely, because he was not put on notice that the statutory deadline to file a DOAH petition applied to him. He argues that the twenty-one-day deadline found in section 409.910(17)(b) was never triggered because AHCA did not first apply the statutory formula found in section 409.910(11)(f), Florida Statutes (2015), to designate the recoverable amount of past medical expenses paid by Medicaid. We find no factual or statutory basis for these arguments.
When there is a recovery by a Medicaid recipient in a tort action, AHCA's reimbursement is determined by a statutory formula set forth in section 409.910(11)(f). "However, the paragraph (11)(f) allocation is merely a default allocation ...." Eady v. State , 279 So. 3d 1249, 1254 (Fla. 1st DCA 2019). Section 409.910(17)(b) provides an administrative procedure for a Medicaid recipient to rebut the presumptively appropriate lien amount. In relevant part, the statute provides:
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.
(Footnotes omitted).
Here, it is undisputed that Mathers did not file his petition "within 21 days" after "placing the full amount of the third-party benefits in the trust account for the benefit of [AHCA]" as required by the first sentence of the statutory provision quoted above. As the statute explains, "[t]his procedure is the exclusive method for challenging the amount of third-party benefits payable to the agency." Still, Mathers claims the twenty-one-day filing deadline did not apply to him because the record does not show that AHCA applied the statutory formula to its lien on his tort settlement. We disagree.
To begin with, Mathers’ claims stray from the allegations of his petition. Below, he alleged: "[AHCA] has maintained that it is entitled to application of Section 409.910's formula to determine the lien amount. ... The only reduction AHCA has offered is the statutory reduction, which would be zero dollars ($0) given the amount of the settlement and a twenty five percent (25%) fee." He also alleged: "In the instant case, blind application of the formula in 409.910(11)(f) requires Mathers to pay back Medicaid all of its claimed lien ...." Thus, Mathers’ own pleading suggests that AHCA applied the statutory formula to its lien determination, and that the result of the formula requires repayment of the entire lien amount.
Moreover, under the plain language of the statute, the twenty-one-day time frame for contesting the formula-based allocation was triggered when Mathers placed his settlement proceeds in trust for the benefit of AHCA. See Holly v. Auld , 450 So. 2d 217, 219 (Fla. 1984) ("[C]ourts of this state are without power to construe an unambiguous statute in a way which would extend, modify, or limit , its express terms or its reasonable and obvious implications .") (quoting Am. Bankers Life Assurance Co. of Fla. v. Williams , 212 So. 2d 777, 778 (Fla. 1st DCA 1968) ). Because Mathers filed his DOAH petition much later, the ALJ properly concluded that he waived his right to a hearing contesting the amount payable to AHCA. Aleong v. State, Dep't of Bus. & Prof'l Regul. , 963 So. 2d 799, 802 (Fla. 4th DCA 2007) (explaining that the "failure to timely file [a] request for an administrative hearing operate[s] as a waiver of [one's] right to such a hearing").
AFFIRMED .
Roberts and Winokur, JJ., concur.