HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, January 8, 2013

Medicaid and Tort Recoveries in the Supreme Court Today

2013 promises to be a very active year for health-care-related cases at the SCOTUS.  Today, the SCOTUS is hearing oral argument in Delia v. E.M.A., in which the state of North Carolina defends its statute creating a lien on any tort recovery equal to the lesser of (a) the total funds advanced by the state Medicaid program for the medical expenses of a Medicaid recipient or (b) one-third of the total recovery.  The question to be decided is whether the North Carolina statute is preempted by the  Medicaid Act’s anti-lien provision, 42 U.S.C. §§ 1396a(a)(25), 1396k(a)?  Apparently, the Fourth Circuit and the Supreme Court of North Carolina disagree about this, with the Fourth Circuit holding the statute preempted, and the North Carolina Supreme Court holding it is not preempted.  The case highlights many of the problems with insurer or government attempts to recover payments made for medical care out of tort recoveries, especially the ability of the tortfeasor and the plaintiff in such a case to characterize settlements so that the payments are not allocated as reimbursement for medical expenses already incurred.  In this case, there is a particularly sympathetic plaintiff, a child who sustained birth injuries and received a multi-million-dollar settlement against the physicians who attended the birth.  Interestingly, despite the push to cut costs in public spending programs, the United States is at odds with the state in this case, siding with the child.  Sounds like North Carolina will be going it alone on this one.  Should be an interesting oral argument.


Cross-posted on Healthy Interests

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