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Florida First DCA reduces amount payable to AHCA for Medicaid lien, finds that agency was bound by its stipulation that decedent's parents had right to contest amount of lien

On January 26, 2018, in Delgado v. Agency for Health Care Administration, No. 1D16-5768, the Florida First DCA reversed an Administrative Law Judge’s (ALJ) determination that the parents and personal representatives of the estate of their deceased daughter, on behalf of whom they had previously settled a medical negligence/wrongful death case, did not have standing to avail themselves of the Agency for Health Care Administration’s (ACHA) administrative procedures for contesting the amount of the Medicaid lien asserted on the settlement proceeds. The ALJ had concluded that the parents were not “recipients” of Medicaid benefits entitling them to be able to administratively contest the amount of Medicaid’s lien under Section 409.910(17)(b). The First DCA found no need to reach this issue, instead deciding the case on the ground that ACHA had in fact stipulated to the parents’ right to contest the lien. The Court quoted Marion Cty. v. Dep’t of Juvenile Justice, 215 So. 3d 621, 626-27 (Fla. 1st DCA 2017) for the proposition that “absent a showing of fraud, misrepresentation or mistake, stipulations are binding on . . . administrative agencies participating in administrative proceedings . . .” The First DCA accepted the finding of the ALJ regarding the amount of Medicaid payments that had actually been recovered, which was substantially reduced from Medicaid’s formula recovery because of the determination by the ALJ that the recovery in the case was substantially less than the total damages.

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