A federal district court holds that following the settlement of a wrongful death suit against a nursing home by the family of a Medicaid recipient, Medicaid is entitled to recover from the settlement proceeds only the payments that it made in connection with the injuries specified in the complaint. King v. Beverly Healthcare -- Tupelo(U.S.D.C., N.D. Miss., No. 1:03CV178, Nov. 28, 2007).
Willie Depriest, a multiple amputee residing in a nursing home and receiving Medicaid benefits, fell in the shower and cut his head, requiring stitches. He later developed pneumonia, was hospitalized and died. Mr. Depriest's son, Kelly King, sued the nursing home. After the parties reached a settlement, the Mississippi Division of Medicaid sought to recover from the settlement proceeds its payment for the entire length of Mr. Depriest's nursing home stay, arguing that Mr. King's complaint broadly alleged a course of misconduct by the nursing home. Mr. King countered that, under a state statute, Medicaid could recover only for the injuries alleged in the complaint.
The U.S. District Court for the Northern District of Mississippi, citing the state statute as well as Arkansas Dept. of Health and Human Servs. al. v. Ahlborn, 547 U.S. 268 (2006), rules that Medicaid's reimbursement is limited to the costs incurred for actions that give rise to a cause of action for a Medicaid recipient. The court finds that the causes of action encompassed in the settlement focused on the cut to Mr. Depriest's head and on his death from pneumonia. Because the date of the head injury was not furnished by the parties, the court concludes that Medicaid is entitled to reimbursement only for its payments made in connection with the hospitalization, totaling $270.03.
For the full text of the court's decision, click here.
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