Benson v. Sebelius

Benson v. Sebelius
Civil Action No. 09-1931 (RMU),
2011 WL 1087254
(D. D.C. March 24, 2011)

This case involved a wrongful death and survival action. The parties settled the claim for $90,000, with 80% of that amount allocated for the wrongful death settlement award and 20% allocated for the survival claim. Medicare issued a final demand for conditional payment recovery in the amount of $25,868.58.

Benson challenged Medicare’s recovery claim arguing that under the Medicare Secondary Payer Statute (MSP) CMS can only recover from that aspect of the settlement related to the Medicare beneficiary’s estate and not from the wrongful death part of the settlement per the per the court’s decision in Bradley v. Sebelius, 621 F.3d 1330 (11th Cir., Sept. 29, 2010). In addition, Benson contended that one of the administrative bodies’ alleged failure to provide him with a requested transcript in a timely manner during the administrative appeals phase of the action violated his 5th Amendment due process rights.

The court rejected the plaintiff’s arguments and ruled in favor Medicare. In reaching its decision that court found the Benson case was factually and legally different from Bradley. For reasons more fully explained in the court’s ruling, the court, in part, found that Medicare could recover its full claimed amount in that in Benson (unlike in Bradley) the plaintiff claimed compensation for the decedent’s medical costs as part of his wrongful death claim. The court also found that there was no violation of 5th Amendment due process rights.

Bradley v. Sebelius

Bradley v. Sebelius
621 F.3d 1330
(11th Cir., Sept. 29, 2010)

This case involved a wrongful death action filed under the Florida Wrongful Death Act for alleged nursing home neglect. The decedent (Mr. Burke) was survived by 10 children. One of his daughters (Cardonvella Bradley) was named personal representative of the estate.

Bradley filed a wrongful death action against the nursing home through which damages were claimed for the estate and the ten surviving children per Florida law. The action was eventually settled without a formal action being filed in court for the nursing home’s policy limits — $52,500. This sum was undifferentiated between the parties.

Medicare asserted a conditional payment claim in the amount approximately $22.480.89 (with said figure representing the full amount of Medicare’s conditional payments minus applicable procurement costs). Bradley requested that Medicare reduce its claim on various grounds. Medicare refused and demanded a full recovery. Continue reading “Bradley v. Sebelius”