U.S. Supreme Court Ruling Blocks State From Recovering One-Third of Disabled Teens Settlement

Seal of U.S. Supreme CourtIn the U.S. Supreme Court case of Wos v. E.M.A., (No. 12-98, March 20, 2013)  the court ruled that the Federal Medicaid Act pre-empts a state’s authority to recover a portion of a Medicaid beneficiary’s personal injury settlement  when the settlement does not designate the amount attributable to payment for medical care. The ruling prevents North Carolina from being reimbursed for the $1.9 million that was spent on a child’s medical treatment.

The 13-year old girl in this case, identified as E.M.A., suffered severe injuries during her birth. In 2003 E.M.A. and her parents filed a medical malpractice lawsuit. Although expert witnesses estimated the damages to be in excess of $42 million, the insurance policy limits of the physician and the hospital largely determined the amount of the settlement. After the family settled the case for $2.8 million, the State of North Carolina claimed a third of the settlement.  The law of North Carolina allows for the Medicaid program to recover up to one-third of the total amount of any settlement or judgment in a medical malpractice case. However, the settlement did not identify the amount of the $2.8 million that accounted for medical vs. non-medical damages. The trial court ordered that one-third of the settlement be placed in escrow pending the determination of  how much the North Carolina Medicaid program was entitled to be re-imbursed.

The U.S. Supreme Court held that the law of North Carolina conflicts with the federal statute.  “The Medicaid anti-lien provision prohibits a State from making a claim to any part of a Medicaid beneficiary’s tort recovery not ‘designated as payments for medical care.'”


Hospital Safety Scores Updated

health care providers washing handsLeapfrog Group, an independent national nonprofit organization, recently concluded a study on Hospital Safety. With a focus on quality and affordable healthcare, the group launched the Hospital Safety Score project in June 2012. Hospitals were graded based on “preventable medical errors, injuries, accidents, and infections”. Of the 2618 hospitals studied, 790 received an A, 678 earned a B, 1004 earned a C, 121 earned a D, and 25 received a failing grade. Both Massachusetts and Maine demonstrated exceptional safety results with 83% of Massachusetts hospitals and 80% of Maine hospitals earning an A score.

Consumers are able to check the safety score of their local hospitals at Hospital Safety Score. For a summary of the Leapfrog Group study go to : http://www.leapfroggroup.org/policy_leadership/leapfrog_news/4971031

The Leapfrog Group encourages people who have been hurt by errors or accidents at a healthcare facility to share their stories with ProPublica, an independent organization that investigates patient safety concerns. People who wish to contact ProPublica may call the organizations hotline at (917)512-0241 or visit the online interactive web survey at: http://www.propublica.org/article/patient-harm-questionnaire.