Gallardo v. Senior
| Decision Date | 18 July 2017 |
| Docket Number | Case No. 4:16cv116-MW/CAS |
| Parties | GIANINNA GALLARDO, AN INCAPACITATED PERSON, BY AND THROUGH HER PARENTS AND CO-GUARDIANS, PILAR VASSALLO AND WALTER GALLARDO, Plaintiff, v. JUSTIN M. SENIOR, IN HIS OFFICIAL CAPACITY AS SECRETARY OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, Defendant. |
| Court | U.S. District Court — Northern District of Florida |
In a cult-classic film, an eccentric inventor transforms a DeLorean sports car into a sleek time machine. Cf. Back to the Future (Universal Pictures 1985). Enthralled, the protagonist travels back in time, where (Great Scott!) he soon realizes that his actions in the past can nonetheless affect the future.
("AHCA")1 has also tried to go back in time but, unlike the protagonist mentioned above, it hopes to change the future (more specifically, this Court's prior judgment). AHCA's vehicle of choice, though, isn't a time-traveling DeLorean; it is a Motion to Alter or Amend the Judgment. In that motion, AHCA makes a number of arguments—most of which were previously available to it. But this is not a movie; AHCA has not pointed to a sufficient reason for this Court to go back in time to allow it to raise those arguments in the first instance. AHCA also presents a separate standing argument, which is properly before this Court. But because AHCA is the agency that administers Medicaid and the only additional steps necessary to redress Gallardo's injuries are purely mechanical, its standing argument is unconvincing on the merits.
AHCA's motion is therefore GRANTED in part and DENIED in part.2
The facts were addressed at length in this Court's originalorder granting summary judgment. Gallardo v. Dudek, No. 4:16-cv-116, 2017 WL 1405166 (N.D. Fla. Apr. 18, 2017). They are summarized briefly below and supplemented with the more recent events in this case.
Medicaid is a joint federal-state program whereby the federal government pays a significant portion of a recipient's medical costs and, in return, participating states must comply with the applicable federal statutes and regulations. Id. at *2. One of those provisions—the so-called anti-lien provision—states that "[n]o lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, [with exceptions not relevant here]." 42 U.S.C. § 1396p(a)(1) (2012). But two other provisions—the third-party liability and assignment provisions—are narrow exceptions that allow the state to assert liens on payments for medical care. See Ark. Dep't of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 285 (2006) ( ).
Florida, which participates in the Medicaid program, applies a one-size fits all statutory formula to determine how much of arecipient's recovery constitutes medical expenses and is therefore available for Medicaid reimbursement. See 409.910(11)(f), Fla. Stat. (2016). The ultimate result is that AHCA is awarded the lesser of (1) the amount it actually paid on the Medicaid recipient's behalf, or (2) 37.5% of the Medicaid recipient's total recovery. Gallardo, 2017 WL 1405166, at *3. The Medicaid recipient, however, may challenge that formula-based allocation and thus reduce the amount payable to AHCA by filing a petition with the Division of Administrative Hearings ("DOAH") and "'prov[ing], by clear and convincing evidence, that a lesser portion of the total recovery should be allocated as reimbursement for past and future medical expenses than the amount' required by the statutory formula." Id. (quoting § 409.910(17)(b), Fla. Stat. (2016)).
Gallardo is currently in the midst of that administrative process. She was struck by a vehicle and suffered severe and permanent injuries. Gallardo's medical expenses were covered by Medicaid and WellCare of Florida, which paid $862,688.77 and $21,499.30, respectively. Id. Gallardo's parents filed suit against those allegedly responsible for her injuries, and AHCA asserted a lien against that cause of action for the $862,688.77 it expended on her behalf. Id. Gallardo's case settled for $800,000. Id. UnderFlorida's formula-based allocation, AHCA was therefore due to be reimbursed $323,508.29 in medical expenses. Id.
Rather than pay that lien in its entirety, Gallardo contested it through the state administrative procedure outlined in § 409.910(17)(b). Id. at *4. In those proceedings, Gallardo has argued that, contrary to federal law, AHCA is attempting to recover its past Medicaid payments from settlement funds that do not represent compensation for past medical expenses. Id. AHCA, however, has argued that it may satisfy its lien from the portion of Gallardo's settlement representing compensation for past and future medical expenses. Id. It has further argued that Gallardo may successfully challenge that formula-based allocation only if she can prove by clear and convincing evidence that the amount of her settlement representing past and future medical expenses is less than $323,508.29. Id.
Gallardo then sought declaratory and injunctive relief from this Court, ECF No. 1, and summary judgment was granted in its favor. More specifically, this Court declared that the federal Medicaid Act preempted certain portions of § 409.910(17)(b) and that AHCA therefore could not (1) "seek[] reimbursement of past Medicaid payments from portions of a recipient's recovery thatrepresents future medical expenses" or (2) "requir[e] a Medicaid recipient to affirmatively disprove . . . § 409.910(17)(b)'s formula-based allocation with clear and convincing evidence to successfully challenge it where, as here, that allocation is arbitrary and there is no evidence that it is likely to yield reasonable results in the mine run of cases." Gallardo, 2017 WL 1405166, at *11. AHCA was therefore enjoined from enforcing § 409.910(17)(b) in its current form. Id.
Apparently frustrated with this Court's ruling, AHCA hired new counsel, see ECF Nos. 42-43 () and moved to vacate or amend the prior judgment, see ECF No. 44 (). According to AHCA, this Court erred in refusing to consider the reimbursement statute's practical effect and improperly shifted the burden to AHCA, thus requiring it—the non-moving party—to present evidence establishing that the reimbursement statute is not in conflict with (and therefore preempted by) federal law. Id. at 2-3. AHCA also asserts that this Court's prior judgment should be vacated because amendments to the federal Medicaid Act—which will apparently allow states "to obtain reimbursement from all or any part of a" Medicaid recipient's recovery—are scheduled to take effect on October 1,2017. Id. at 17. Finally, AHCA submits that it does not enforce certain preempted portions of the reimbursement statute; thus, the judgment must be vacated or amended. Id. at 3.
Rules 59 and 60 of the Federal Rules of Civil Procedure are tools of limited utility. They are not intended to provide disgruntled litigants with a second bite at the apple. See O'Neal v. Kennamer, 958 F.2d 1044, 1047 (11th Cir. 1992) (); Seamon v. Vaughan, 921 F.2d 1217, 1220 n.6 (11th Cir. 1991) (). That is because the extraordinary remedy of reconsideration is only appropriate in rare circumstances. See Pensacola Firefighters' Relief Pension Fund Bd. of Trs. v. Merrill Lynch Pierce Fenner & Smith, Inc., 265 F.R.D. 589, 591 (N.D. Fla. 2010) .
AHCA moves for reconsideration on three separate grounds, one of which is Rule 59(e). Reconsideration under Rule 59(e) isavailable in the limited scenarios "where there is newly-discovered evidence, an intervening change in the law, or manifest errors of law or fact." Fisher v. Carnival Corp., No. 11-22316-CIV, 2013 WL 12061861, at *1 (S.D. Fla. July 29, 2013) (citing Arthur v. King, 500 F.3d 1335, 1343 (11th Cir. 2007))). It is thus improper to use that vehicle "to relitigate old matters, raise forgotten arguments, or present evidence that could have been, but was not, raised prior to the entry of judgment." Id. (citing Michael Linet, Inc. v. Village of Wellington, Fla., 408 F.3d 757, 763 (11th Cir. 2005)). Relief under Rule 59(e) is particularly inappropriate when the moving "party has failed to articulate any reason for the failure to raise an issue at an earlier stage in the litigation." Lussier v. Dugger, 904 F.2d 661, 667 (11th Cir. 1990) (citing Van Ryn v. Korean Air Lines, 640 F. Supp. 284, 286 (C.D. Ca. 1985)).
AHCA also moves for reconsideration under Rule 60(b)(4) and (5). Rule 60(b)(4) offers relief only when the judgment was void—that is, rendered without jurisdiction or "in a manner inconsistent with due process of law." Burke v. Smith, 252 F.3d 1260, 1263 (11th Cir. 2001) (quoting In re Edwards, 962 F.2d 641, 644 (7th Cir. 1992)). Relief is warranted under Rule 60(b)(5) only if the moving party can establish "a significant change either infactual conditions or in law." Fla. Wildlife Fed'n Inc. v. Admin, U.S. Envtl. Protective Agency, 620 F. App'x 705, 707 (11th Cir. 2015) (quoting Sierra Club v. Meiburg, 296 F.3d 1021 (11th Cir. 2002)). Such relief is rarely granted. See Enax v. Goldsmith, 322 F. App'x 833, 835 (11th Cir. 2009) ...
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