Wilhoite v. Missouri Dept. of Social Services - Ahlborn Class Action?

Posted date in Jason D. Lazarus, J.D., LL.M., MSCC Ahlborn, Liens, Medicaid

According to NAELA:

“Ramona Wilhoite sued the Dallas County Sheriff's Department. Wilhoite, alleging that it refused to provide her with necessary medical treatment for internal bleeding during her incarceration at the Dallas County Jail. She was eventually taken to a hospital where she was treated. Medicaid paid her $4,021 bill. Ramona settled her non-medical claims for $20,000. She contended that none of her settlement was for reimbursement of medical care. Nonetheless, the Missouri Department asserted a lien against the settlement. Ramona then filed suit in federal court, seeking class certification. Her contention was that the Department was violating 42 U.S.C. 1396p(a)(1) and Ahlborn. Ramona argued that she adequately represented other Medicaid recipients settling claims against third parties where the State made claims against the non-medical portion of the recovery. The State argued that Ramona did not adequately represent other potential class members because, among other reasons, a portion of Ramona’s settlement was set aside in trust pending the outcome of the litigation. The court found this distinction to be a de minimus difference. Finding the class action device to be a superior way to resolve the issue, the Court certified the class.”

Wilhoite asserted three counts against the Missouri Department of Social Services.  First, injunctive relieve and damages under Section 1983 alleging violations of rights secured by 42 USC 1396p(a)(1) and by the Fifth and Fourteenth Amendments.  Second, Wilhoite seeks “disgorgement of all amounts collected in violation of section 1396p(a)(1) and a permanent injunction under an unjust enrichment theory.”  Third, damages are sought under a breach of contract theory based upon an alleged violation of 1396p(a)(1).  Class certification was sought for similarly situated Missouri citizens “who have received Medicaid and who had liens asserted and/or monies taken by Defendant out of their third party civil settlements or judgments from January 21, 2000 to present, where said settlements or judgments were unrelated to medical care and services, or where the liens asserted and or monies taken by the Defendants were in excess of the amount of said settlement or judgment related to medical care and services, in violation of 42 U.S.C. § 1396p(a)(1).”

Because of the multitude of claims that this class can bring and the important questions raised, this case could have a large impact on application of Ahlborn across the country.  Stay tuned!