Medicare Set Aside and MMSEA Section 111 Legal Cases - Benson v. Sebelius

Blackburn Group, Inc. MSA and MMSEA Section 111 Legal Cases - 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 where 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, Medicare 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 Bradley decision. 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, which violated his 5th Amendment due process rights.

The court rejected the plaintiff's arguments and ruled in favor Medicare. In reaching its Decision, the 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 because the plaintiff claimed compensation for the decedent's medical costs as part of his wrongful death claim. This was not the case in Bradley noted above. The court also found that there was no violation of his 5th Amendment due process rights.