Articles Posted in Public Benefits

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In this case the Supreme Court was asked to decide whether a charitable hospital may pursue payment for medical care provided to a Medicaid-eligible patient by filing a lien against a settlement between the patient and an insurance company covering the liability of a tortfeasor responsible for the patient's injuries. To answer the question, the Court balanced the complex state and federal legal framework surrounding Medicaid with Wis. Stat. 779.80 (hospital lien statute). The Court concluded that the soundest harmonization of the two permitted the liens at issue here. In so doing, the Court reversed the court of appeals, which reversed the circuit court's reasoning that the hospital was authorized to either file the liens or bill Medicaid. View "Gister v. Am. Family Mut. Ins. Co." on Justia Law

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The State brought a civil action against Pharmacia Corporation, alleging that the company reported inflated drug prices to Wisconsin Medicaid. A jury found Pharmacia liable for violating the Deceptive Trade Practices Act (DTPA) and the Medicaid fraud statute. The jury awarded the State $2 million for the DTPA claim and $7 million for the Medicaid fraud claim. The jury also determined that Pharmacia committed 1,440,000 separate violations of the Medicaid fraud statute. In post-trial proceedings, the circuit court reduced the number of violations to 4,578. Both parties appealed. The court of appeals certified three issues to the Supreme Court. The Court affirmed the circuit court's judgment on the issues and remanded to the court of appeals, holding (1) the State was entitled to a jury trial on its Medicaid fraud claim; (2) the jury did not impermissibly speculate in determining the damage award; and (3) the circuit court properly reduced the number of violations found by the jury. View "State v. Abbott Labs." on Justia Law