Medical Bills: Medicare Benefits

The issue of whether a Plaintiff can submit to a jury the total amount of past medical bills from medical providers when they are a Medicare recipient rather than the amount paid by Medicare has been a hotly litigated issue in the past few years. The decision in Joerg v. State Farm in 2015 seemed to blur this issue and cause confusion with inconsistent rulings from trial courts. However, recently in Dial v. Calusa Palms Master Association (SC21-43), the Florida Supreme Court clarified the issue so there can be no further confusion.

The Second District Court of Appeals certified the below question of great public importance:

DOES THE HOLDING IN _JOERG V. STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., 176 SO.3D 1247 (FLA. 2015), PROHIBITING THE INTRODUCTION OF EVIDENCE OF MEDICARE BENEFITS IN A PERSONAL INJURY CASE FOR PURPOSES OF A JURY’S CONSIDERATION OF FUTURE MEDICAL EXPENSES ALSO APPLY TO PAST MEDICAL EXPENSES?

The certified question asks whether the holding in Joerg applies to past medical expenses. The Court clarified that the holding in Joerg only applied to evidence of future Medicare benefits and has no application to past medical expenses.

Practically speaking, a plaintiff who is a Medicare recipient can only present to the jury past medical bills for the amount paid by Medicare rather than the total amount actually billed by the provider. For example, if a medical provider billed $10,000 for their services but they accepted the Medicare reimbursable rate of $200 for these services, Plaintiff would only be entitled to submit to the jury the $200 actually paid to the provider from Medicare.

In a concurring opinion, Judge Ricky Polston broaches the issue of limiting the admissible evidence of past medical expenses to the amounts medical providers are willing or required to accept as full satisfaction for services rendered regardless of whether the amounts are from government insurance, private insurance, or other third-party arrangements. This is consistent with the concurring opinion in Goble v. Frohman which the Florida Supreme Court ruled on in 2005. Justice Polston stated that inflated “Billed Amounts” that a plaintiff seeks to admit are irrelevant to the proper measure of compensatory damages and should be inadmissible at trial. He opined that the measure of compensatory damages for past medical expenses is the same regardless of the source of a plaintiff’s insurance: private or governmental funded. This may foretell a change limiting what a plaintiff can seek for past medical bills to the amounts medical providers are willing or required to accept as full satisfaction of a bill.