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Pillars of Justice

Published Opinions

Notable Decisions in Healthcare Industry


A.W. v. Humana Medical Plan, Inc.

Attorney Maria Santi, Esq. represented a Medicaid Beneficiary following denial by Medicaid plan administrator of coverage for certain outpatient services, Medicaid recipient requested a Medicaid Fair Hearing through state Agency for Health Care Administration, providing her contact information, including her e-mail address, during the initial phone call to request the hearing. Notice of recipient's hearing was sent only via e-mail. Recipient did not appear at hearing. Agency's order to show cause why recipient's request for a fair hearing should not be dismissed due to her failure to appear was also sent only via e-mail. Agency's subsequent final order deeming recipient's request abandoned was sent via e-mail and regular mail. Recipient appealed.

The Fourth District Court of Appeal held that recipient's act of providing her e-mail address during initial phone call did not constitute election of e-mail service, and thus delivery of hearing notice only via e-mail constituted a material error in procedure. The action was reversed and remanded to the Agency for hearing. 

A.W. v. Humana Med. Plan, Inc.,

270 So. 3d 400 (Fla. 4th DCA 2019).

Girl at the Pediatrician

Q.H. v. Sunshine State Health Plan, Inc.

Attorney Maria Santi, Esq. and co counsel Morgan Weinstein, Esq. represented a Medicaid recipient who sought judicial review of decision by the Agency for Health Care Administration (AHCA), which concluded that recipient's growth hormone treatment was not medically necessary and therefore not eligible for coverage under the Medicaid Act's early and periodic screening, diagnostic, and treatment (EPSDT) program.

The Fourth District Court of Appeal held that evidence was sufficient to establish that the growth hormone treatment was medically necessary. The decision was reversed and remanded.

Q.H. v. Sunshine State Health Plan, Inc., 307 So. 3d 1 (Fla. 4th DCA 2020).

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