E.D.P. v. Clair presents an interesting tale of statutory interpretation with clear lessons for practitioners. E.D.P. resolved what the Pennsylvania Supreme Court deemed a split between the Superior Court that decided the 2007 underlying case, Bowmaster v. Clair, and the Commonwealth Court’s 2008 decision in Shaffer-Doan v. Department of Public Welfare. Bowmaster and Shaffer-Doan are actually similar in their outcomes, although they take markedly different approaches.
The key to these cases is the different ways in which the courts interpreted the statutory definition of “beneficiary” under the Fraud and Abuse Control Act (FACA), 62 P.S. § 1409(b)(13), and how they limited or expanded this definition by applying the common law, other statutory provisions, and/or the U.S. Supreme Court case Arkansas Department of Health and Human Services v. Ahlborn, which stated that the state’s lien for payment of medical expenses is limited to a portion of settlement designated for medical expenses.
