Render unto Caesar

A 70-year-old man was admitted to the hospital for a bowel resection. Following surgery, the patient's condition worsened considerably; He spent months in the ICU on a ventilator, was fed through a gastrostomy tube, and his mental status waned. After some time, it was suspected that his deteriorating condition might be related to sepsis from a bowel perforation. Subsequent surgery confirmed this diagnosis. Attempts to repair the perforation failed, and, ultimately the patient died. Medicare paid the patient's medical bills, which exceeded $500,000. The patient's family commenced a lawsuit, alleging that the surgeon's negligence caused the bowel perforation. During the litigation, the Medicare Trust Fund sent a correspondence to the patient's estate, asserting a claim of reimbursement for the benefits Medicare paid from any recovery that the estate might obtain.