Justia Government & Administrative Law Opinion Summaries

A group of anesthesiology specialty medical practices sued the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to challenge the Merit-based Incentive Payment System (MIPS). MIPS evaluates eligible clinicians across several performance categories and adjusts their Medicare reimbursement rates accordingly. The plaintiffs received unfavorable MIPS scores and argued that the Total Per Capita Cost (TPCC) measure, one of MIPS’s performance metrics, was arbitrary and capricious as applied to them.The United States District Court for the Northern District of Texas concluded that the plaintiffs' suit was statutorily barred and granted summary judgment for the defendants. The district court determined that 42 U.S.C. §§ 1395w-4(q)(13)(B)(iii) and (p)(10)(C) preclude judicial review of the plaintiffs' claims. Additionally, the court found that even if the claims were justiciable, CMS did not exceed its statutory authority in establishing the TPCC measure and its attribution methodology, and that the TPCC measure, as applied to the plaintiffs, was not arbitrary or capricious.The United States Court of Appeals for the Fifth Circuit reviewed the case and affirmed the district court’s dismissal. The appellate court agreed that 42 U.S.C. § 1395w-4(q)(13)(B)(iii) bars judicial review of the plaintiffs' challenge because CMS’s establishment of an attribution methodology for the TPCC measure falls within the “identification of measures and activities.” The court also concluded that 42 U.S.C. § 1395w-4(p)(10)(C) bars judicial review of the plaintiffs' claims, as it precludes review of the evaluation of costs, including the establishment of appropriate measures of costs. The court found no merit in the plaintiffs' assertion that CMS exceeded its statutory authority. Thus, the appellate court affirmed the district court’s decision to dismiss the plaintiffs' claims for lack of jurisdiction. View "U.S. Anesthesia Partners of Texas v. Health and Human Services" on Justia Law

The plaintiffs, Norene Rodríguez and Iris Rodríguez, sued Encompass Health Rehabilitation Hospital of San Juan, Inc. and Dr. José Báez Córdova for medical malpractice related to the treatment of their mother, Gloria Rodríguez González, who died after being treated for COVID-19. They alleged negligence in her care, particularly in failing to provide timely prophylactic medication for deep vein thrombosis, which they claimed led to her death.The United States District Court for the District of Puerto Rico granted summary judgment in favor of the defendants. The court concluded that the plaintiffs had not demonstrated any genuine issue of material fact and that the defendants were entitled to judgment as a matter of law. The court also found that Dr. Báez was immune from suit under Puerto Rico law, as he was acting within his duties as a faculty member of the University of Puerto Rico (UPR) at the time of the alleged malpractice. Consequently, Encompass could not be held vicariously liable for his actions. The plaintiffs' remaining claims were deemed waived for lack of development.The United States Court of Appeals for the First Circuit reviewed the case and affirmed the district court's decision. The appellate court agreed that Dr. Báez was immune from suit under Puerto Rico law, as he was acting in his capacity as a UPR faculty member supervising medical residents. The court also upheld the district court's application of the local anti-ferret rule, which disregarded certain facts not adequately supported by specific citations to the record. The plaintiffs' argument that Encompass was vicariously liable for the actions of other non-immune personnel was deemed waived, as it was not raised in the lower court. The appellate court found no abuse of discretion in the district court's denial of an evidentiary hearing. View "Rodriguez v. Encompass Health Rehabilitation Hospital of San Juan, Inc." on Justia Law

The Pharmaceutical Coalition for Patient Access (the Coalition), a charitable organization involving drug manufacturers, challenged an unfavorable advisory opinion issued by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS). The dispute centered on the Coalition’s proposed patient assistance program for Medicare beneficiaries, which aimed to subsidize co-pays for oncology drugs. The OIG determined that the program would violate the Anti-Kickback Statute if the required mens rea were present, as it would offer remuneration to induce the purchase of specific drugs.The United States District Court for the Eastern District of Virginia granted summary judgment in favor of the defendants, the United States, HHS, and related officials, and dismissed the Coalition’s claims. The court found that the OIG’s advisory opinion was not arbitrary or capricious and that the Coalition’s program would indeed fall within the Anti-Kickback Statute’s prohibitions.The United States Court of Appeals for the Fourth Circuit reviewed the case de novo. The court affirmed the district court’s decision, agreeing that the word “induce” in the Anti-Kickback Statute should be construed under its ordinary meaning, not its specialized criminal law meaning. The court also concluded that “remuneration” in the statute includes any payment or compensation, not just corrupt payments that distort medical decision-making. The court found that the Coalition’s program involved a quid pro quo, as it offered subsidies for the purchase of specific drugs.The Fourth Circuit also upheld the district court’s dismissal of the Coalition’s disparate treatment claim for lack of subject matter jurisdiction, ruling that the OIG’s enforcement discretion is not subject to judicial review. The court concluded that the OIG had consistently applied the Anti-Kickback Statute to similar proposals and that the Coalition’s challenge was directed against the OIG’s enforcement discretion, which is unreviewable under the Administrative Procedure Act. View "Pharmaceutical Coalition for Patient Access v. United States" on Justia Law

Krishna Kishore Geda and Chaya Durga Sruthi Keerthi Nunna, married Indian nationals residing in the U.S. on employment-based nonimmigrant visas, filed I-485 applications for adjustment of status to lawful permanent residents. After waiting nearly eight years, they were informed that their applications were on hold due to the unavailability of the required immigrant visa. Frustrated by the delay, they sued the United States Citizenship and Immigration Services (USCIS) and its Director, claiming unlawful withholding and unreasonable delay under the Administrative Procedure Act (APA).The United States District Court for the District of New Jersey dismissed their claims for lack of subject-matter jurisdiction, stating that the Adjudication Hold Policy is a discretionary decision shielded from judicial review under 8 U.S.C. § 1252(a)(2)(B)(ii).The United States Court of Appeals for the Third Circuit reviewed the case and affirmed the District Court's decision. The Third Circuit held that the decision to delay adjudication of the Gedas' applications under the Adjudication Hold Policy is a discretionary action specified under 8 U.S.C. § 1255(a), which grants the Secretary of Homeland Security broad discretion over the adjustment of status process. Consequently, the court found that it lacked jurisdiction to review the claims under 8 U.S.C. § 1252(a)(2)(B)(ii), which precludes judicial review of discretionary decisions by the Secretary of Homeland Security. The court concluded that only the executive and legislative branches could provide the relief sought by the Gedas. View "Geda v. Director United States Citizenship and Immigration" on Justia Law

Relators Ralph Billington, Michael Aceves, and Sharon Dorman filed a qui tam action against HCL Technologies Ltd. and HCL America, Inc., alleging that HCL defrauded the United States by securing visas for foreign employees, primarily from India, to avoid paying higher salaries to American citizens. They claimed this scheme violated the False Claims Act (FCA) by underpaying H-1B visa workers, thus reducing tax obligations, and by applying for less expensive visas instead of the required H-1B visas, thereby avoiding higher visa application fees.The United States District Court for the District of Connecticut dismissed all claims, concluding that relators could not demonstrate that HCL avoided or decreased any established obligation to pay money to the United States. The court found no established obligation for HCL to pay federal payroll taxes on wages it never paid and no obligation to pay higher H-1B visa fees when it applied for B-1 and L-1 visas instead.The United States Court of Appeals for the Second Circuit reviewed the case and agreed with the district court. The appellate court held that HCL did not have an obligation under the FCA to pay taxes on wages it never paid, as the duty to pay taxes arises only from wages actually paid. Similarly, the court found no obligation for HCL to pay higher visa application fees for visas it never applied for. The court affirmed the district court’s judgment, concluding that relators failed to state a plausible claim that HCL decreased or avoided an established obligation to pay money to the United States. View "United States ex rel. Billington v. HCL Techs. Ltd." on Justia Law

On December 19, 2023, Lee Meiers was arrested for driving under the influence. The arresting officer read Meiers the implied consent advisory and conducted a chemical breath test, which showed an alcohol concentration above the legal limit. The officer completed and certified a report and notice form, printed and signed the test record and checklist, and provided copies to Meiers and the North Dakota Department of Transportation (NDDOT). However, the officer did not certify the test record and checklist before forwarding it to the NDDOT.Meiers requested an administrative hearing, where he objected to the admission of the uncertified test record and checklist, arguing that it was not certified as required by N.D.C.C. § 39-20-03.1, and thus the NDDOT lacked authority to suspend his driving privileges. The hearing officer overruled the objection, admitted the test record and checklist, and suspended Meiers’s driving privileges for 180 days. Meiers appealed to the District Court of Mountrail County, which reversed the hearing officer’s decision, concluding that a certified copy of the test record and checklist was required to invoke the NDDOT’s authority.The North Dakota Supreme Court reviewed the case and reversed the district court’s judgment. The Supreme Court held that the requirement in N.D.C.C. § 39-20-03.1(4) for the test record and checklist to be certified is not a basic and mandatory provision that impacts the NDDOT’s authority to suspend a driver’s privileges. The court emphasized that the certification requirement is for evidentiary purposes and can be accomplished through other means. Therefore, the NDDOT had the authority to suspend Meiers’s driving privileges despite the lack of certification on the test record and checklist. The Supreme Court reinstated the NDDOT’s decision to suspend Meiers’s driving privileges. View "Meiers v. NDDOT" on Justia Law

Courthouse News Service, a news organization, sought remote online access to civil court records from the Circuit Court for Prince William County, Virginia, similar to the access granted to Virginia attorneys. Virginia law prohibits the clerk from providing such access to non-attorneys. Courthouse News sued, claiming this restriction violated its First Amendment and Equal Protection rights.The United States District Court for the Eastern District of Virginia dismissed Courthouse News's Equal Protection claim and granted summary judgment for the defendants on the First Amendment claims. The court found the restrictions to be content-neutral time, place, and manner regulations justified by the state's interests in the orderly administration of justice and protecting sensitive personal information.The United States Court of Appeals for the Fourth Circuit reviewed the case. The court affirmed the district court's ruling on the First Amendment and Equal Protection claims, holding that the access restriction was a content-neutral regulation narrowly tailored to serve significant governmental interests. The court found that the restriction did not violate the First Amendment as it provided ample alternative channels for accessing court records and did not burden more access than necessary. The court also concluded that the restriction did not violate the Equal Protection Clause for the same reasons it passed First Amendment scrutiny.However, the court vacated the district court's ruling on the Dissemination Restriction claim, finding that Courthouse News lacked standing to challenge it since the restriction only applied to those with remote access, which Courthouse News did not have. The case was remanded for the district court to dismiss this claim without prejudice. View "Courthouse News Service v. Smith" on Justia Law

The plaintiff filed two successive applications for disability benefits under Title XVI of the Social Security Act. Her first application, alleging disability beginning June 24, 2017, was denied by an Administrative Law Judge (ALJ) on September 18, 2018. While appealing this denial to the district court, she filed a second application for benefits for a later period. Washington State Disability Determination Services (DDS) reviewed the second application and awarded benefits, determining she was disabled starting September 19, 2018, the day after the ALJ denied her first application.The district court partially ruled in her favor on the first application and remanded it for further proceedings. The Appeals Council remanded the case to the ALJ with instructions. On June 23, 2021, the ALJ reopened the second application and denied the benefits previously granted by DDS. The ALJ concluded that the plaintiff was disabled beginning July 14, 2020, on her first application. The district court held it lacked jurisdiction to review the ALJ’s reopening and denial of benefits on the second application.The United States Court of Appeals for the Ninth Circuit reversed the district court’s decision, holding that the district court had jurisdiction to review the ALJ’s reopening of the second application. The Appeals Council did not reopen the second application, and the ALJ’s reopening occurred more than two years after the award, which is only permissible in cases of fraud or similar fault. Finding no evidence of fraud or similar fault, the Ninth Circuit held that the ALJ erred in reopening and reversing the award of benefits on the second application. The court remanded for the district court to direct the agency to award benefits according to DDS’s decision. The Ninth Circuit affirmed the district court’s decision on the first application, concluding that the ALJ’s finding that the plaintiff was not disabled between June 24, 2017, and September 19, 2018, was supported by substantial evidence. View "NEVIN V. COLVIN" on Justia Law

Four Native American tribes operating casinos in Oklahoma filed a federal lawsuit in August 2020 to invalidate certain tribal-gaming compacts entered into by the Governor of Oklahoma and other tribes. These compacts were approved by the U.S. Secretary of the Department of the Interior by operation of law. The tribes argued that the Governor lacked the authority to enter into these compacts, violating Oklahoma law and their rights under the Indian Gaming Regulatory Act (IGRA).The Governor, represented by private counsel, defended the compacts' validity under federal law, arguing that any provisions violating state law could be severed. In July 2023, the Oklahoma Attorney General filed a notice to assume control of the state's defense, asserting that the compacts were invalid under state law. The Governor moved to strike the Attorney General's appearance, arguing that he had the authority to retain counsel and that the Attorney General could not override this.The United States District Court for the District of Columbia certified a question to the Supreme Court of Oklahoma regarding whether the Attorney General could assume control of the defense over the Governor's objection. The Supreme Court of Oklahoma held that the Attorney General could not take control of the defense in this case. The court emphasized the Governor's constitutional role as the "Supreme Executive" with the authority to select and direct counsel for the state's interests. The court also noted that the Attorney General could appear in the case but could not override the Governor's choice of counsel. View "CHEROKEE NATION v. UNITED STATES DEPARTMENT OF THE INTERIOR" on Justia Law

Interfaith Sanctuary Housing Services, Inc. (IFS) applied for a conditional use permit (CUP) to operate a large-scale low-barrier shelter home in Northwest Boise. The Planning and Zoning Commission (PZC) initially denied the application, citing concerns about compatibility with the neighborhood, undue burden on public facilities, adverse effects on nearby properties, and insufficient information on mitigating adverse impacts. IFS appealed to the Boise City Council, which reversed the PZC’s decision and granted the CUP, imposing 30 conditions of approval. The Veterans Park Neighborhood Association, Inc. (VPNA) sought reconsideration, which was denied, and then petitioned the district court for judicial review.The district court upheld the City Council’s decision, finding no error in the Council’s actions. VPNA appealed to the Idaho Supreme Court, arguing that the City Council’s decision was arbitrary and capricious, based on unlawful procedure, and that the Council’s reasoned statement was inadequate under the Local Land Use Planning Act (LLUPA).The Idaho Supreme Court found that the City Council’s decision was arbitrary and capricious and based on unlawful procedure because the PZC’s determination that the CUP could not be conditioned into compliance with the CUP criteria was not an error. The Court also found that the City Council’s reasoned statement was conclusory and failed to adequately resolve pertinent factual disputes, thus violating LLUPA and depriving VPNA of due process. The Court concluded that VPNA demonstrated a prejudice to its substantial rights.The Idaho Supreme Court reversed the district court’s decision and remanded the case with instructions to invalidate the City Council’s approval of the CUP. VPNA was awarded costs but not attorney fees on appeal. View "Veterans Park Neighborhood Association, Inc. v. City of Boise" on Justia Law