St. Vincent Health group acquired Randolph County Hospital and decided to replace the 80-year-old building. In 2002 the Hospital financed the project by borrowing $15.3 million from a fraternal corporation. Within a year, St. Vincent Health group was acquired by Ascension, the nation’s largest Roman Catholic health-care system. Ascension loaned the Hospital $15.6 million to refinance the loan. The Hospital sought reimbursement under 42 U.S.C. 1395f(b)(1), 1395x(v)(1)(A), and 42 C.F.R. 413.153, for “the necessary and proper costs of financing medical facilities.” Recognizing its problems with poor documentation, the Hospital withdrew its request that Medicare cover any expense before 2004 but requested compensation for 2004-2008, after Ascension had refinanced the loan in compliance with section 413.153(c)(2). The Provider Reimbursement Review Board ordered the 2004-2008 claims paid, finding that problems with the 2002 loan did not taint the refinancing. The Centers for Medicare and Medicaid Services reversed. The district court rejected reasoning concerning the initial loan but granted summary judgment, finding that the Hospital had not established that the Ascension loan refinanced that loan. The Seventh Circuit vacated, stating the “taint” theory is legally untenable and cannot be reasserted on remand, but the agency is free to request more or better documentation and to explore the significance of the difference in the principal amounts of the loans. View "St. Vincent Randolph Hospital, v. Price" on Justia Law

Kolton deposited money into an interest-bearing bank account in Illinois. Years passed without activity in the account, so the bank transferred Kolton’s money to the state as the Disposition of Unclaimed Property Act requires. The Act is not an escheat statute; it gives Illinois custody, not ownership, of “presumed abandoned” property. Most such property gets invested, with any income that accrues earmarked for Illinois’s pensioners. Owners may file a claim for return of their property, but the Act limits the Treasurer to returning the amount received into custody. Kolton brought a purported class action under 42 U.S.C. 1983, claiming violation of the Takings Clause, which protects the time value of money just as much as it does money itself. The judge dismissed for want of subject-matter jurisdiction, stating that under the Supreme Court’s “Williamson” holding, a plaintiff usually must try to obtain compensation under state law before litigating a takings suit. Kolton filed neither a claim with the Treasurer nor a lawsuit in state court seeking just compensation. The Seventh Circuit vacated, noting that Section 1983 does not create a cause of action against the state and the Treasurer, personally, did not deprive Kolton of his money. Williamson was not concerned with jurisdiction. View "Kolton v. Frerichs" on Justia Law

The Supreme Court affirmed the circuit court judgments denying two employers’ requests for permanent writs of mandamus against the Missouri Commission on Human Rights (MCHR). The circuit court rejected Employers’ arguments that the MCHR was required to first determine whether Employers’ employees’ complaints of discrimination were timely filed with the MCHR before the MCHR had authority to issue the employees a right-to-sue letter. The Supreme Court held (1) Mo. Rev. Stat. 213.111.1 requires the MCHR to issue a right-to-sue letter and terminate all proceedings related to a complaint if 180 days have elapsed and the employee has made written request for a right-to-sue letter; and (2) because that is what occurred in both of these cases, the MCHR was required to issue the right-to-sue letters, and the circuit court properly refused to issue writs directing the MCHR to perform an act the MHRA prohibits. View "State ex rel. Tivol Plaza, Inc. v. Missouri Commission on Human Rights" on Justia Law

Vanderklok wanted to fly from Philadelphia to Miami, to run a half-marathon. In his carry-on luggage, he had a heart monitor and watch stored inside a piece of PVC pipe, capped on both ends. During screening at the airport security checkpoint, the pipe and electronics prompted secondary screening, supervised by Transportation Security Administration (TSA) employee Kieser. According to Vanderklok, Kieser was disrespectful, so Vanderklok stated an intent to file a complaint against him. Vanderklok claims that Kieser, in retaliation, called the Philadelphia police and falsely reported that Vanderklok had threatened to bring a bomb to the airport. Vanderklok was arrested. He was acquitted because Kieser’s testimony about Vanderklok’s behavior did not match airport surveillance footage. Vanderklok sued. The district court concluded that Kieser lacked qualified immunity as to Vanderklok’s First Amendment claim and that a reasonable jury could find in Vanderklok’s favor as to his Fourth Amendment claim. The Third Circuit vacated. Because Kieser sought and was denied summary judgment on the merits of Vanderklok’s Fourth Amendment claim, rather than on the basis of qualified immunity, that claim cannot be reviewed on interlocutory appeal. The court concluded that no First Amendment claim against a TSA employee for retaliatory prosecution even exists in the context of airport security screenings. View "Vanderklok v. United States" on Justia Law

Rosewood is a skilled nursing facility, 42 U.S.C. 1395i-3(a), participating in Medicare and Medicaid as a provider. The Secretary of Health and Human Services, which enforces the statutory and regulatory provisions governing nursing homes operating in the Medicare/Medicaid network, assessed a civil monetary penalty against Rosewood on the grounds that it had failed to protect a resident from abuse, failed to timely report or to investigate thoroughly allegations of abuse, and failed to implement its internal policies on abuse, neglect, and misappropriation of property. The Centers for Medicare and Medicaid Services (CMS) determined that these deficiencies placed residents in “immediate jeopardy.” An Administrative Law Judge and the Department Appeals Board affirmed the $6,050 per day penalty imposed by CMS. The Seventh Circuit affirmed. Substantial evidence supports the Agency’s findings. The court noted three specific examples of noncompliance and concluded that there was a systemic failure to implement Rosewood’s policies aimed at conforming to federal regulations View "Rosewood Care Center of Swansea v. Price" on Justia Law

Gazelle served in the U.S. Army, 1962-1965, and incurred service-connected disabilities. He receives compensation for: degenerative disc disease and joint disease of the cervical spine rated at 20 percent; degenerative disc disease and spondylosis of the thoracolumbar spine rated at 20 percent; left upper extremity radiculopathy rated at 10 percent; left lower extremity radiculopathy rated at percent; and post-traumatic stress disorder. In 2009, the VA increased Gazelle’s disability rating for his service-connected PTSD to 100 percent. Gazelle filed a Notice of Disagreement, alleging the VA failed to award him additional special monthly compensation under 38 U.S.C. 1114(s)(1). In 2011, Gazelle was denied entitlement to special monthly compensation because he did not have additional service-connected “disabilities . . . independently ratable as [60 percent] or more disabling.” Instead of adding together Gazelle’s additional service-connected disabilities at their respective amounts, the VA calculated the independent additional rating via the combined ratings table pursuant to 38 C.F.R. 4.25 (2010), which resulted in a combined rating of 50 percent. In 2014, the Board affirmed. The Veterans Court and Federal Circuit affirmed, holding that consistent with the plain meaning of subsection 1114(s), the Board appropriately applied the combined ratings table to determine eligibility for special monthly compensation benefits. View "Gazelle v. Shulkin" on Justia Law

Prime Hospitals provide inpatient services under the Medicare program, submitting payment claims to private contractors, who make initial reimbursement determinations. Prime alleged that many short-stay claims were subject to post-payment review and denied. Prime appealed through the Medicare appeal process. Prime alleged short-stay claims audits were part of a larger initiative that substantially increased claim denials and that the Center for Medicare & Medicaid Services (CMS) was overwhelmed by the number of appeals. CMS began offering partial payment (68 percent) in exchange for dismissal of appeals. Prime alleged that it executed CMS's administrative settlement agreement so that CMS was contractually required to pay their 5,079 Medicare appeals ($23,205,245). CMS ultimately refused to allow the Prime to participate because it was aware of ongoing False Claims Act cases or investigations involving the facilities. Prime alleged that the settlement agreement did not authorize that exclusion. The district court denied a motion to dismiss Prime’s suit but transferred it to the Court of Federal Claims. The Federal Circuit affirmed in part. The breach of contract claim is fundamentally a suit to enforce a contract and does not arise under the Medicare Act, so the Claims Court has exclusive jurisdiction under the Tucker Act, 28 U.S.C. 1491. That court does not have jurisdiction, however, over Prime’s alternative claims seeking declaratory, injunctive, and mandamus relief from an alleged secret and illegal policy to prevent and delay Prime from exhausting administrative remedies. View "Alvarado Hospital, LLC v. Cochran" on Justia Law

Sierra Club challenged the Commission's decision approving the construction and operation of three new interstate natural-gas pipelines in the southeastern United States. Determining that it has jurisdiction to entertain Sierra Club's claims, the DC Circuit held that the Commission's environmental impact statement did not contain enough information on the greenhouse-gas emissions that will result from burning the gas that the pipelines will carry. However, the Commission acted properly in all other respects. Accordingly, the court granted Sierra Club's petition for review and remanded for preparation of a conforming environmental impact statement. View "Sierra Club v. FERC" on Justia Law

Plaintiffs challenged the Government's approval of the location, construction, and specifications for a military base in Okinawa, Japan. Plaintiffs sought claims for declaratory and injunctive relief based on the Government's alleged violations of Section 402 of the National Historic Preservation Act (NHPA), 54 U.S.C. 307101(e), and the Administrative Procedure Act (APA), 5 U.S.C. 701 et seq. The Ninth Circuit held that plaintiffs have standing to bring declaratory relief claims limited to whether the Government's evaluation, information gathering, and consultation process discharged the Government's obligations under the NHPA and otherwise satisfied the requirements of the APA. The panel also held that plaintiffs' injunctive relief claim did not present a political question. Accordingly, the panel affirmed the district court's conclusion that plaintiffs' claims for declaratory and injunctive relief did not present a political question; reversed the district court's conclusion that plaintiffs lacked standing to seek declaratory relief; and reversed the district court's conclusion that plaintiffs' claim for injunctive relief presented a political question. The panel remanded for further proceedings. View "Center for Biological Diversity v. Mattis" on Justia Law

The Hospitals challenged HHS's implementation of a Medicare outlier-payment program in the late 1990s and early 2000s. The Hospitals contend that HHS violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by failing to identify and appropriately respond to flaws in its methodology that enabled certain "turbo-charging" hospitals to manipulate the system and receive excessive payments at the expense of non-turbo-charging hospitals, including the Hospitals. The DC Circuit held that District Hospital Partners, L.P. v. Burwell, 786 F.3d 46 (D.C. Cir. 2015), controlled to the extent that the Hospitals repeated challenges decided in that case. In regard to the remaining challenges, the court affirmed the district court's denials of the Hospitals' motions to supplement the record and to amend their complaint, and its decision that HHS acted reasonably in a manner consistent with the Medicare Act in fiscal years (FYs) 1997 through 2003, and 2007. However, because HHS inadequately explained aspects of the calculations for FYs 2004 through 2006, the court reversed summary judgment in that regard and remanded for further proceedings. View "Banner Health v. Price" on Justia Law