Justia Government & Administrative Law Opinion Summaries

Dr. Korban and his medical practice Delta, practice diagnostic and interventional cardiology. In 2007, Dr. Deming filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A)–(C), (G) against Korban, Jackson Regional Hospital, and other Tennessee hospitals, alleging “blatant overutilization of cardiac medical services.” The United States intervened and settled the case for cardiac procedures performed in 2004-2012. Korban entered into an Integrity Agreement with the Office of Inspector General, effective 2013-2016 that was publicly available and required an Independent Review Organization. The U.S. Department of Justice issued a press release that detailed the exposed fraudulent scheme and outlined the terms of Korban’s settlement. In 2015, Jackson Regional agreed to a $510,000 settlement. The Justice Department and Jackson both issued press releases.In 2017, Dr. Maur, a cardiologist who began working for Delta in 2016, alleged that Korban was again performing “unnecessary angioplasty and stenting” and “unnecessary cardiology testing,” paid for in part by Medicare. In addition to Korban and Jackson, Maur sued Jackson’s corporate parent, Tennova, Dyersburg Medical Center, and Tennova’s corporate parent, Community Health Systems. The United States declined to intervene. The district court dismissed, citing the FCA’s public-disclosure bar, 31 U.S.C. 3730(e)(4). The Sixth Circuit affirmed. Maur’s allegations are “substantially the same” as those exposed in a prior qui tam action and Maur is not an “original source” as defined in the FCA. View "Maur v. Hage-Korban" on Justia Law

Plaintiff County of Monterey (County) appealed when the trial court denied its petition for writ of mandate and complaint for declaratory and injunctive relief. The County was the successor agency for its former redevelopment agency ("RDA"), and challenged decisions by the Department of Finance (Department) relating to a development known as the East Garrison Project, which was part of the Fort Ord Redevelopment Project located on a closed military base in Monterey. The County claimed the trial court erroneously determined that a written agreement entered into between its former RDA and a private developer (real party in interest, UCP East Garrison, LLC) was not an enforceable obligation within the meaning of the dissolution law because the former RDA did not have the authority to approve the agreement on the date the governor signed the 2011 dissolution legislation. The County further contended the trial court erred in determining the County failed to show the Department abused its discretion in disapproving two separate requests for funding related to administration of the East Garrison Project. The County claimed these administrative costs were expended to complete an enforceable obligation within the meaning of the dissolution law, and therefore the Department should have approved its requests for payment of such costs. Finally, the County argued the Department’s application of the dissolution law improperly impaired UCP’s contractual rights. The Court of Appeal rejected each of the County's contentions and affirmed judgment. View "County of Monterey v. Bosler" on Justia Law

The Supreme Court affirmed the circuit court's dismissal of West Virginia Counties Group Self-Insurance Risk Pool, Inc.'s (WVCoRP) claims against Great Cacapon Volunteer Fire Department, Inc. (VFD), holding that the circuit court did not err.When a fire destroyed the building where VFD was housed, the owner of the building, the Morgan County Commission, was reimbursed for the loss by WVCoRP. Seeking to recover the funds it expended, WVCoRP sued the VFD and other parties for negligence. In the process, WVCoRP invoked a contractual right to subrogation. The circuit court determined that the claims against VFD were barred by W. Va. Code 29-12A-13(c), which prohibits claims against political subdivisions made under a right of subrogation. The Supreme Court affirmed, holding (1) WVCoRP's claims spring from its coverage contract with the Commission and fall within any plain meaning of subrogation; and (2) section 29-12A-13(c) is not an insurance law of the State from which WVCoRP is exempt. View "West Virginia Counties Group v. Great Cacapon Volunteer Fire Department, Inc." on Justia Law

The Supreme Court affirmed the decision of the court of appeals requiring Appellant to comply with a subpoena duces tecum issued to him by the Secretary of the Finance and Administration Cabinet (Secretary), holding that the subpoena powers of the Secretary extend to suspected violations of Kentucky's Model Procurement Code (KMPC) and that the Secretary has the power to subpoena non-government employees as part of an investigation into a possible violation of the KMPC.The Secretary issued a subpoena to Frank Lassiter seeking information to assist in an investigation into whether certain government contracts complied with the KMPC. Lassiter refused to comply with the subpoena, arguing that the Secretary's authority to issue subpoenas under Ky. Rev. Stat. Chapter 45 did not extend to investigations into potential KMPC violations and, regardless, did not allow him to subpoena non-government employees. The circuit court denied the Secretary's motion to compel Lassiter's compliance, finding that the Secretary subpoena power did not apply to investigations into possible violations of the KMPC. The court of appeals reversed. The Supreme Court affirmed, holding that the Secretary's subpoena power applies to investigations into possible violations of the KMPC. View "Lassiter v. Landrum" on Justia Law

Appellant SEDA-COG Joint Rail Authority (the “JRA”) was a joint authority formed pursuant to the MAA, governed by a sixteen member Board, with each of the eight member counties appointing two members. In addition to the MAA, the Board’s operations were governed by the JRA’s bylaws and a code of conduct. Appellee Susquehanna Union Railroad Company (“SURC”) was a third-party rail line operator. The JRA began the process to award a new operating agreement. At an October 2014 Board meeting, the JRA’s counsel announced because the Board had sixteen members, a nine-vote majority was required for the Board to act. Carload Express received twenty-four points, SURC received twenty-three, and Northern Plains Railroad received thirteen. A roll call vote was taken on the motion to award the contract to Carload and, of the ten voting Board members, seven voted in favor and three against. When certain Board members questioned the nine vote requirement for action, the Board voted unanimously to table the decision to award the operating agreement to Carload pending further review of the JRA’s bylaws and the applicable law. After the meeting, Carload submitted its position to the JRA, arguing that it had been awarded the operating agreement based upon the seven-to-three vote. The JRA responded by filing an action requesting a declaration upholding its use of the nine vote requirement. The Supreme Court granted discretionary appeal to determine whether Section 5610(e) of the Pennsylvania Municipality Authorities Act's use of the phrase “members present” abrogated the common law rule that a simple majority (a majority vote of the voting members who make up the quorum of a municipal authority) carried a vote. Because the Court concluded that it did not, it affirmed the Commonwealth Court. View "Seda-Cog Joint Rail Auth v. Carload Express et al" on Justia Law

The Joint Enterprise Defense Infrastructure Cloud procurement is directed to the long-term provision of enterprise-wide cloud computing services to the Defense Department. Its solicitation contemplated a 10-year indefinite-delivery, indefinite-quantity contract with a single provider. The JEDI solicitation included “gate” provisions that prospective bidders would be required to satisfy, including that the contractor must have at least three existing physical commercial cloud offering data centers within the U.S., separated by at least 150 miles, providing certain offerings that were “FedRAMP Moderate Authorized” at the time of proposal (a reference to a security level). Oracle did not satisfy the FedRAMP Moderate Authorized requirement and filed a pre-bid protest.The Government Accountability Office, Claims Court, and Federal Circuit rejected the protest. Even if Defense violated 10 U.S.C. 2304a by structuring the procurement on a single-award basis, the FedRAMP requirement would have been included in a multiple-award solicitation, so Oracle was not prejudiced by the single-award decision. The FedRAMP requirement “constituted a specification,” not a qualification requirement; the agency structured the procurement as a full and open competition. Satisfying the gate criteria was merely the first step in ensuring that the Department’s time was not wasted on offerors who could not meet its minimum needs. The contracting officer properly exercised her discretion in finding that the individual and organizational conflicts complained of by Oracle did not affect the integrity of the procurement. View "Oracle America Inc. v. United States" on Justia Law

The Supreme Court affirmed the order of the district court vacating and modifying the orders of the Montana Public Service Commission (PSC) reducing standard-offer contract rates and maximum contract lengths for small solar qualifying facilities (QFs), holding that the district court did not err.Specifically, the Supreme Court held (1) the district court did not err in determining that the PSC's calculation of the avoided-cost rate was arbitrary and unlawful; and (2) the district court did not err in concluding that the PSC arbitrarily and unreasonably calculated QF capacity contribution values and arbitrarily and unreasonably reduced maximum-length QF-1 contracts to fifteen years. View "Vote Solar v. Montana Department of Public Service Regulation" on Justia Law

The False Claims Act, 31 U.S.C. 3729–3733, authorizes relators to file qui tam suits on behalf of the U.S. government. If such an action is successful, the relator receives part of the recovery. The Act prohibits presenting to a federal healthcare program a claim for payment that violates the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), Venari formed 11 daughter companies, each for the purpose of prosecuting a separate qui tam action, alleging essentially identical violations of the False Claims Act by pharmaceutical companies. CIMZNHCA, a Venari company, filed suit alleging illegal kickbacks to physicians for prescribing Cimzia to treat Crohn’s disease in patients who received federal healthcare benefits. The government did not exercise its right “to intervene and proceed” as the plaintiff but moved to dismiss the action, representing that it had investigated the Venari claims and found them to lack merit. The court denied that motion, finding the government’s general evaluation of the Venari claims insufficient as to CIMZNHCA and that the decision to dismiss was “arbitrary and capricious.”The Seventh Circuit reversed with instructions to dismiss, construing the government’s motion as a motion to both intervene and dismiss. By treating the government as seeking to intervene, a court can apply Federal Rule of Civil Procedure 41, which provides: “The Government may dismiss the action” without the relator’s consent if the relator receives notice and opportunity to be heard. View "United States v. UCB, Inc." on Justia Law

In the Patient Protection and Affordable Care Act (ACA), Congress directed each state to establish an online exchange through which insurers may sell health plans if the plans meet certain requirements. One requirement is that insurers must reduce the “cost-sharing” burdens—such as the burdens of making co-payments and meeting deductibles—of certain customers. When insurers meet that requirement, the Secretary of Health and Human Services shall reimburse them for those cost-sharing reductions, 42 U.S.C. 18071(c)(3)(A). In October 2017, the Secretary stopped making reimbursement payments, due to determinations that such payments were not within the congressional appropriation that the Secretary had, until then, invoked to pay the reimbursements. Sanford, a seller of insurance through the North Dakota, South Dakota, and Iowa exchanges, and Montana Health, a seller through the Montana and Idaho exchanges, sued.The trial courts granted the insurers summary judgment, reasoning that the ACA reimbursement provision is “money-mandating” and that the government is liable for damages for its failure to make reimbursements for the 2017 reductions. The court did not reach the contract claim in either case. The Federal Circuit affirmed, citing the Supreme Court’s 2020 “Maine Community,” addressing a different payment-obligation ACA provision. Maine Community indicates that the cost-sharing-reduction reimbursement provision imposes an unambiguous obligation on the government to pay money; that obligation is enforceable in the Claims Court under the Tucker Act, 28 U.S.C. 1491(a)(1). View "Sanford Health Plan v. United States" on Justia Law

The Patient Protection and Affordable Care Act (ACA), 124 Stat. 119, directed each state to establish an online exchange through which insurers may sell health plans that meet certain requirements. Insurers must reduce the “cost-sharing” burdens, such as co-payments and deductibles, of certain customers. When insurers meet that requirement, the Secretary of Health and Human Services (HHS) shall reimburse them for the required cost-sharing reductions, 42 U.S.C. 18071(c)(3)(A). In October 2017, the Secretary stopped making reimbursement payments, due to determinations that such payments were not within the congressional appropriation that the Secretary had invoked to pay the reimbursements. Insurers sued.The Federal Circuit affirmed summary judgment in favor of the insurers on liability, reasoning that the ACA reimbursement provision is “money-mandating” and that the government is liable for damages. The court cited the Supreme Court’s 2020 “Maine Community,” addressing a different ACA payment-obligation as indicating that the cost-sharing-reduction reimbursement provision imposes an unambiguous obligation on the government to pay money; that obligation is enforceable through a damages action under the Tucker Act, 28 U.S.C. 1491(a)(1). The court remanded the issue of damages. The government is not entitled to a reduction in damages with respect to cost-sharing reductions not paid in 2017. As to 2018, the Claims Court must reduce the insurers’ damages by the amount of additional premium tax credit payments that each insurer received as a result of the government’s termination of cost-sharing reduction payments. View "Community Health Choice, Inc. v. United States" on Justia Law