Justia Government & Administrative Law Opinion Summaries

Keith Huck, an elected member of the Perry County Common Council, was covered under the county's group health insurance plan. In 2023, the Perry County Board of Commissioners voted to exclude part-time employees from health insurance coverage, classifying elected officials, including Huck, as part-time employees. As a result, Huck and his spouse lost their health insurance coverage on January 1, 2024. Huck sought declaratory and injunctive relief, arguing that as an elected official, he should be considered a full-time employee and thus eligible for health insurance coverage.The Perry Circuit Court granted Huck's request for a preliminary injunction, ordering the county to reinstate his insurance coverage. The County appealed, and the Indiana Court of Appeals determined that the county had the authority to classify elected officials as part-time employees and exclude them from health insurance coverage. Huck then sought transfer to the Indiana Supreme Court, which vacated the appellate opinion and reviewed the case.The Indiana Supreme Court held that the county was within its rights to classify Huck as a part-time employee and exclude him from group health insurance coverage. The court found that Indiana law allows local governmental units to exclude part-time employees from group health insurance and that the county's classification of Huck as a part-time employee was permissible. The court reversed the trial court's ruling, vacated the preliminary injunction, and remanded the case for further proceedings consistent with its opinion. View "Perry County v. Huck" on Justia Law

A healthcare provider, Neurological Surgery Practice of Long Island, PLLC, provides out-of-network medical services governed by the No Surprises Act. This Act requires out-of-network providers to seek compensation from the patient’s healthcare plan rather than billing patients directly. If a provider and a healthcare plan cannot agree on a compensation amount, an independent dispute resolution (IDR) process is used. Neurological Surgery alleges that a backlog of disputes has resulted in unpaid or delayed reimbursements due to the Departments of Health and Human Services, Treasury, and Labor failing to implement the Act properly, violating the Administrative Procedure Act (APA) and the Due Process Clause of the Fifth Amendment.The United States District Court for the Eastern District of New York dismissed Neurological Surgery’s claims. The court concluded that the claims were moot due to the reopening of the IDR portal, Neurological Surgery lacked standing to compel the Departments to enforce the Act’s deadlines on third parties, and the claims regarding the Departments’ failure to certify a sufficient number of arbitrators and provide guidance on New York’s surprise billing law were foreclosed by the APA.The United States Court of Appeals for the Second Circuit reviewed the case. The court affirmed the district court’s judgment, agreeing that the challenge to the pause of the IDR portal was moot since the portal was operational. The court also held that Neurological Surgery lacked standing to compel the Departments to enforce deadlines on healthcare plans and IDR entities, as the injury was caused by third parties, not the Departments. Additionally, the court found that the challenge to the Departments’ failure to certify a sufficient number of IDR entities was foreclosed by the APA, as the Act did not specify discrete actions required by the Departments. Lastly, the court held that the challenge to the Departments’ failure to issue guidance on New York’s surprise billing law failed to state a claim under the APA. View "Neurological Surgery v. Department of Health & Human Services" on Justia Law

Plaintiffs, limited liability companies, filed class action lawsuits in the United States District Court for the District of Maryland seeking relief under the Medicare Secondary Payer (MSP) provisions. These provisions make Medicare a secondary payer when a beneficiary has other insurance coverage. Plaintiffs obtained assignments from Medicare Advantage Organizations and other secondary payers to seek reimbursement from primary payers like the defendants, Government Employees Insurance Company and its affiliates (GEICO). Plaintiffs had no preexisting interest in the claims and were compensated on a contingency basis.The United States District Court for the District of Maryland denied GEICO's motion to dismiss the case, which argued that the assignments were void as against Maryland public policy based on the doctrines of maintenance, champerty, and barratry. The court found no clear statement of Maryland law on this issue and certified questions to the Supreme Court of Maryland.The Supreme Court of Maryland held that Plaintiffs did not violate Maryland’s barratry statute, which prohibits soliciting another person to sue for personal gain without an existing relationship or interest. Plaintiffs did not solicit secondary payers to file lawsuits but obtained the right to sue in their own names through assignments. The court also held that the common law doctrines of maintenance, champerty, and barratry, to the extent they still apply, do not invalidate Plaintiffs’ assignments. The court concluded that the assignments are not void as against public policy and did not address the enforceability of choice-of-law provisions in the agreements. View "GEICO v. MAO-MSO Recovery II" on Justia Law

Mississippi Methodist Hospital and Rehabilitation Center Inc. appealed the Hinds County Chancery Court's decision affirming the Mississippi State Department of Health's grant of a certificate of need (CON) to Encompass Health Rehabilitation Hospital of Flowood LLC. The Department identified a need for additional comprehensive medical rehabilitation (CMR) beds, prompting Encompass to apply for a CON to build a new facility in Flowood. Methodist opposed the application, arguing that Encompass's proposed facility would not meet indigent care requirements and would unnecessarily duplicate existing services.The Hinds County Chancery Court initially reversed the Department's decision, finding that the hearing officer failed to consider the relevance of a CON granted to Baptist Memorial Rehabilitation Hospital - Madison LLC. However, the Mississippi Supreme Court vacated this decision, ruling that the hearing officer had considered the relevance of the Baptist CON and found it irrelevant. On remand, the chancery court affirmed the Department's grant of the Encompass CON, finding that the decision was supported by substantial evidence.The Mississippi Supreme Court reviewed the case and affirmed the chancery court's decision. The Court held that the hearing officer's findings were based on substantial evidence, including Encompass's commitment to providing indigent care and the unmet need for CMR services in the Jackson metro area. The Court also rejected Methodist's argument that the state health officer should have considered the impact of the Baptist CON, noting that this issue had already been resolved in the previous appeal. The Court remanded the case to the chancery court to determine the amount of attorneys' fees to which Encompass is entitled under Section 41-7-201(2)(f). View "Mississippi Methodist Hospital and Rehabilitation Center Inc. v. Mississippi State Department of Health and Encompass Health Rehabilitation Hospital of Flowood, LLC" on Justia Law

Karen Jean Anderson, a licensed advanced practice registered nurse (APRN), was accused by the Utah Division of Professional Licensing (DOPL) of unlawfully practicing medicine and exceeding her APRN license by performing tumescent liposuction and fat grafting procedures. These procedures are classified as ablative cosmetic medical procedures under Utah law. DOPL barred Anderson from performing these procedures and imposed a fine. Anderson sought agency review with the Department of Commerce, which reduced the fine but upheld DOPL’s order. Anderson then sought judicial review.The Utah Board of Nursing initially found that Anderson did not unlawfully practice medicine or exceed her APRN license, reasoning that the Nurse Practice Act (NPA) allows APRNs broad authority, including the ability to perform procedures like tumescent liposuction and fat grafting. However, DOPL rejected this recommendation, stating that the legislature had granted exclusive authority to perform non-exempt ablative cosmetic medical procedures to medical and osteopathic doctors. The Department of Commerce affirmed DOPL’s decision, leading Anderson to file a petition for judicial review with the Utah Court of Appeals, which certified the case to the Utah Supreme Court.The Utah Supreme Court held that the Utah Code bars APRNs from independently performing ablative cosmetic medical procedures. The court found that the statutory scheme limits such procedures to those licensed to practice medicine or those whose scope of practice includes the authority to operate or perform surgery. Since the scope of practice for APRNs does not include such authorization, Anderson unlawfully practiced medicine and exceeded her APRN license. The court affirmed the Department’s order, maintaining the restrictions and fine imposed on Anderson. View "Anderson v. Department of Commerce" on Justia Law

In the wake of the U.S. Supreme Court's decision in Dobbs v. Jackson Women’s Health Organization, which held that the U.S. Constitution does not protect the right to abortion, plaintiffs filed a lawsuit seeking a declaration that Wisconsin Statute § 940.04(1), which criminalizes the intentional destruction of an unborn child, does not ban abortion. The plaintiffs included the Attorney General, the Department of Safety and Professional Services, the Medical Examining Board, and three physicians. They argued that the statute either does not apply to abortion or has been impliedly repealed by subsequent legislation.The Dane County Circuit Court denied the defendant's motion to dismiss, concluding that the plaintiffs stated a claim upon which relief could be granted because § 940.04 does not prohibit consensual medical abortions. The court later issued a declaratory judgment that the statute does not prohibit abortions.The Wisconsin Supreme Court reviewed the case de novo. The central question was whether § 940.04(1) bans abortion. The court concluded that comprehensive legislation enacted over the last 50 years, which regulates various aspects of abortion, impliedly repealed the 19th-century near-total ban on abortion. The court held that the legislature's detailed regulation of abortion was meant as a substitute for the earlier statute, and therefore, § 940.04(1) does not ban abortion in Wisconsin.The court affirmed the circuit court's judgment and order, holding that the comprehensive legislative framework governing abortion impliedly repealed the near-total ban on abortion in § 940.04(1). View "Kaul v. Urmanski" on Justia Law

Martin Flanagan, a former employee of Fresenius Medical Care Holdings, Inc., filed a qui tam lawsuit under the False Claims Act (FCA) against his former employer. He alleged that Fresenius engaged in a fraudulent kickback scheme to induce referrals to its dialysis clinics, violating the Anti-Kickback Statute (AKS). Flanagan claimed that Fresenius offered below-cost contracts to hospitals, overcompensated medical directors, and provided other benefits to secure patient referrals, which were then billed to Medicare and Medicaid.The U.S. District Court for the District of Maryland initially handled the case, which was later transferred to the U.S. District Court for the District of Massachusetts. The district court dismissed Flanagan's complaint for failing to meet the heightened pleading standard under Rule 9(b) of the Federal Rules of Civil Procedure. The court found that the amended complaint did not adequately allege specific false claims or provide representative examples. Additionally, the court ruled that some of Flanagan's claims were barred by the FCA's public-disclosure and first-to-file rules. The district court also denied Flanagan's motion to amend his complaint, citing undue delay and potential prejudice to Fresenius.The United States Court of Appeals for the First Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Flanagan failed to plead the alleged fraud with the required particularity. The appellate court also upheld the denial of the motion to amend, noting that Flanagan had ample time to address the deficiencies in his complaint but failed to do so. The First Circuit concluded that the district court did not abuse its discretion in its rulings. View "Flanagan v. Fresenius Medical Care Holdings, Inc." on Justia Law

In 1984, the Department of Health and Human Services (HHS) created the U.S. Preventive Services Task Force to make evidence-based recommendations on preventive healthcare services. The Affordable Care Act of 2010 required most health insurers to cover services rated "A" or "B" by the Task Force without cost sharing. Plaintiffs, including Braidwood Management, objected to these requirements and argued that Task Force members are principal officers who must be appointed by the President with Senate consent, not by the Secretary of HHS.The U.S. District Court for the Northern District of Texas agreed with the plaintiffs, ruling that Task Force members are principal officers because they have no superior who supervises and directs them. The court enjoined the government from enforcing the insurance coverage mandates based on Task Force recommendations issued after 2010. The U.S. Court of Appeals for the Fifth Circuit affirmed, holding that Task Force members are principal officers because they cannot be independent and free from political pressure while being supervised by a political appointee.The Supreme Court of the United States reversed the Fifth Circuit's decision, holding that Task Force members are inferior officers. The Court reasoned that the Secretary of HHS has the authority to remove Task Force members at will and to review and block their recommendations before they take effect. This supervision and direction by the Secretary, a principal officer, means that Task Force members are inferior officers. Therefore, their appointment by the Secretary of HHS is consistent with the Appointments Clause of the Constitution. The case was remanded for further proceedings consistent with this opinion. View "Kennedy v. Braidwood Management, Inc." on Justia Law

In 2018, South Carolina excluded Planned Parenthood from its Medicaid program, citing state law prohibiting public funds for abortion. Planned Parenthood and patient Julie Edwards sued, claiming the exclusion violated the Medicaid any-qualified-provider provision, which allows Medicaid beneficiaries to obtain services from any qualified provider. Edwards preferred Planned Parenthood for gynecological care but needed Medicaid coverage. They filed a class action under 42 U.S.C. §1983 to enforce rights under the federal Medicaid statutes.The district court granted summary judgment for the plaintiffs and enjoined the exclusion. The Fourth Circuit affirmed. The Supreme Court granted certiorari, vacated, and remanded the case in light of Health and Hospital Corporation of Marion Cty. v. Talevski, which addressed whether another spending-power statute created §1983-enforceable rights. On remand, the Fourth Circuit reaffirmed its decision.The Supreme Court of the United States held that Section 1396a(a)(23)(A) does not clearly and unambiguously confer individual rights enforceable under §1983. The Court emphasized that spending-power statutes rarely create enforceable rights and that the any-qualified-provider provision lacks the clear rights-creating language necessary to support a §1983 action. The Court reversed the Fourth Circuit's decision and remanded the case for further proceedings consistent with this opinion. View "Medina v. Planned Parenthood South Atlantic" on Justia Law

Michael Cannata served as a firefighter for the town of Mashpee for over a decade before leaving in 2004 as a "deferred retiree." During his employment, he was enrolled in the town's group health insurance plan, but his enrollment ended upon his departure. In 2021, after turning fifty-five and beginning to collect retirement benefits, Cannata sought to re-enroll in the town's health insurance plan as a retiree. The town denied his request, citing various reasons, including his lack of "time in-service" and the town's practice of denying coverage to retirees not enrolled in the plan at the time of retirement.Cannata filed an action in the Superior Court, seeking a judgment declaring that the town's denial of benefits violated G. L. c. 32B, § 9. The Superior Court judge granted the town's motion to dismiss for failure to state a claim, concluding that Cannata was required to apply for continued coverage and pay the full premium cost during his deferral period in order to later enroll in the town's group health insurance plan upon retirement. Cannata appealed the decision.The Supreme Judicial Court of Massachusetts reviewed the case. The court held that G. L. c. 32B, § 9, neither requires nor prohibits a municipality from enrolling individuals like Cannata in its group health insurance plan upon retirement. The court concluded that the third paragraph of the statute, which the lower court relied on, did not govern Cannata's case. The court determined that municipalities may, but are not obligated to, allow such individuals to enroll in group health insurance upon retirement. The court affirmed the judgment of dismissal on the alternative ground that Cannata's complaint failed to plausibly allege entitlement to relief beyond a speculative level. The case was remanded with instructions to dismiss the complaint without prejudice, allowing Cannata an opportunity to amend his request for declaratory relief. View "Cannata v. Town of Mashpee" on Justia Law