Justia Government & Administrative Law Opinion Summaries

In November 2013, Ahmad Rashad Davis was indicted for Medicaid fraud and theft by deception for defrauding Medicaid of $14,505.36 by falsifying timesheets over two years. In May 2014, the Commonwealth of Kentucky and Davis entered into a plea agreement in which Davis agreed to plead guilty to Medicaid fraud, and in exchange, the Commonwealth recommended to the trial court that Davis's theft by deception charge be dismissed. The trial court accepted Davis's guilty plea and sentenced him to one year of imprisonment, probated for three years or until restitution was paid in full, and dismissed the theft by deception charge. In December 2021, Davis filed a petition to expunge the theft by deception charge. The Commonwealth objected, arguing that the charge was dismissed in exchange for Davis's guilty plea to Medicaid fraud, making it ineligible for expungement under Kentucky Revised Statute (KRS) 431.076(1)(b). The circuit court granted Davis's petition without holding a hearing, and the Court of Appeals affirmed the decision. The Supreme Court of Kentucky granted discretionary review and reversed the decisions of the lower courts.The Supreme Court of Kentucky held that a circuit court can look beyond the sentencing court's final judgment to determine whether a dismissal was granted in exchange for a guilty plea to another charge. The court ruled that the circuit court erred in failing to do so in Davis's case. As a result, the Supreme Court reversed the Court of Appeals and vacated the circuit court's order granting expungement. View "COMMONWEALTH OF KENTUCKY V. DAVIS" on Justia Law

The United States Court of Appeals for the Fifth Circuit affirmed the district court’s decision to order Marty Johnson, the owner of a mental health rehabilitation clinic, and Keesha Dinkins, an employee of the clinic, to pay $3.5 million in restitution. Johnson and Dinkins had pleaded guilty to charges related to a fraudulent billing scheme targeting Medicaid that lasted from 2014 to 2018. On the day before their jury trial was set to begin, both defendants pled guilty to their respective charges and agreed in their plea deals to recommend $3.5 million in restitution. However, after their pleas were accepted, both defendants objected to the restitution order, arguing that it was erroneous. Johnson challenged the loss and restitution calculation while Dinkins argued that the entire loss should not have been attributed to her. The court held that the defendants were bound by the plea agreements they had made and affirmed the district court’s order for each defendant to pay $3.5 million in restitution. The court found that there was sufficient evidence to support the pleas, the restitution amount did not exceed the actual loss, and the district court appropriately used the total loss amount when calculating Dinkins’s sentence. View "USA v. Dinkins" on Justia Law

In this case, Gardena Hospital in California appealed a decision regarding its reporting of patient days for the purpose of calculating Medi-Cal reimbursement. The controversy centered around whether "bed hold" days — days when a patient is not physically in the hospital's subacute section but is expected to return — should be included in the reported patient days. If these days were included, it would result in a smaller per diem reimbursement to the hospital by the state. The hospital argued that bed hold days should be excluded, pointing to the Accounting and Reporting Manual for California Hospitals (the "Hospital Manual"), which does not specifically mention bed holds. The state, on the other hand, referred to the Accounting and Reporting Manual for California Long-Term Care Facilities (the "Long-Term Manual"), which specifically states that bed hold days should be included in total patient days.The Court of Appeal of the State of California, Second Appellate District, Division Eight ruled in favor of the state, affirming the lower court's decision. The court held that where two state manuals guide health care facility accounting, the one that specifically addresses the issue at hand — in this case, the Long-Term Manual's explicit reference to bed holds — governs. The court reasoned that the specific provision controls the general one and can be regarded as a correction to it. Thus, according to this holding, Gardena Hospital must include bed hold days in its reported patient days for the calculation of Medi-Cal reimbursement. View "Gardena Hospital, L.P. v. Baass" on Justia Law

The case revolves around Windy Hill Hospital's request to change from a long-term care hospital to a short-term care hospital in Georgia, without obtaining a new Certificate of Need (CON) from the Department of Community Health. The case addresses two preliminary questions: whether a CON confers a private right or a public right on a hospital, and the proper framework for interpreting the Department's CON regulations.The Supreme Court of Georgia held that a CON confers a private right as it provides the individual, usually a corporate entity, with the right to operate a particular kind of hospital. This is because the right to use one's property in a particular way is a traditional property right. The Court also clarified the framework for interpreting administrative rules, stating that courts may defer to an agency's interpretation of its own rule only if the rule's meaning is ambiguous. In this case, the Court did not definitively determine if the Court of Appeals had applied this framework correctly in interpreting the Department's regulations relevant to this case.The case was remanded to the Court of Appeals for further proceedings consistent with this opinion, without deciding several other issues that could be dispositive of this case. The Court did not rule on whether Windy Hill Hospital ever held a CON to operate as a long-term care hospital, whether the hospital's 1996 correspondence with the State Health Planning Agency constituted a "CON process", and whether any rights purportedly conferred by a CON ultimately vested. View "KENNESTONE HOSPITAL, INC. v. EMORY UNIVERSITY" on Justia Law

A group of current and former inmates, or their representatives, filed a class action lawsuit against Kate Brown, the Governor of Oregon, and Patrick Allen, the Director of the Oregon Health Authority, claiming that the state's COVID-19 vaccine rollout plan, which prioritized corrections officers over inmates, violated their Eighth Amendment rights. The defendants moved to dismiss the claim, asserting immunity under the Public Readiness and Emergency Preparedness (PREP) Act. The district court denied the motion, and the defendants appealed.The United States Court of Appeals for the Ninth Circuit reversed the district court's decision, finding that the defendants were immune from liability for the vaccine prioritization claim under the PREP Act. The court held that the statutory requirements for PREP Act immunity were met because the "administration" of a covered countermeasure includes prioritization of that countermeasure when its supply is limited. The court further concluded that the PREP Act's provisions extend immunity to persons who make policy-level decisions regarding the administration or use of covered countermeasures. The court also held that the PREP Act provides immunity from suit and liability for constitutional claims brought under 42 U.S.C. § 1983, even if those claims are federal constitutional claims. View "MANEY V. BROWN" on Justia Law

In the case before the Court of Appeal of the State of California, Second Appellate District, Division Two, the plaintiff, Ali Shalghoun, appealed a judgment from the Superior Court of Los Angeles County in favor of the defendant, North Los Angeles County Regional Center, Inc. Shalghoun, an administrator of a residential facility for developmentally disabled persons, sued the regional center after he was attacked by a resident at the facility. The resident, known as J.C., was a client of the regional center, which had arranged for his placement at the facility.The central issue in the case was whether the regional center had a legal duty to protect the employees of a residential facility from a developmentally disabled person who had been placed there. The plaintiff argued that the regional center was negligent in failing to immediately move J.C. to another facility after being informed that the facility could no longer provide the level of care he required.However, the appellate court affirmed the lower court's decision, finding that the regional center did not owe a duty of care to the facility's employees. The court reasoned that the regional center's duty, as mandated by the Lanterman Developmental Disabilities Services Act, was to provide services and support to the developmentally disabled person (the "consumer"), not to protect third-party employees at a residential facility. The court also noted that the regional center did not have the unilateral power to relocate a consumer; it depended on the acceptance of the consumer by another residential facility.According to the court, the imposition of liability on regional centers for injuries inflicted by consumers could potentially drive the centers out of business, disrupt the entire system of services and support for developmentally disabled individuals, and contradict the Act's mandate to place consumers in the least restrictive environment. The court therefore concluded that public policy factors weighed against recognizing a duty of care running from the regional center to the employees of the residential facility. View "Shalghoun v. North Los Angeles County Regional Center, Inc." on Justia Law

The case involves appellant Soleiman Mobarak, who appealed the judgment of the Tenth District Court of Appeals dismissing his petition for a writ of mandamus against appellee, Franklin County Court of Common Pleas Judge Jeffrey M. Brown. Mobarak had sought to vacate his criminal convictions for lack of subject-matter jurisdiction in the trial court. The court of appeals held that the trial court had jurisdiction over Mobarak’s criminal case and that Mobarak had an adequate remedy in the ordinary course of the law.In 2012, Mobarak was indicted on charges of engaging in a pattern of corrupt activity, aggravated trafficking in drugs, and aggravated possession of drugs. The charges alleged that Mobarak had possessed and sold a controlled-substance analog commonly known as bath salts. In his petition, Mobarak asserted that the trial court lacked subject-matter jurisdiction over his criminal case on several grounds including that there was no statute prohibiting the possession or sale of bath salts at the time his offenses were alleged to have occurred, and that the controlled-substance-analogs law was unconstitutionally vague.The Supreme Court of Ohio affirmed the Tenth District Court of Appeals' judgment dismissing Mobarak’s petition. The court held that Mobarak’s petition failed to state a mandamus claim because he had an adequate remedy in the ordinary course of the law and failed to show that the trial court had patently and unambiguously lacked jurisdiction over his criminal case. The court found that by virtue of the Ohio Constitution and R.C. 2931.03, the trial court had jurisdiction over Mobarak’s criminal case. The court also noted that Mobarak’s arguments were similar to those raised and rejected in his prior appeals. The court stated that extraordinary writs may not be used as a substitute for an otherwise barred second appeal or to gain successive appellate reviews of the same issue. View "State ex rel. Mobarak v. Brown" on Justia Law

In South Carolina, two hospitals, Walterboro Community Hospital and Trident Medical Center, appealed an Administrative Law Court (ALC) order which approved the certificate of need (CON) for the Medical University Hospital Authority (MUHA). MUHA had applied for a CON to construct a new general hospital in Berkeley County to address capacity issues at its existing hospital in Charleston. The appellant hospitals raised four issues against ALC's decision: 1) the ALC's dismissal of certain errors in the review by the South Carolina Department of Health and Environmental Control (DHEC), 2) a misinterpretation of the State Health Plan by the ALC, 3) the ALC's approval of MUHA's application conditional on the closure of a freestanding emergency department planned by MUHA, and 4) the appeal bond required by South Carolina law is unconstitutional.The Supreme Court of South Carolina affirmed the ALC's decision and held that despite errors in DHEC's review process and decision, the ALC's de novo review rendered these errors harmless. The court also agreed with ALC's interpretation of the State Health Plan and found no issue in the ALC's condition of approval. The court further held that the appeal bond requirement was not unconstitutional, as the appellant hospitals were statutory affected persons and there was a rational basis for different treatment for a party opposing an approved CON and a party appealing the denial of its own CON application. However, the court did instruct that the appeal bond be voided and returned to Trident Medical Center. View "Walterboro Comm Hospital v. SCDHEC" on Justia Law

In a dispute with the Department of Human Services (DHS) in Minnesota, Nobility Home Health Care, Inc. (Nobility) was found to have violated Minnesota Statutes section 256B.064 and Minnesota Rule 9505.2165 by failing to maintain health service records as required by law and by submitting claims for services for which underlying health service records were inadequate. The Minnesota Supreme Court held that such conduct constitutes "abuse" under the statute, even if there was no intent to deceive the DHS. However, the court declined to interpret or apply the phrase "improperly paid... as a result of" abuse in the statute, which governs the grounds for monetary recovery. The court reversed the decision of the court of appeals and remanded the case to the DHS for further analysis of this issue. The court's decision means that DHS's demand for an overpayment for Nobility’s first-time paperwork errors may not be reversed unless the DHS also establishes that the provider was improperly paid because of that abuse. View "In the Matter of SIRS Appeal by Nobility Home Health Care, Inc" on Justia Law

In the case before the United States Court of Appeals for the Sixth Circuit, the defendant, Thomas O’Lear, was convicted of healthcare fraud, making a false statement in connection with healthcare services, and aggravated identity theft. O’Lear ran a company that provided mobile x-ray services to residents in nursing homes. However, he used the company to defraud Medicare and Medicaid programs by billing for fictitious x-rays using the identities of nursing-home residents. When an audit revealed the fraud, O’Lear attempted to conceal it by forging staff names and duplicating x-rays in the patient files.On appeal, O’Lear raised several questions. Firstly, he questioned whether his Sixth Amendment right to an impartial jury was violated by excluding individuals who had not been vaccinated against COVID-19 from the jury pool. The court ruled that the unvaccinated do not qualify as a “distinctive group” that can trigger Sixth Amendment concerns. Secondly, O’Lear questioned whether the nursing-home residents were “victims” of his fraud under a “vulnerable victims” sentencing enhancement, even though the monetary losses were suffered by Medicare and Medicaid. The court ruled that the residents were indeed victims, as O’Lear had used their identities and health records without their permission, which constituted taking advantage of them.O’Lear also challenged his two aggravated-identity-theft convictions and objected to his 180-month sentence on various grounds, but these arguments were also dismissed by the court. Ultimately, the court affirmed O’Lear's conviction and sentence. View "United States v. O'Lear" on Justia Law