Justia Government & Administrative Law Opinion Summaries

The hospital, located in Philadelphia, received a reclassification into the New York City area, which would sizably increase the hospital’s Medicare reimbursements due to that area’s higher wage index, 42 U.S.C. 1395ww(d). Although a statute makes such reclassifications effective for three fiscal years, the agency updated the geographical boundaries for the New York City area before the close of that period and reassigned the hospital to an area in New Jersey with an appreciably lower wage index. The hospital successfully sued three agency officials in the Eastern District of Pennsylvania.The Third Circuit vacated and remanded for dismissal. The Medicare Act, 42 U.S.C. 1395oo(f)(1), channels reimbursement disputes through administrative adjudication as a near-absolute prerequisite to judicial review. The hospital did not pursue its claim through administrative adjudication before suing in federal court. By not following the statutory channeling requirement, the hospital has no valid basis for subject-matter jurisdiction. View "Temple University Hospital, Inc. v. Secretary United States Department of Health & Human Services" on Justia Law

The 2010 Patient Protection and Affordable Care Act required most Americans to obtain minimum essential health insurance coverage and imposed a monetary penalty upon most individuals who failed to do so; 2017 amendments effectively nullified the penalty. Several states and two individuals sued, claiming that without the penalty, the Act’s minimum essential coverage provision, 26 U.S.C. 5000A(a), is unconstitutional and that the rest of the Act is not severable from section 5000A(a).The Supreme Court held that the plaintiffs lack standing to challenge section 5000A(a) because they have not shown a past or future injury fairly traceable to the defendants’ conduct enforcing that statutory provision. The individual plaintiffs cited past and future payments necessary to carry the minimum essential coverage; that injury is not “fairly traceable” to any “allegedly unlawful conduct” of which they complain, Without a penalty for noncompliance, section 5000A(a) is unenforceable. To find standing to attack an unenforceable statutory provision, seeking only declaratory relief, would allow a federal court to issue an impermissible advisory opinion.The states cited the indirect injury of increased costs to run state-operated medical insurance programs but failed to show how that alleged harm is traceable to the government’s actual or possible enforcement of section 5000A(a). Where a standing theory rests on speculation about the decision of an independent third party (an individual’s decision to enroll in a program like Medicaid), the plaintiff must show at the least “that third parties will likely react in predictable ways.” Nothing suggests that an unenforceable mandate will cause state residents to enroll in benefits programs that they would otherwise forgo. An alleged increase in administrative and related expenses is not imposed by section 5000A(a) but by other provisions of the Act. View "California v. Texas" on Justia Law

In the lawsuit underlying these consolidated writ proceedings, the People of the State of California, by and through the Santa Clara County Counsel, the Orange County District Attorney, the Los Angeles County Counsel, and the Oakland City Attorney, filed an action against defendants— various pharmaceutical companies involved in the manufacture, marketing, distribution, and sale of prescription opioid medications. The People alleged the defendants made false and misleading statements as part of a deceptive marketing scheme designed to minimize the risks of opioid medications and inflate their benefits. This scheme, the People alleged, caused a public health crisis in California by dramatically increasing the number of opioid prescriptions, the use and abuse of opioids, and opioid-related deaths. These proceedings pertained to a discovery dispute after several of the defendants served subpoenas on two nonparty counties, petitioners County of Los Angeles and County of Alameda, seeking records of patients in various county programs, including individual prescription data and individual patient records related to substance abuse treatment. After petitioners and the Johnson & Johnson defendants engaged in various informal and formal means to attempt to resolve the dispute, the superior court issued a discovery order granting the Johnson & Johnson defendants’ motions to compel production of the records. The Court of Appeal concluded petitioners established that the superior court’s order threatened a serious intrusion into the privacy interests of the patients whose records were at issue: the Johnson & Johnson defendants failed to demonstrate their interests in obtaining “such a vast production of medical information” outweighed the significant privacy interests that the nonparty petitioners identified. Accordingly, the Court granted petitioners’ writ petitions and directed the superior court to vacate its order compelling production of the requested documents, and to enter a new order denying Johnson & Johnson defendants’ motions to compel. View "County of Los Angeles v. Superior Ct." on Justia Law

The Supreme Court affirmed the decisions of the circuit court in these consolidated cases, holding that the West Virginia Health Care Authority's interpretation of the State Health Plan Home Health Services Standards was not arbitrary or capricious and was entitled to judicial deference pursuant to Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. 467 U.S. 837 (1984).The Standards governed the Authority's consideration of applications from entities and individuals seeking to provide home health care services in a particular county. The Standards included a methodology for determining whether there was an unmet need for such services in the county. Petitioners argued that unmet need could not be established unless the evidence showed that at least 229 individuals in the subject county were in need of home health care services. Respondents countered that the Standards required the new applicant to demonstrate a need at or beyond the 229 average usage figure. The circuit court concluded that the Authority did not err. The Supreme Court affirmed, holding that the Authority did not exceed its constitutional or statutory authority and its decision was not arbitrary or capricious. View "Amedisys West Virginia, LLC v. Personal Touch Home Care of W. Va., Inc." on Justia Law

M&K Construction (M&K) appealed a workers’ compensation court’s order (the Order) making it reimburse plaintiff Vincent Hager for the ongoing costs of the medical marijuana he was prescribed after sustaining a work-related injury while employed by M&K. Specifically, M&K contends that New Jersey’s Jake Honig Compassionate Use Medical Cannabis Act was preempted as applied to the Order by the federal Controlled Substances Act (CSA). Compliance with the Order, M&K claims, would subject it to potential federal criminal liability for aiding-and-abetting or conspiracy. M&K also claimed medical marijuana was not reimbursable as reasonable or necessary treatment under the New Jersey Workers’ Compensation Act (WCA). Finally, M&K argued that it fit within an exception to the Compassionate Use Act and was therefore not required to reimburse Hager for his marijuana costs. After review, the New Jersey Supreme Court determined: (1) M&K did not fit within the Compassionate Use Act’s limited reimbursement exception; (2) Hager presented sufficient credible evidence to the compensation court to establish that the prescribed medical marijuana represents, as to him, reasonable and necessary treatment under the WCA; and (3) the Court interpretsed Congress’ appropriations actions of recent years as suspending application of the CSA to conduct that complied with the Compassionate Use Act. As applied to the Order, the Court thus found the Act was not preempted and that M&K did not face a credible threat of federal criminal aiding-and-abetting or conspiracy liability. M&K was ordered to reimburse costs for, and reasonably related to, Hager’s prescribed medical marijuana. View "Hager v. M&K Construction" on Justia Law

Abbott Laboratories and Abbott Laboratories, Inc. (collectively, "Abbott"), petitioned the Alabama Supreme Court for a writ of mandamus to direct the Mobile Circuit Court to dismiss all claims asserted by the Mobile County Board of Health and the Family Oriented Primary Health Care Clinic (collectively, "Mobile Health") against Abbott on the basis that those claims are barred by the rule of repose or by the applicable statute of limitations. Mobile Health alleged that Abbott had participated in the marketing of a specific prescription drug, OxyContin. Mobile Health alleged that this marketing campaign "precipitated" an "opioid crisis" in the United States, and specifically in Alabama, because it caused an astronomical increase in the use of opioids by patients who quickly became dependent upon the drugs. Mobile Health asserted that it brought this action because of the burdens it had to bear as a result of the "opioid epidemic." The Alabama Supreme Court concluded the applicable statutes of limitations barred Mobile Health's claims against Abbott. Therefore, the Court granted Abbott's petition for a writ of mandamus, and directed the circuit court to enter an order dismissing Mobile Health's claims against Abbott. View "Ex parte Abbott Laboratories and Abbott Laboratories, Inc." on Justia Law

On March 13, 2020, North Dakota Governor Doug Burgum declared a state of emergency and activated the North Dakota State Emergency Operations Plan via Executive Order (“E.O.”) 2020-03. Governor Burgum’s declaration of a state emergency was in response to the public health crisis resulting from the novel coronavirus (“COVID-19”). On March 19, 2020, Governor Burgum issued E.O. 2020-06 which closed certain business establishments in North Dakota, limited physical access to other business establishments in North Dakota, directed state agencies and offices to regulate staffing, and limited access to the North Dakota State Capitol by appointment only. These restrictions were set to expire on April 6, 2020. On March 27, 2020, E.O. 2020-06 was amended as E.O. 2020-06.1 to include the closure of salons and ordering licensed cosmetologists to cease operations. Kari Riggin appealed a criminal judgment entered after she conditionally pled guilty to a violation of Executive Order 2020-06, an infraction. Riggin challenged the Governor’s authority to restrict her ability to engage in cosmetology services within an assisted living facility as part of the State’s response to a declared state of emergency. Finding the governor did not exceed the statutory authority delegated to him through N.D.C.C. ch. 37-17.1. Riggin failed to adequately support her challenge E.O. 2020-06 was unconstitutional because it restricted her right to conduct business, engage in employment, and failed to adequately support her contention the executive order and the criminal penalties imposed for a violation of an executive order were unconstitutionally vague and overbroad. Accordingly, judgment was affirmed. View "North Dakota v. Riggin" on Justia Law

St. Luke’s Meridian Medical Center (St. Luke’s) provided inpatient hospital care for an indigent patient from January 26, 2016, until March 9, 2016. St. Luke’s sought payment from the Board by submitting a medical indigency application. In September 2016, the Board issued an initial determination, only approving payment from January 26 through February 2, 2016. St. Luke’s appealed the denial. The Board amended its determination by only partially extending payment approval through February 18, 2016. St. Luke’s petitioned for judicial review. In October 2017, the district court affirmed the Board’s decision. St. Luke’s appealed to the Idaho Supreme Court, and the Supreme Court held that the Board’s findings did not provide a reasoned analysis, as required by the Idaho Administrative Procedures Act (IDAPA). The case was remanded back to the Board for it to make the required findings of fact and conclusions of law. On remand, the Board entered its findings of fact, conclusions of law, and order, again denying payment and finding that the services provided were not the most cost-effective services as required under the Idaho Medical Indigency Act. St. Luke’s again filed a petition for judicial review, and the district court again affirmed the Board’s decision. Once more, St. Luke’s timely appealed. The Idaho Supreme Court determined the Board’s decision reflected a misinterpretation of the definition of “medically necessary services;” the Board’s decision was set aside and the matter remanded for further proceedings. View "St. Luke's Health System v. Board of Commissioners of Gem County" on Justia Law

An indigent patient was admitted to St. Alphonsus Regional Medical Center (St. Alphonsus) on October 7, 2017, and continued to receive treatment in the hospital until she was discharged on January 12, 2018. During her stay, St. Alphonsus filed a third-party medical indigency application on her behalf, and later filed two additional requests for payment of services. The Board of Ada County Commissioners (the Board) approved payment for dates of service from October 7 until October 10, 2017, but denied payments for services provided from October 11 until December 31, 2017, relying on the opinion of the Ada County Medical Advisor that the services provided on those dates were not “medically necessary” under the definition in Idaho Code section 31-3502(18)A(e). St. Alphonsus appealed the Board’s initial determination, but the final determination upheld the denial for payment beyond October 11. Upon St. Alphonsus’ petition, a district court reversed the Board’s decision, finding that the services “currently available” to a patient were to be considered as a “necessary medical service.” The Board argued “there did exist options for the Patient to proceed to rehabilitation at a facility other than St. Alphonsus, but for the Patient’s lack of funding.” Furthermore, the Board asserted that Idaho Code section 31-3502(18)A(e) is unambiguous in that “[t]here is no wording in [sub]section (e) of the statute that limits the ‘most cost-effective services’ to services that the Patient can afford to pay for.” After review, the Idaho Supreme Court determined the Board exceeded its statutory authority in denying St. Alphonsus reimbursement for providing medically necessary services. “The Board’s denial of payment was not based on substantial evidence and prejudiced St. Alphonsus’ substantial right to compensation for services rendered to an indigent patient.” View "St. Alphonsus Regional Medical v. Ada County" on Justia Law

In 2018, B.W. went to his primary car provider’s office for “anxiety” and “agitation.” The provider’s notes reflect B.W. discussed making “credible threats of violence against a co-worker.” The provider recommended inpatient treatment, “involuntary if necessary.” B.W. made no threats to the provider’s staff. The provider certified B.W. needed involuntary examination and treatment, and B.W. was transported to another hospital for such examination. The hospital evaluator noted B.W. was “homicidal toward a co-worker,” and was “severely mentally disabled and in need of treatment.” B.W. was involuntarily committed and released after 72 hours. Thereafter, B.W. petitioned to expunge his mental health record, averring there was no basis for the involuntary commitment. A trial court found it undisputed B.W. made threats to harm his co-worker. Though he made no “act in furtherance” of his threats, the court concluded the medical evaluators’ records reflecting B.W.’s statement he would “strangle his co-worker the next time he saw” that person, was sufficient to support B.W. was a clear and present danger to others. The Pennsylvania Supreme Court considered whether the superior court erred in ordering the expungement of B.W.’s records on grounds that the trial court’s conclusion was wrong. The Supreme Court determined the records contained sufficient facts to prove B.W. made a threat to harm another person, and acted in furtherance of that threat, which the physicians found credible. Accordingly, judgment was reversed. View "In Re: B. W., Appeal of: Blair Dept Human Services" on Justia Law