Justia Government & Administrative Law Opinion Summaries

Tennessee family medicine physicians, mostly in rural areas, received increased Medicaid payments in 2013-2014. In 2015 Tennessee’s Medicaid agency, TennCare, brought an administrative action to “recoup” an average of more than $100,000 per physician, alleging that the physicians had not met the 60-percent requirement of the Final Medicaid Payment Rule. Under 42 U.S.C. 13961(a)(13(C), a state plan for medical assistance must provide payment for primary care services furnished in 2013 and 2014 by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine at a specified rate; “primary specialty designation” was interpreted to mandate that the physician either show board certification in that specialty or that 60 percent of her recent Medicaid billings were for certain primary care services. The Sixth Circuit affirmed summary judgment in favor of the physicians, declaring the Rule invalid. The Centers for Medicare and Medicaid Services interpreted “a physician with a primary specialty designation” to have different meanings in parallel provisions of the Affordable Care Act although the context was the same. There is no 60-percent-of-billings requirement in 42 U.S.C. 1396a(a). The phrase “a physician with a primary specialty designation” means in section 1396a(a) the same thing that the agency said it means in section 1395l(x): a physician who has himself designated, as his primary specialty, one of the specialties recited in those provisions. View "Averett v. United States Department of Health & Human Services" on Justia Law

Respondent R.M. appealed a circuit court order that renewed his involuntary admission to New Hampshire Hospital for the purpose of allowing him to remain on a conditional discharge for a period of five years. Respondent was a 30-year-old man who had been hospitalized on multiple occasions as a result of schizophrenia. When respondent doesn't take his prescribed anti-psychotic medication, he becomes paranoid, violent, and suicidal. In addition, he experienced hallucinations, paranoid delusions, and difficulties with impulse control and exhibited “a serious level of aggression.” Respondent was first hospitalized in 2010 after voicing suicidal ideation, stating that he would be “better off dead.” Pertinent here, was admitted on an emergency basis again in February 2015 due to concerns of suicidal threats, incapacity, and his paranoid belief that people were conspiring against him. In early March 2019, a few weeks before the respondent’s three-year conditional discharge was set to expire, the local community mental health center filed a petition to renew his conditional discharge. On appeal, respondent challenged the sufficiency of the evidence and argued the five-year renewal was not the least restrictive treatment option. Finding no reversible error, the New Hampshire Supreme Court affirmed. View "In re R.M." on Justia Law

Advantage Health filed suit, alleging that HHS's continuing recoupment of overpayments before completion of the severely delayed administrative process was denying it procedural due process. The district court granted a preliminary injunction, enjoining HHS from withholding Medicare payments to Advantage Health to effectuate recoupment of any alleged overpayments.The Fourth Circuit held that the injunction entered in this collateral proceeding, which prohibits HHS from recouping overpayments in accordance with applicable law, was inappropriately entered because the delay of which Advantage Health complains could have been and still can be avoided by bypassing an ALJ hearing and obtaining judicial review on a relatively expeditious basis, as Congress has provided. Therefore, this administrative review process did not deny Advantage Health procedural due process and thus Advantage Health has not demonstrated a likelihood of success on the merits. View "Accident, Injury and Rehabilitation, PC v. Azar" on Justia Law

In 2012, Sauvageau became a Lakewood resident, paying for her residency through her pension and Social Security income without other government assistance. Sauvageau stopped paying in August 2013. On October 28, 2013, Lakewood sent her a notice of involuntary transfer or discharge. Sauvageau’s counsel requested a hearing. She applied for Medicaid benefits; the application was denied on January 13, 2014. On February 10, 2014, at a prehearing conference, Lakewood argued that, under the Nursing Home Care Act (210 ILCS 45/1-101), the Department could not conduct a hearing more than 10 days from the date of a resident’s request. The ALJ denied Lakewood’s motion. The hearing was conducted on March 24, 2014. In April 2014, the ALJ recommended that the involuntary discharge be approved. On May 6, the Department’s final administrative decision approved Lakewood’s notice of involuntary discharge. Sauvageau left Lakewood on May 29, 2014. Lakewood sought review, asserting that the Department lacked authority to exceed the statutory 10-day hearing time and 14-day decision time for involuntary transfer or discharge proceedings. The Illinois Supreme Court held that section 3-411 of the Act is directory because it does not contain negative language precluding the Department from conducting a hearing beyond the 10-day time period and because the rights of nursing home residents will not be generally injured by a directory construction. View "Lakewood Nursing and Rehabilitation Center, LLC v. Department of Public Health" on Justia Law

This case arose following the death of Eric, a resident of Chapala House, licensed as a “long-term health care facility” under the Long-Term Care, Health, Safety, and Security Act of 1973 (the Act) - more specifically, as an “[i]ntermediate care facility/developmentally disabled habilitative” (ICF/DD-H). Plaintiff-appellant RSCR Inland, Inc. (ResCare) owned Chapala House. Defendant-appellant California Department of Public Health (the Department) issued a citation and imposed a civil penalty on ResCare in connection with Eric’s death, and ResCare brought this lawsuit to challenge the citation and penalty. The Court of Appeal addressed the scope of the “reasonable licensee defense” through which a California long-term health care facility could show that a citation for a regulatory or statutory violation should be dismissed, even though there was a factual basis for the citation. The Department argued the defense was available only in the event of an “emergency” or “special circumstances.” The Court of Appeal rejected that view, holding that the facility may succeed in dismissing a citation by demonstrating that it did what might reasonably be expected of a long-term health care facility licensee, acting under similar circumstances, to comply with the regulation or statute that allegedly was violated. “This standard differs from the required showing of due care in a typical negligence case because the facility must show reasonable care directed at complying with the regulation or statute, not reasonable conduct in general. But the standard does not require an emergency or an unusual circumstance.” Applying the statutory standard, the Court concluded substantial evidence supported the trial court’s finding that the facility here had established the reasonable licensee defense. View "RSCR Inland, Inc. v. State Dept. of Public Health" on Justia Law

The issue this case presented for the Colorado Supreme Court’s review centered on whether an investigative subpoena issued by the Colorado Medical Board (the “Board”) can have a lawfully authorized purpose if the investigation was prompted by a complaint made by the Colorado Department of Public Health and Environment (the “CDPHE”) pursuant to a policy that violated the Open Meetings Law (the “OML”) or the State Administrative Procedure Act (the “APA”). Scott McLaughlin, M.D. was a physician licensed to practice medicine in Colorado. As part of his practice, he evaluated patients to see if they had a qualifying condition that would benefit from the use of medical marijuana. Information related to medical marijuana in Colorado is maintained by the CDPHE in a confidential registry that includes the names of all patients who have applied for and are entitled to receive a marijuana registry identification card, as well as the names and contact information for the patients’ physicians and, if applicable, their primary caregivers. In May 2014, the CDPHE referred McLaughlin to the Board for investigation based on a high caseload of patients for whom marijuana was recommended. McLaughlin refused to comply with the subpoena, and he and several other physicians whom the CDPHE had referred to the Board and who had received subpoenas from the Board filed suit in the Denver District Court, seeking, among other things, to enjoin the Board from enforcing its subpoenas. The Supreme Court concluded that because neither the CDPHE’s adoption of the Referral Policy nor its referral of Boland to the Board violated the OML or the APA, Boland’s contention that the subpoena to him was void because the Policy and referral were void was based on a flawed premise and was therefore unpersuasive. Even if the adoption of the Referral Policy and the referral itself violated the OML or the APA, however, we still conclude that the Board’s subpoena to Boland had a lawfully authorized purpose because it was issued pursuant to the Board’s statutory authority to investigate allegations of unprofessional conduct and was properly tailored to that purpose. View "Colorado Medical Board v. McLaughlin" on Justia Law

This case was companion to Colorado Medical Board v. McLaughlin, 2019 CO 93, __ P.3d __, wherein the Colorado Supreme Court was asked to determine whether an investigative subpoena issued by the Colorado Medical Board (the “Board”) could have a lawfully authorized purpose if the investigation was prompted by a complaint made by the Colorado Department of Public Health and Environment (the “CDPHE”) pursuant to a policy that violated the Open Meetings Law (the “OML”) or the State Administrative Procedure Act (the “APA”). Petitioner James Boland, M.D. was a physician licensed to practice medicine in Colorado. He primarily examined patients to determine if they would benefit from the use of medical marijuana. Information related to medical marijuana in Colorado is maintained by the CDPHE in a confidential registry that includes the names of all patients who have applied for and are entitled to receive a marijuana registry identification card, as well as the names and contact information for the patients’ physicians and, if applicable, their primary caregivers. In June 2014, the CDPHE referred Boland to the Board for investigation based on his “[h]igh plant count recommendations and high percent of patients under age of 30 [sic] for medical marijuana referrals.” Boland refused to comply with the subpoena, and he and several other physicians whom the CDPHE had referred to the Board and who had received subpoenas from the Board filed suit in the Denver District Court, seeking, among other things, to enjoin the Board from enforcing its subpoenas. The Supreme Court concluded that because neither the CDPHE’s adoption of the Referral Policy nor its referral of Boland to the Board violated the OML or the APA, Boland’s contention that the subpoena to him was void because the Policy and referral were void was based on a flawed premise and was therefore unpersuasive. Even if the adoption of the Referral Policy and the referral itself violated the OML or the APA, however, we still conclude that the Board’s subpoena to Boland had a lawfully authorized purpose because it was issued pursuant to the Board’s statutory authority to investigate allegations of unprofessional conduct and was properly tailored to that purpose. View "Boland v. Colorado Medical Board" on Justia Law

Consistent with Medical Marijuana Policy No. 2014-01 (the “Referral Policy”), which the Colorado Department of Public Health and Environment (the “CDPHE”) had developed after receiving input from staff of the Colorado Medical Board (the “Board”), the CDPHE referred John Does 1–9 (the “Doctors”) to the Board for investigation of unprofessional conduct regarding the certification of patients for the use of medical marijuana. The Doctors filed suit, contending, among other things, that: (1) the Referral Policy was void because it was developed in violation of the Colorado Open Meetings Law (the “OML”); and (2) both the Referral Policy and the referrals to the Board constituted final agency actions under the State Administrative Procedure Act (the “APA”), and the CDPHE did not follow the procedures outlined therein, thereby rendering both the Referral Policy and the referrals void. After review, the Colorado Supreme Court concluded: (1) an entire state agency could not be a “state public body” within the meaning of the OML, and therefore the Doctors did not establish the CDPHE violated the OML; (2) the Referral Policy was an interpretive rather than a legislative rule, therefore, it fell within an exception to the APA and was not subject to the APA’s rulemaking requirements; and (3) the act of referring the Doctors to the Board did not constitute final agency action and therefore was not reviewable under the APA. View "Doe v. Colorado Department of Public Health and Environment" on Justia Law

J.B. was born four weeks prematurely but progressed normally. At his four-month well-baby visit, J.B. was healthy, with normal chest and lungs and no fever, nasal congestion, or cough; J.B. received vaccinations for diphtheria-tetanus-acellular pertussis, inactivated polio, pneumococcal conjugate, rotavirus, and Hepatitis B. That evening, J.B. reportedly had a fever. At 4:00 AM and 8 AM, J.B.’s parents gave him Advil. In the early afternoon, J.B.’s father put him down for a nap on his back in his crib. J.B.’s mother checked on him and found him unresponsive on his right side. At 2:39 PM, J.B.’s mother called 911 and attempted CPR. Responders transported J.B. to the hospital. J.B. was pronounced dead at 4:01 PM. His crib contained soft blankets and a flat soft pillow but no clutter or toys. The medical examiner concluded that the cause of death was SIDS. In a case under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1, a Special Master found that the parents were entitled to compensation. The Claims Court reversed and the Federal Circuit agreed, holding that the Special Master erred by lowering the standard of proof for causation in a case involving an injury not listed on the Vaccine Act Injury Table. The parents failed to prove by a preponderance of the evidence that vaccinations can and did cause or contribute to J.B.’s SIDS death. View "Boatmon v. Secretary of Health & Human Services" on Justia Law

Coleman challenged the Commission's decision that its 18 working-days-late response to a citation notice that had been misplaced in the company's internal mail system demonstrated inexcusable neglect and barred the company from contesting the citations for nearly $70,000.The Fifth Circuit held that the Commission's decision misapplied Federal Rule of Civil Procedure 60(b), which applied under the Commission's own regulations. The court held that the equities weighed in favor of the Company having an opportunity to assert its defenses in OSHA's administrative proceedings. Therefore, the Commission's contrary determination denying relief from the untimely filing was legally in error and an abuse of discretion. Accordingly, the court vacated that decision, remanding for a hearing on the merits of the OSHA violations. View "Coleman Hammons Construction Co. v. Occupational Safety and Health Review Commission" on Justia Law