Justia Government & Administrative Law Opinion Summaries

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

The Supreme Court of New Jersey affirmed the judgment of the Appellate Division in a case concerning the New Jersey State Health Benefits Program Act. The case was brought by James Meyers, a retired state police officer, who challenged the State Health Benefits Commission's (SHBC) decision that he was not exempt from health benefits premium-sharing obligations imposed by the Act. The Act requires public employees to contribute towards the cost of their healthcare benefits upon retirement, with an exemption for employees who had 20 or more years of creditable service in a state or locally administered retirement system as of June 28, 2011. Meyers had 17 years and 9 months of creditable service at that time. Upon his retirement in 2015, he was erroneously offered retiree health benefits at no premium cost. This mistake was discovered in 2017, and the state began deducting premium-sharing contributions from his pension payments.The Court held that Meyers was not eligible for the exemption under the Act, and correcting the erroneous exemption was proper. The court found that neither Meyers' subsequent service nor his purchase of four years of military service credit could change the fact that he did not meet the Act's requirement as of June 28, 2011. The court also agreed with the Appellate Division's determination that it was not necessary to reach the issue of equitable estoppel. The court noted that a governmental entity cannot be estopped from refusing to take an action that it was never authorized to take under the law, even if it had mistakenly agreed to that action. In this case, the SHBC was never authorized to offer Meyers free healthcare benefits, an act beyond the jurisdiction of the SHBC and therefore ultra vires in the primary sense. Thus, the doctrine of equitable estoppel did not apply. View "Meyers v. State Health Benefits Commission" on Justia Law

In the case of Wages and White Lion Investments, L.L.C., doing business as Triton Distribution; Vapetasia, L.L.C., versus the Food & Drug Administration, the court found that the FDA acted arbitrarily and capriciously in its denial of Premarket Tobacco Product Applications (PMTAs) for flavored e-cigarette products.The petitioners, Triton Distribution and Vapetasia, are manufacturers of flavored e-cigarette liquids. They filed PMTAs for their products, as required by the Family Smoking Prevention and Tobacco Control Act, which prohibits the sale of any “new tobacco product” without authorization from the FDA. The FDA, after issuing detailed guidance on the information it required for approval of e-cigarette products, subsequently denied all flavored e-cigarette applications, including those of the petitioners, on the grounds that they failed to predict new testing requirements imposed by the FDA without notice.The court found that the FDA had failed to provide the manufacturers with fair notice of the rules, had not acknowledged or explained its change in position, and had ignored the reasonable and serious reliance interests that manufacturers had in the pre-denial guidance. Furthermore, the FDA attempted to cover up its mistakes with post hoc justifications at oral argument.As a result, the court granted the petitions for review, set aside the FDA's marketing denial orders, and remanded the matters to the FDA. The court rejected FDA's argument that even if it arbitrarily and capriciously denied petitioners’ applications, that error was harmless, stating that the harmless error doctrine is narrow and does not apply to discretionary administrative decisions. The court also rejected FDA's contention that it gave manufacturers fair notice of their obligations to perform long-term scientific studies in its pre-denial guidance documents. View "Wages and White Lion Invest v. FDA" on Justia Law

In this appeal, Marcus Raper contested the Social Security Administration’s (SSA) 2020 denial of his claim for disability insurance benefits. Raper raised three arguments: (1) that the administrative law judge's (ALJ) initial lack of constitutional appointment under the Appointments Clause tainted his later constitutionally appointed review of his case, (2) that the ALJ failed to clearly articulate good cause for not fully crediting his treating physician’s medical opinion, and (3) that the ALJ wrongly discredited his subjective complaints of pain by not properly considering evidence other than objective medical evidence.The United States Court of Appeals for the Eleventh Circuit affirmed the lower court’s decision. First, the court found no Appointments Clause violation as the ALJ's initial decision, made when he was unconstitutionally appointed, had been vacated on the merits and the case was remanded to the same ALJ who was then constitutionally appointed. Second, the court held that the ALJ articulated good cause for discounting Raper's treating physician’s opinion, finding the opinion inconsistent with the record. Lastly, the court found that the ALJ had properly considered Raper’s subjective complaints in light of the record as a whole and adequately explained his decision not to fully credit Raper’s alleged limitations on his ability to work. View "Raper v. Commissioner of Social Security" on Justia Law

In a case involving the State of Texas, the American Association of Pro-Life Obstetricians & Gynecologists, and the Christian Medical & Dental Associations as plaintiffs, and the United States Department of Health and Human Services (HHS), its Secretary Xavier Becerra, the Centers for Medicare and Medicaid Services (CMS), and other officials as defendants, the United States Court of Appeals for the Fifth Circuit affirmed the district court's decision. The plaintiffs challenged HHS's guidance on the Emergency Medical Treatment and Active Labor Act (EMTALA), which they alleged mandated providers to perform elective abortions beyond HHS's authority and contrary to state law. The plaintiffs sought to enjoin the enforcement of this guidance. The district court granted the injunction within Texas or against any member of a plaintiff organization, and HHS appealed.The Court of Appeals held that the HHS guidance constituted a final agency action as it binds HHS to a particular legal position and has clear legal consequences should a physician or hospital violate it. The court found that HHS's guidance exceeds the statutory language of EMTALA, which does not mandate any specific type of medical treatment, let alone abortion care. The court also held that HHS was required to subject the guidance to notice and comment as it "establishes or changes a substantive legal standard." The court affirmed the injunction, finding it not overbroad, but rather tailored based on the parties, issues, and evidence before it. View "Texas v. Becerra" on Justia Law

The Supreme Court of Missouri ruled in favor of three employees of a medical facility, Jayla Ruiz Morales, John Kimani, and Valarie Johnson, who were sued for wrongful death by the legal guardian of a patient, Ronald Scheer. Scheer, a resident at the St. Louis Developmental Disabilities Treatment Center-St. Charles Habilitation Center, died after his wheelchair's belt constricted his breathing. The employees were accused of failing to adequately supervise Scheer, failing to ensure that his wheelchair's seatbelt and pelvic harness were properly fastened, among other allegations. The employees argued that they were entitled to official immunity, a doctrine that protects public officials from liability for acts of negligence committed during the course of their official duties. The lower court rejected this argument and the employees sought a writ of prohibition from the Supreme Court of Missouri.The Supreme Court of Missouri held that the employees were entitled to official immunity. The court found that the tasks they were required to perform were not ministerial (routine or mundane tasks) but required discretion. Tasks such as checking on the patient, repositioning him, and using a seat belt and pelvic harness required the employees to use judgment to determine if Scheer needed additional care, and if so, what care to be administered. Therefore, these tasks were not ministerial and the employees were entitled to official immunity. The court made its preliminary writ of prohibition permanent, barring the lower court from taking further action in the case. View "State ex rel. Jayla Ruiz-Morales v. Alessi" on Justia Law

In this case heard before the United States Court of Appeals for the Fourth Circuit, the plaintiff, Daniella Easterbrook, appealed the denial of her application for disability benefits by the Social Security Administration. Easterbrook, who has suffered from persistent back pain since 2011, argued that the Administrative Law Judge (ALJ) failed to provide a "good reason," supported by substantial evidence, for not giving adequate weight to the opinions of her treating physician, Dr. John Kim.The court agreed with Easterbrook, stating that the ALJ erred in not applying the "treating source rule" to Dr. Kim's opinions and not providing a sufficient justification for giving his opinions less weight. The court noted that Dr. Kim's opinions were well-supported by medically acceptable clinical and laboratory diagnostic techniques and were consistent with the substantial evidence in the record.The court also found that the ALJ's reasons for discounting Dr. Kim's opinions, such as Easterbrook's decision not to undergo certain treatments, were inappropriate and did not constitute "good reasons." The court stated that a patient's refusal to pursue a specific type of medical treatment does not automatically call into question the severity of her pain.As a result, the court reversed the Commissioner's decision and remanded the case for a determination consistent with its opinion. View "Easterbrook v. Kijakazi" on Justia Law

Facing a tight deadline from the Ninth Circuit, the Environmental Protection Agency banned the use of chlorpyrifos on food crops. Two environmental groups petitioned the EPA in 2007 to have all tolerances revoked. In denying the petition, the EPA concluded that their objections were “not supported by valid, complete, and reliable evidence.”   The Eighth Circuit granted the petitions, finding that the EPA’s decision was arbitrary and capricious. The court explained that in this case, the EPA believed it lacked discretion or at least acted that way. The Ninth Circuit’s opinion had already narrowed its options down to two: revoke the tolerances or modify them. With little time to act, the agency ruled out the second option, leaving only revocation by default. In doing so, however, it misread the statute and misunderstood the “scope of its discretion”. Therefore, the court set aside the decision as arbitrary and capricious. Further, the court explained that a partial ban was a real alternative for the EPA. It could have canceled some registrations and retained others that satisfied the statutory safety margin. View "RRVSG Assoc. v. Michael Regan" on Justia Law

Adams, born in 1960, smoked about a pack a day starting at age 18 and worked in coal mines at times between 1979-1995, mostly underground using a “cutting machine” in the “dustiest” areas. Adams struggled to breathe after his retirement. Adams’s 1998 application under the Black Lung Benefits Act, 30 U.S.C. 901(b), was denied because he failed to prove that he had pneumoconiosis. In 2008, Adams sought benefits from Wilgar. His treating physician, Dr. Alam, identified the causes of his 2013 death as cardiopulmonary arrest, emphysema, coal worker’s pneumoconiosis, throat cancer, and aspiration pneumonia.A 2019 notice in the case stated “the Court may look to the preamble to the revised” regulations in weighing conflicting medical opinions. Wilgar unsuccessfully requested discovery concerning the preamble and the scientific studies that supported its conclusions. The ALJ awarded benefits, finding that Adams had “legal pneumoconiosis” and giving Dr. Alam’s opinion that Adam’s coal mine work had substantially aggravated his disease “controlling weight.” All things being equal, a treating physician’s opinion is “entitled to more weight,” 30 C.F.R. 718.104(d)(1). Wilgar's three experts had opined that Adams’s smoking exclusively caused his disease The ALJ gave “little weight” to these opinions, believing that they conflicted with the preamble to the 2001 regulation.The Benefits Review Board and Sixth Circuit affirmed. The preamble interpreted the then-existing scientific studies to establish that coal mine work can cause obstructive diseases, either alone or in combination with smoking. The ALJ simply found the preamble more persuasive than the experts. View "Wilgar Land Co. v. Director, Office of Workers’ Compensation Programs" on Justia Law

The Supreme Court affirmed the orders entered by the circuit court granting summary judgment to Defendants in the underlying action brought after investigators identified unsafe, non-sterile injection techniques, holding that the circuit court did not err.Plaintiffs, a pain management clinic and its physician, brought the underlying action alleging that the West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, and its former Commissioner and State Health Officer (collectively, the DHHR Defendants) breached their duty of confidentiality when they issued a press release announcing that Defendants used unsafe injection practices and encouraging Plaintiffs' patients to be tested for bloodborne illnesses. Plaintiffs also sued the West Virginia Board of Ostseopathic Medicine and its executive director (together, the BOM Defendants), asserting a due process claim for failing to timely provide a hearing after their summary suspension of the physician's medical license. The circuit court concluded that the DHHR defendants were entitled to qualified immunity and that the claim against the BOM defendants was barred by res judicata. The Supreme Court affirmed, holding that there was no error in the circuit court's judgment. View "Chalifoux v. W. Va. Dep't of Health & Human Resources" on Justia Law