Justia Government & Administrative Law Opinion Summaries

John Boman appealed the grant of summary judgment in favor of the City of Gadsden. Boman worked as a Gadsden police officer from 1965 until he retired in 1991. Following his retirement, Boman elected to pay for retiree health coverage through a group plan offered by Gadsden to retired employees. This retired-employee-benefit plan was also administered by Blue Cross and provided substantially similar benefits to those Boman received as an active employee. In 2000, however, Gadsden elected to join an employee-health-insurance-benefit plan ("the plan") administered by the State Employees' Insurance Board ("the SEIB"). When Boman turned 65 in 2011, he was receiving medical care for congestive heart failure and severe osteoarthritis of the spine. After his 65th birthday, Blue Cross began denying his claims for medical treatment based on the failure to provide Blue Cross with a "record of the Medicare payment." However, Boman had no Medicare credits. Boman was hired before March 31, 1986, and, although Gadsden did begin participation in the Medicare program in 2006, Boman's employee group had not opted to obtain Medicare coverage before Boman retired. Consequently, Boman never paid Medicare taxes and did not claim to have Medicare coverage. The SEIB ultimately determined that the plan was the secondary payer to Medicare. Boman sued Gadsden, asserting that it had broken an agreement, made upon his employment, to provide him with lifetime health benefits upon his retirement. Boman also sued the members of the SEIB charged with administering the plan, challenging the SEIB's interpretation of the plan. Finding no reversible error in the grant of summary judgment to Gadsden, the Supreme Court affirmed. View "Boman v. City of Gadsden" on Justia Law

The Minnesota Department of Human Services (DHS) assessed surcharges against seven hospitals and hospital systems (collectively, the Hospitals) on their net patient revenue under Minn. Stat. 256.957(2). The Hospitals appealed their surcharge assessments for various months, alleging that federal law preempted the surcharge to the extent it required them to pay a surcharge on revenues obtained from insurance carriers that participated in the Federal Employee Health Benefits Program and the TRICARE program. The Commissioner of DHS denied the claim. The court of appeals affirmed. The Supreme Court affirmed, holding that the surcharge was not preempted by federal law. View "In re Consolidated Hosp. Surcharge Appeals of Gillette Children’s Specialty Healthcare" on Justia Law

The amount of additional Medicare reimbursements that a hospital is entitled to receive for serving a disproportionate share of low-income patients depends, in part, on the number of days that the hospital served patients who were “eligible for medical assistance under a State plan approved under [the Medicaid statute].” 42 U.S.C. 1395ww(d)(5)(F)(vi)(II). Kentucky hospitals contend that because Kentucky has chosen in its Medicaid plan to award additional Medicaid funds to hospitals based on how many days they treat patients who are eligible for the Kentucky Hospital Care Program (KHCP), a state program that provides medical coverage to low-income individuals who do not qualify for Medicaid, KHCP patient days should be counted in the calculation of the additional Medicare reimbursements. The Sixth Circuit affirmed rejection of the state’s argument on summary judgment, stating that the statutory term “eligible for medical assistance under a State plan approved under [the Medicaid statute]” is synonymous with “eligible for Medicaid” and KHCP patients are, by definition, not eligible for Medicaid. View "Owensboro Health, Inc. v. United States Dept. of Health & Human Servs." on Justia Law

JTB Tools challenges the dismissal of its suit against defendants, alleging that the district court erred in granting OSHA’s Rule 12(b)(1) motion to dismiss for lack of subject-matter jurisdiction and in transferring the case to this court. The court affirmed the district court's transfer, holding that this court has exclusive jurisdiction to review OSHA’s actions pursuant to 29 U.S.C. 655(f). Because JTB Tools failed to adequately brief its merits arguments before this court, the court held that JTB Tools waived any potential right to relief and the court dismissed the case. View "JTB Tools & Oilfield v. United States" on Justia Law

"The facts as alleged in the complaint and in plaintiff’s declaration in opposition to the motion to strike are not at all clear." Plaintiff Un Hui Nam, a new medical resident in the anesthesiology department at UC Davis Medical Center, "got off to a rocky start" in July of 2009. The Court of Appeal surmised that there appeared to have been some tension and misunderstandings right from the beginning of plaintiff's residency. What occurred thereafter and why was the subject of the underlying lawsuit and appeal. Plaintiff labeled the hospital's actions as "retaliation" when she questioned whether residents were allowed to intubate patients. She expressed her disagreement with any policy that would compel the residents in an emergency to wait for the on-call team rather than independently intubating a patient. The week prior to this email, she had received excellent performance evaluations. Plaintiff copied all of the residents in her email. Some of these residents thereafter informed her that she should expect retaliation for sending it. Defendant, however, insisted the e-mail excited no such reaction. Defendant’s version of plaintiff's residency file consisted of a series of complaints, warnings, investigations, and leaves of absence necessitated by plaintiff’s "shortcomings" over a three-year period and culminating in her ultimate termination. The record contained both complaints and testimonials about plaintiff’s performance. Apparently she had a particularly good rapport with nurses. Defendant built a paper trail of warnings for unprofessional conduct and an inability to get along with other doctors. But many of defendant’s allegations were not substantiated during the internal investigations that ensued, and the anesthesiology department was criticized repeatedly for what it did, and did not do, to teach plaintiff the clinical and interpersonal skills needed to succeed in the program. Plaintiff requested, without success, a formal hearing to contest the termination. In January 2013 she filed her complaint for retaliation, discrimination, sexual harassment, wrongful termination, violations of the Business and Professions Code, and breach of contract. Defendant filed a motion to strike pursuant to section 425.16 of the Code of Civil Procedure, alleging that plaintiff’s complaint constituted a SLAPP (strategic lawsuit against public participation) and arose from written complaints made in connection with an official proceeding. Defendant argued that the investigations and corrective action were protected conduct. The trial court disagreed and denied the motion. The trial court's denial of defendant's motion to strike was affirmed: "It is hard to imagine that a resident’s complaint alleging retaliatory conduct was designed to, or could, stifle the University from investigating and disciplining doctors who endanger public health and safety. The underlying lawsuit may or may not have merit that can be tested by summary judgment, but it is quite a stretch to consider it a SLAPP merely because a public university commences an investigation." View "Nam v. Regents of UC" on Justia Law

In a 2007 ruling, the Alaska Supreme Court recognized that the State had "compelling interests" in aiding parents to help their minor children make informed and mature pregnancy-related decisions, and at that time, the Court indicated that a parental notification law might be implemented without unduly interfering with minors’ fundamental privacy rights. The 2010 voter-enacted Parental Notification Law revived an exception in the existing medical emancipation statute, creating considerable tension between a minor’s fundamental privacy right to reproductive choice and how the State could advance its compelling interests. By this 2016 opinion, the Alaska Court concluded that the Notification Law violated the Alaska Constitution’s equal protection guarantee and could not be enforced. "But the decision we reach today is narrow in light of the limited State interests offered to justify the Notification Law. The State expressly disclaims any interest in how a minor exercises her fundamental privacy right of reproductive choice, and it does not suggest that it has an interest in limiting abortions generally or with respect to minors specifically. And as a court we are not concerned with whether abortion is right, wrong, moral, or immoral, or with whether abortions should be available to minors without restriction. We are concerned only with whether, given its stated underlying justifications, the current Notification Law complies with the Alaska Constitution’s equal protection guarantee — and it does not." View "Planned Parenthood of the Great Northwest v. Alaska" on Justia Law

In 2013, the State Board of Nursing invoked N.J.A.C. 13:37-1.3(c)(2) to deny accreditation to the Licensed Practical Nurse to Registered Nurse Bridge Program (Bridge Program), a nursing program instituted by Eastwick College (Eastwick). Interpreting the term graduating class in N.J.A.C. 13:37-1.3(c)(2) to include all graduates of the program who took the licensing examination during a given calendar year, regardless of the year a particular student graduated from the program, the Board found that Eastwick's Bridge Program's first and second graduating classes failed to achieve the 75% pass rate mandated by the regulation. Eastwick appealed the Board's determination, challenging the methodology used by the Board to calculate the pass rate of the Bridge Program's graduates on the licensing examination. Eastwick contended that only students who graduated during a specific calendar year and took the licensing examination in that year should be included in that year's graduating class. Using that methodology, Eastwick argued that its second graduating class had a pass rate in excess of 75%, and that the Board improperly declined to accredit its nursing program. An Appellate Division panel affirmed the Board's determination denying accreditation. Based on the plain language of N.J.A.C. 13:37-1.3(c)(2), the New Jersey Supreme Court concluded that the Board's construction of its regulation was plainly unreasonable, and accordingly held that the Board improperly denied accreditation to Eastwick's Bridge Program. The Court therefore reversed the Appellate Division's judgment affirming the Board's action, and remanded this matter for further proceedings. View "In the Matter of the Revocation or the Suspension of the Provisional Accreditation of and/or the Imposition of Probation on Eastwick College LPN-to-RN Bridge Program" on Justia Law

The Public Health Service Act (PHSA), 42 U.S.C. 201, establishes coverage requirements for all health insurance plans except those it deems “excepted benefits.” The Patient Protection and Affordable Care Act (ACA), 26 U.S.C. 5000A(a), updated the PHSA’s coverage requirements and mandated that all applicable individuals maintain “minimum essential coverage.” The ACA left intact and incorporated the PHSA’s rules regarding excepted benefits. In May 2014, HHS announced its plan “to amend the criteria for fixed indemnity insurance to be treated as an excepted benefit” in the individual health insurance market. On top of the requirements codified in the PHSA, HHS added another. To be an “excepted benefit,” the plan may be “provided only to individuals who have . . . minimum essential coverage.” Several providers challenged the rule as an impermissible interpretation of the PHSA, and after a hearing, the district court permanently enjoined HHS’s enforcement of the rule under Chevron Step One. The court affirmed the district court's permanent injunction because HHS lacked authority to demand more of fixed indemnity providers than Congress required. View "Central United Life Ins. v. Burwell" on Justia Law

West Virginia filed suit challenging the President’s determination not to enforce certain controversial provisions of the Affordable Care Act, 42 U.S.C. 300gg-22(a)(1), for a transitional period. That decision, implemented by a letter from the Secretary of the Department of Health and Human Services, left the responsibility to enforce or not to enforce these provisions to the States, and West Virginia objects to being put in that position. The district court concluded that West Virginia lacked standing. The court agreed, rejecting the State's claim that requiring the States to assume the political responsibility of deciding whether or not to implement a federal statute supposedly creates an injury-in-fact. The court concluded that there is simply no support for this extraordinary claim. The court stated that the State's injury is nothing more than the political discomfort in having the responsibility to determine whether to enforce or not – and thereby annoying some West Virginia citizens whatever way it decides. And no court has ever recognized political discomfort as an injury-in-fact. Even assuming that the administration’s action created a theoretical breach of State sovereignty, West Virginia nevertheless lacks a concrete injury-in-fact. Finally, the court rejected West Virginia's argument that any party, whether or not a governmental entity, has standing to challenge a delegation from the government to carry out a governmental responsibility. Accordingly, the court affirmed the judgment. View "State of West Virginia v. HHS" on Justia Law

S.H. appealed a court order committing her to the Montana State Hospital. In late 2014, S.H. sought help from the emergency department at the Billings Clinic. S.H. complained she was suffering from food poisoning, that there were snakes in her stomach, black bugs in the toilet, and the voices of God and Satan were arguing in her head. A psychiatrist at the Clinic examined S.H. and, upon his recommendation, the State filed a petition to involuntarily commit S.H. on November 12, 2014. The petition notified S.H. of her rights—including her “right to refuse any but lifesaving medication for up to 24 hours prior to any hearing held pursuant to [§ 53-21-115(11), MCA].” The District Court ordered S.H. detained at the Billings Clinic pending resolution of the petition. The District Court then appointed counsel to represent S.H., held an initial hearing, and ordered an evaluation. At the conclusion of the hearing, the District Court found that the State proved to a reasonable medical certainty that S.H. suffers from the mental disorder of bipolar disorder and that S.H. “is in a manic state, delusional, agitated and paranoid.” S.H. challenged the evidence presented against her as insufficient to support the order committing her to hospital care. The Supreme Court reviewed the District Court record, found sufficient evidence, and affirmed the District Court's decision. View "Matter of S.H." on Justia Law