Justia Government & Administrative Law Opinion Summaries

The issues this case presented to the Court of Appeal filed by the petitioners in this matter were two-fold: (1) whether the Workers' Compensation Appeals Board retain jurisdiction over a medical billing dispute pertaining to more than 300 consolidated claims, after the Legislature passed significant workers' compensation reform legislation that created a new administrative independent review process for the resolution of billing disputes; and (2) if the Board did retain jurisdiction over this dispute, was there substantial evidence to support the workers' compensation judge's (WCJ) findings of fact regarding his determination of the "reasonable fee" to be paid for arthroscopic knee procedures, arthroscopic shoulder procedures, and epidural injection procedures performed at three commonly managed ambulatory surgical center (ASC) facilities in San Diego County? After review, the Court concluded that although the text of the relevant legislation and resulting statutes was ambiguous, the most reasonable interpretation of the legislation was that it does not divest the Board of jurisdiction to decide the dispute at issue in this case. Furthermore, the Court held that the WCJ's findings were supported by substantial evidence.View "Cal. Ins. Guarantee Assn. v. Workers' Comp. App. Bd." on Justia Law

Kawa filed suit challenging the Treasury's decision to postpone the enforcement of the employer mandate provisions of the Patient Protection and Affordable Care Act (ACA), 26 U.S.C. 4980H, and sought a declaratory judgment and injunction setting aside the Treasury's transition relief. Kawa had expended time and money to determine how to comply with the employer mandate between early 2013 and the end of June 2013. After Kawa incurred these expenses, the Treasury announced it would not enforce the mandate for a transition period of one year - until the end of 2014. The Treasury then extended the transition relief for certain employers, including Kawa, for a second year. The court affirmed the district court's dismissal of the complaint because Kawa lacked Article III standing where Kawa failed to allege an injury in fact, a causal connection, and a likelihood of success.View "Kawa Orthodontics, LLP v. Secretary, U.S. Dept. of the Treasury, et al." on Justia Law

At issue in these consolidated cases is whether a regulatory accommodation for religious nonprofit organizations that permit them to opt out of the contraceptive coverage requirement under the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg-13(a)(4), itself imposes an unjustified substantial burden on plaintiffs' religious exercise in violation of the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb. The court concluded that the challenged regulations do not impose a substantial burden on plaintiffs' religious exercise under RFRA. All plaintiffs must do to opt out is express what they believe and seek what they want via a letter or two-page form. Religious nonprofits that opt out are excused from playing any role in the provision of contraceptive services, and they remain free to condemn contraception in the clearest terms. The ACA shifts to health insurers and administrators the obligation to pay for and provide contraceptive coverage for insured persons who would otherwise lose it as a result of the religious accommodation. Because the regulatory opt-out mechanism is the least restrictive means to serve compelling governmental interests, it is fully consistent with plaintiffs' rights under RFRA. The court also found no merit in plaintiffs' additional claims. The court rejected all of plaintiffs' challenges to the regulations and affirmed the district court's opinion in Priests for Life in its entirety. As for the RCAW decision, the court vacated the district court's grant of summary judgment for Thomas Aquinas and its holding as to the unconstitutionality of the non-interference provision and affirmed the remainder of the decision.View "Priests For Life v. HHS" on Justia Law

At issue in this case was whether the certificates of death that doctors, coroners, and funeral directors file with county health departments under Ind. Code 16-37-3 are public records that the public may freely obtain from county health departments. In 2012, Rita Ward sent a letter to the Vanderburgh County Health Department requesting certain copies of records created under Ind. Code 16-37-3-3 and maintained by the Department. The Department denied the request. The Evansville Courier & Press newspaper subsequently requested access to certain Vanderburgh County death records. The Department denied the request. Thereafter, Ward and the Courier & Press sued the Department, arguing that the death certificates were public records covered by the Indiana Access to Public Records Act. The trial court entered judgment in favor of the Department. The Supreme Court reversed, holding that death certificates are public records that a county health department must provide public access to under the Act.View "Evansville Courier & Press v. Vanderburgh County Health Dep’t" on Justia Law

Groups of hospitals in the Cincinnati area and in rural Iowa, challenged the Secretary of Health and Human Services’ calculation of how much to pay those hospitals for inpatient services under Medicare Part A. The hospitals objected to the agency’s decision to include in the calculation the hours associated with a short-term disability program paid from a hospital’s general funds through its payroll system and a program offering a full-time salary for part-time weekend work. The district court entered summary judgment for the Secretary. The Sixth Circuit affirmed, finding the agency’s interpretation was not arbitrary or capricious and referring to “the most completely impenetrable texts within human experience,” statutes and regulations that “one approaches ... at the level of specificity herein demanded with dread.” View "Atrium Medical Ctr. v. U.S. Dep't of Health & Human Servs." on Justia Law

Scrogham, then age 53, applied for disability benefits under the Social Security Act, submitting medical conditions including degenerative discs, spinal stenosis, sleep apnea, hypertension, arthritis, atrial fibrillation and restless leg syndrome. An ALJ denied the application and the Appeals Council denied his request for review. The district court affirmed, holding that the ALJ did not err in giving less weight to the opinion of a treating physician than to the opinions of nontreating physicians, that the ALJ permissibly found Scrogham not to be credible and that the ALJ’s decision otherwise was supported by substantial evidence. The Seventh Circuit reversed and remanded. The ALJ impermissibly ignored a line of evidence demonstrating the progressive nature of Scrogham’s degenerative disc disease and arthritis and inappropriately undervalued the opinions of Scrogham’s treating physicians, whose longitudinal view of Scrogham’s ailments should have factored prominently into the ALJ’s assessment of his disability status. Even considering only “the snapshots of evidence that the ALJ considered,” that limited evidence does not build the required logical bridge to her conclusions. The ALJ apparently misunderstood or at least considered only partially some of the evidence about Scrogham’s daily activities, rehabilitation efforts and physicians’ evaluations. View "Scrogham v. Colvin" on Justia Law

Two nurses, formerly employed by Momence, alleged that, during their employment at Momence, they uncovered evidence that Momence knowingly submitted "thousands of false claims to the Medicare and Medicaid programs” in violation of the False Claims Act (FCA) and Illinois Whistleblower Reward and Protection Act. They filed a qui tam action on behalf of the government and alleged that Momence retaliated against them for reporting its fraud. A jury awarded the government more than $3 million in compensatory damages and imposed about $19 million in fines for the qui tam claims. Pursuant to the FCA, the compensatory damages were trebled to more than $9 million. The district court set aside the fines as violating the Excessive Fines Clause of the Eighth Amendment. The jury also awarded the nurses $150,000 and $262,320, respectively, on their retaliation claims. The Seventh Circuit vacated. Both claims failed as a matter of law. Rejecting claims of “worthless services” and false certification, the court stated that, at best, a reasonable jury might be able to say that some of Momence’s claims were false, but that is not enough to satisfy the burden of proof. The employment of one nurse was not terminated, the other’s employment was terminated for an unrelated matter. View "Absher v. Momence Meadows Nursing Ctr., Inc." on Justia Law

The Hospital filed suit against various federal agencies and officials, seeking a declaratory judgment that 18 U.S.C. 4006(b)(1), where Congress has elected to impose the Medicare rate as full compensation for medical services rendered to federal detainees, is unconstitutional as applied. The court concluded that the Hospital voluntarily opted into the Medicare program and is, as a result, required to provide emergency services to federal detainees. Consequently, the Hospital was foreclosed from challenging this compensation scheme as an unconstitutional taking under the Fifth Amendment. The court noted that the Hospital's most effective remedy may lie with Congress rather than the courts. Accordingly, the court affirmed the district court's dismissal of the action. View "Baker County Medical Services v. U.S. Attorney General, et al." on Justia Law

Employee was injured in a work-related accident. Employee obtained approval for surgery from a union-sponsored benefit plan (the Fund) and proceeded with the surgery at a Hospital. After a hearing, a workers’ compensation judge concluded that the surgery was not reasonable and necessary and ordered Employer to reimburse the Fund for the medical bills but also concluded that Employer could seek reimbursement of the expenses from the medical providers. The Hospital was not given notice of that hearing. Before a second hearing on Employer’s request for reimbursement, the Hospital intervened. The compensation judge ordered the Hospital to reimburse Employer. The Workers’ Compensation Court of Appeals (WCCA) reversed, concluding that the automatic-reimbursement rule announced in Brooks v. A.M.F., Inc. should be extended to the Hospital because it was not given notice of the first hearing. The Supreme Court reversed after declining to extend its decision in Brooks and require automatic payment of a medical provider’s treatment expenses when an employer fails to give the medical provider notice of its right to intervene in a workers’ compensation proceeding to determine responsibility for those expenses, holding that the Hospital was not entitled to automatic payment of its medical bills for Employee’s treatment. Remanded. View "Gamble v. Twin Cities Concrete Prods." on Justia Law

Relators filed suit under the False Claims Act (FCA), 31 U.S.C. 3729-3733, alleging that appellants committed numerous FCA violations concerning improper incentives for patient referrals. Assuming arguendo that qualified immunity is an available defense, the court held on the merits that appellants are not entitled to qualified immunity against these FCA claims where relators sufficiently pleaded that appellants violated the FCA and the courses of conduct allegedly taken by appellants were objectively unreasonable in light of clearly established law. Accordingly, the court affirmed the district court's denial of appellants' motion to dismiss. View "United States ex rel Parikh" on Justia Law