Justia Government & Administrative Law Opinion Summaries

Keith Westphal and Joyce Osborn Wilson filed suit against David Northcutt III, DMD, Bobby R. Wells, DMD, Stephen R. Stricklin, DMD, Thomas T. Willis, DMD, Sam J. Citrano, Jr., DMD, William Chesser, DMD, and Sandra Kay Alexander, RDH, in their official capacities as members of the Alabama Board of Dental Examiners. Westphal and Wilson sought a judgment declaring unconstitutional the portion of the Alabama Dental Practice Act, (Sec. 34-9-1 et seq., Ala. Code 1975) that made it unlawful for anyone other than a duly licensed dentist to perform teeth-whitening services, and sought a permanent injunction forbidding future enforcement of the prohibition in the Act on teeth-whitening services performed by non-dentists. The parties submitted cross-motions for a summary judgment, and the Jefferson Circuit Court entered a summary judgment in favor of the Dental Board. Westphal and Wilson appealed. But finding no reversible error, the Supreme Court affirmed. View "Westphal v. Northcutt III" on Justia Law

Plaintiff’s minor daughter, Brayden, who suffers from Coffin-Lowry Syndrome, had been receiving home and community-based waiver services for approximately twelve years when the Nebraska Department of Health and Human Services (DHHS) determined that she no longer qualified for waiver services and terminated the services. Plaintiff filed this action on behalf of Brayden, contending that DHHS used the wrong criteria to evaluate Brayden’s eligibility and erred in finding that she did not qualify for waiver services. The district court affirmed the termination of those services. The Supreme Court reversed, holding (1) DHHS’ creation and use of exhibit 4, the assessment document used to evaluate children with disabilities, to evaluate Brayden was arbitrary and produced an unreasonable result; and (2) DHHS should have found that Brayden qualified for waiver services. View "Merie B. v. State" on Justia Law

Plaintiffs, hospitals that participate in Medicare, filed suit against the Secretary, claiming that she violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by engaging in arbitrary and capricious decision-making. This dispute arose from plaintiffs' belief that the Secretary set the monetary threshold for outlier payments too high in 2004, 2005, and 2006. The court affirmed the district court’s partial denial of the motion to supplement the administrative record and its rejection of the APA challenges to the 2005 and 2006 outlier thresholds. The district court erred, however, in concluding that the Secretary adequately explained the 2004 outlier threshold. Therefore, the court reversed the grant of summary judgment on this claim and remanded for further proceedings. View "District Hosp. Partners v. Burwell" on Justia Law

In 2013, Emma Reiger entered the Good Samaritan Society's basic care facility. She executed a general durable power of attorney appointing two women "to be my attorneys-in-fact and co-agents in my name and for my benefit." Rieger signed a "Designation of Authorized Representative" authorizing the Society to "(i) initiate an application for Medicaid benefits on my behalf, (ii) participate in all reviews of my eligibility for Medicaid benefits and (iii) take such action as may be necessary to establish my eligibility for Medicaid." On the same date, Rieger signed a separate document titled, "Assignment of Medicaid Benefits," which assigned to the Society her right to obtain Medicaid benefits for services provided to her by the Society, and an "Authorization for Release of Health Information." These documents were provided to the Department of Human Services. The Department oappealed a judgment reversing the Department's dismissal of Rieger's appeal challenging its denial of her Medicaid application and remanding for a fair hearing on the application. Because the law allowed The Evangelical Good Samaritan Society, doing business as the Good Samaritan Society - Mott ("Society"), to act as Rieger's authorized representative for purposes of appealing the Department's denial of her Medicaid application, the Court affirmed the judgment. View "Evangelical Good Samaritan Society v. N.D. Dep't of Human Services" on Justia Law

The Commissioner of Children and Families filed a neglect petition seeking an order of temporary custody of Cassandra C., a minor, after medical providers reported that Cassandra and her mother were refusing to obtain appropriate medical treatment for Cassandra, who had been diagnosed with Hodgkin’s lymphoma. The trial court granted the order and placed Cassandra in the temporary custody of the Department of Children and Families, directing Respondents to cooperate with Cassandra’s medical care providers. Thereafter, Cassandra started chemotherapy but ran away before the treatment could be completed. The Commissioner moved to reopen the evidence to consider evidence regarding whether Cassandra was competent to make life-death decisions regarding her medical care. After a hearing, the trial judge ordered that Cassandra remain in the custody of the Department and authorized the Department to make all medical decisions for her. The Supreme Court affirmed, holding (1) the trial judge’s finding that Cassandra was not competent to make her own medical decisions at the time of the underlying events was not clearly erroneous; (2) this was not a proper case in which to decide whether to adopt the mature minor doctrine, which allows a sufficiently mature minor to refuse medical treatment; and (3) Respondents’ constitutional rights were not violated. View "In re Cassandra C." on Justia Law

The Patient Protection and Affordable Care Act (ACA) creates “navigators,” to assist consumers in purchasing health insurance from exchanges, 42 U.S.C. 18031(i), and authorizes the Department of Health and Human Services to establish standards for navigators and exchanges. HHS regulations recognize: federal navigators, certified application counselors (CACs), and non-navigator assistance personnel. They conduct many of the same activities, but federal navigators have more extensive duties. Plaintiffs, federally-certified counselor designated organizations, employ CACs. The federal government established a Missouri Federally Facilitated Exchange. The Health Insurance Marketplace Innovation Act (HIMIA), Mo. Rev. Stat. 376.2000, regulates “person[s] that, for compensation, provide[] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange.” Regulatory provisions dictate what state navigators and cannot do. Plaintiffs challenged: the definition of state navigators; three substantive provisions; and penalty provisions. The district court granted a preliminary injunction, finding that the ACA preempted HIMIA. The Eighth Circuit affirmed in part, finding likelihood of success in challenges to HIMIA requirements that: state navigators refrain from providing information about health insurance plans not offered by the exchange; that in some circumstances, the navigator must advise consultation with a licensed insurance producer regarding private coverage; and that CACs provide information about different health insurance plans and clarify the distinctions. The court vacated the preliminary injunction, holding that ACA does not entirely preempt HIMIA. View "St. Louis Effort For AIDS v. Huff" on Justia Law

The Secretary of the United States Department of Health and Human Services imposed a civil money penalty on Plott Nursing Home in California for Plott’s violations of the Medicare Act’s standards of care for nursing home patients. The Department’s Appeals Board largely affirmed. Plott petitioned for review. The Ninth Circuit affirmed in part and reversed in part, holding (1) sufficient evidence supported the Secretary’s determination that Plott violated the quality of care for bed sores; (2) the Secretary’s finding that Plott violated the quality of care for urinary tract infections was not supported by substantial evidence on the record; and (3) Plott was entitled to administrative review of all cited deficiencies. Remanded with directions to review or dismiss the violations that were not reviewed by the agency. View "Plott Nursing Home v. Burwell" on Justia Law

The Center for Investigative Reporting filed a Public Records Act request for copies of all citations issued by the Department of Public Health (DPH) to the long-term health care facilities the Center was investigating. The DPH disclosed heavily redacted copies of the citations it had issued to the facilities, asserting that Cal. Welf. & Inst. Code 5328 obligated it not to release confidential information obtained in the course of providing services to mentally ill and developmentally disabled individuals. The trial court determined that the Long-Term Care, Health, Safety, and Security Act's mandate that DPH citations be made public with minimal redaction trumped section 5328’s confidentiality provisions. The Court of Appeal vacated the judgment of the trial court and ordered DPH to disclose such information as the Court of Appeal deemed consistent with the common purpose of both statutes while permitting DPH to redact such information as the court deemed inconsistent with that common purpose. The Supreme Court reversed and remanded with instructions for the Court of Appeal to deny the petition, holding that DPH citations issued under the Act are public records and must be disclosed to the Center subject only to the specific redactions mandated by the Act. View "State Dep’t of Pub. Health v. Superior Court" on Justia Law

The State of Tennessee operated the Arlington Developmental Center, an institutional home for people with mental disabilities. In 1992, the United States sued Tennessee under the Civil Rights of Institutionalized Persons Act alleging that, among other things, Tennessee had failed to provide Arlington’s residents with adequate food, medical care, supervision, and shelter. After a trial on the merits, the district court found that Arlington’s conditions violated the due-process rights of its residents. The court ordered the State to submit a plan to improve conditions there. Since then, People First of Tennessee has presented 19 applications for attorneys’ fees to the district court. Tennessee consented to pay every dollar of fees requested in the first 18 applications filed by intervenors-appellees People First of Tennessee (a total of about $3.6 million, including over $400,000 for the period at issue here). But the State objected to People First’s 19th application, which for the most part sought fees for a contempt motion that the district court had stricken from the docket and that People First never renewed. The 19th application also sought fees for hours that People First’s attorneys had chosen to spend monitoring the State’s compliance with the consent decree, even though the State had already paid $10.6 million in fees to a monitor whom the court had appointed for that same purpose. Despite those circumstances, the district court awarded People First $557,711.37 pursuant to the application, holding that People First had been a “prevailing party” with respect to its contempt motion. The State appealed the district court's award. After review, the Sixth Circuit disagreed with the district court's judgment, reversed and remanded. View "United States v. Tennessee" on Justia Law

Defendant-appellant Dr. Kamal Patel was a physician who commonly prescribed home health care services for his patients. Federal investigators learned that defendant had been receiving undisclosed payments from Grand Home Health Care. Patel was charged with six counts of violating (and one count of conspiring to violate) the Anti-Kickback Statute. During his bench trial, at the close of the government’s evidence, defendant moved to acquit, arguing that he had not “referred” any patients to Grand because there was no evidence that he steered or directed his patients to Grand; rather, the patients independently chose Grand as their provider after defendant prescribed home health care. The district court rejected that argument, holding that, even if a patient had initially chosen Grand, defendant “referred” the patient to Grand when he certified or recertified that the patient needed care, that the care would be provided by Grand, and that Grand could be reimbursed by Medicare for services provided. On appeal, defendant argued that the district court erred by holding that the certification and recertification, via a standardized Medicare form (Form 485), of patients for treatment constituted a “referral” under the Anti-Kickback Statute. He also argued that even if those certifications were referrals, there was insufficient evidence to conclude that Patel was paid “in return for” certifications, as required by the statute. Finding no reversible error, the Seventh Circuit affirmed the district court's judgment. View "United States v. Patel" on Justia Law