Justia Government & Administrative Law Opinion Summaries

Plaintiff, an orthopedic surgeon and former consultant at Stryker, filed suit alleging that Stryker and I-Flow violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by marketing their pain pumps to encourage the placement of pain pumps directly into patients' joint spaces after orthopedic procedures. The court concluded that the district court did not err in concluding that plaintiff's allegations had been publicly disclosed and that plaintiff was not excepted under section 3730(e)(4)(B) as an "original source" of the information. The court rejected plaintiff's claim of procedural error and affirmed the district court's dismissal of the claims under section 3730(e)(4)(A). View "Paulos v. Stryker Corp., et al." on Justia Law

Plaintiffs Coons and Novack filed suit challenging the constitutionality of two provisions of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (Affordable Care Act): the individual mandate and the establishment of the Independent Payment Advisory Board (IPAB). Plaintiffs also sought a declaration that the Arizona Health Care Freedom Act, Ariz. Const. art. XXVII, section 2, is not preempted by the Affordable Care Act. The court affirmed the district court's holding that the individual mandate does not violate Coons' substantive due process right to medical autonomy; affirmed the dismissal of Coons' challenge, based on lack of ripeness, to the individual mandate for violation of his substantive due process right to informational privacy; affirmed the district court's holding that the Affordable Care Act preempts the Arizona Act; and, with respect to Novack's challenge to IPAB, the court vacated the district court's decision on the merits of the claim and remanded with instructions to dismiss for lack of jurisdiction. View "Coons v. Lew" on Justia Law

Section 5000A of the Patient Protection and Affordable Care Act, 26 U.S.C. 5000A, mandates that as of January 2014, non-exempt individuals maintain minimum health care coverage or, with limited exceptions, pay a penalty. Plaintiff filed suit alleging that the mandate violated the Commerce Clause and the Origination Clause of the Constitution. The court concluded that plaintiff's contention that the mandate obligating him to buy government-approved health insurance violates the Commerce Clause fails under the Supreme Court's interpretation of the mandate in National Federation of Independent Business v. Sebelius; plaintiff's contention that the mandate's shared responsibility payment was enacted in violation of the Origination Clause fails under Supreme Court precedent interpreting the Clause; and, therefore, the court affirmed the district court's dismissal of his complaint. View "Sissel v. HHS, et al." on Justia Law

The State appealed the district court's grant of summary judgment and an injunction in favor of plaintiffs, enjoining enforcement of Florida's Firearm Owners Privacy Act, Fla. Stat. 381.026, 456.072, 790.338, on First and Fourteenth Amendment grounds. The Act seeks to protect patients' privacy by restricting irrelevant inquiry and record-keeping by physicians regarding firearms. The court concluded that plaintiffs have standing to challenge the Act and plaintiffs' claims are ripe for adjudication; the Act is a legitimate regulation of professional conduct where the Act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient's care, and any burden the Act places on physician speech is incidental; and the Act is not unconstitutionally vague when the Act is properly understood as a regulation of physician conduct intended to protect patient privacy and curtail abuses of the physician-patient relationship, and it is readily apparent from the language of the Act the type of conduct the Act prohibits. Accordyingly, the court reversed the district court's grant of summary judgment and vacated the injunction. View "Wollschlaeger, et al. v. Governor State of FL, et al." on Justia Law

Twenty California counties were plaintiffs in this petition for writ of mandate and complaint for declaratory and injunctive relief against defendants the State and its pertinent officials (DHCS and DMH). In their petition, the Counties alleged that a DHCS 2009 Memorandum and a DMH 2010 Letter were invalid. Under federal Medicaid law, the federal government did not pay for services to IMD patients between the ages of 21 and 65. In 1999, California added a state-only Medi-Cal benefit by enacting Welfare and Institutions Code section 14053.1. The section provided that the State would pay for "ancillary outpatient services" for IMD patients within the federal IMD exclusion. The specific focus of this appeal involved two Assembly Bills: No. 2877 (1999-2000 Reg. Sess.) and No. 430 (2000-2001 Reg. Sess.) that concerned subsequent sunsetting legislation regarding section 14053.1. Assembly Bill 2877 (enacted in 2000) sought to extend the original sunset provision an additional year, and Assembly Bill 430 (enacted in 2001) sought to eliminate the sunset provision altogether, thereby making section 14053.1 effective indefinitely. The counties argued the memorandum and letter were: (1) inconsistent with section 14053.1; and (2) they constituted underground regulations adopted in violation of the state Administrative Procedures Act (Gov. Code, 11340.5, subd. (a)). The Counties similarly sought a writ/injunction prohibiting the State from applying them against the Counties. The trial court denied the Counties' petition for writ of mandate and complaint for injunctive relief, and issued a declaratory judgment in favor of the State. The court concluded that the subsequent sunsetting amendments (Assem. Bills 2877 & 430) were void because they were enacted after the statute had already sunset by its own terms in 2000. Thus, in the absence of section 14053.1, the State did not promulgate an underground regulation by issuing the DHCS 2009 Memorandum and the DMH 2010 Letter and ancillary outpatient services for Medi-Cal eligible IMD patients within the federal IMD exclusion. The Court of Appeal concluded that section 14053.1 remained a valid law, and that 14053.1's presence in the California statutes was not the result of a legislative amendment to a repealed act. The Counties' petition for writ of mandate and complaint for declaratory and injunctive relief was granted: the DHCS 2009 Memorandum and the DMH 2010 Letter contravened section 14053.1 and were therefore invalid. The State was enjoined from applying them. The judgment of the trial court was reversed. View "Colusa County v. Douglas" on Justia Law

Townsend applied for social security disability benefits and supplemental security income in 2003, at age 44, claiming that she had become incapable of full‐time gainful employment in May 2002 when she had stopped working as a result of multiple physical and psychiatric ailments, including fibromyalgia. In 2012 an ALJ decided that she had become totally disabled in November 2008. By the time that decision was rendered she had died (of pulmonary diseases apparently unrelated to the ailments alleged to have made her totally disabled). Her father was substituted for her. The district court upheld the decision. The Seventh Circuit reversed and remanded, noting multiple errors in determining the onset of total disability. View "Williams v. Colvin" on Justia Law

The issues this case presented to the Supreme Court both arose from the Georgia Department of Community Health's ("DCH's") granting of an application for a Certificate of Need ("CON") to develop an outpatient ambulatory surgery service in East Cobb County to Kennestone Hospital, Inc. Kennestone's application was eventually approved by the DCH after the service was determined to be "part of a hospital" pursuant to Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a). Northside Hospital, Inc. opposed the CON and sought administrative review of the DCH's initial decision. After the appeal was unsuccessful, Northside then filed a petition for judicial review with the superior court. The superior court reversed the DCH's decision to grant the CON on the basis that the "case-by-case" provision in Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a) was unconstitutionally vague. The Court of Appeals upheld the superior court's determination. "The gist of the Rule is to afford a less stringent review for ambulatory surgery service proposals that are 'part of a hospital.' [. . .] the final sentence of the Rule cannot be read in isolation from the other language contained in it. Thus, contrary to Northside's contentions, the Rule is not unconstitutionally vague on its face, and the Court of Appeals was incorrect to conclude otherwise." View "Georgia Dept. of Community Health v. Northside Hospital, Inc." on Justia Law

Ector Manuel Savala-Quintero sustained injuries when he jumped through the fourth-story window of room in the Wabaunsee County jail where he had been placed by sheriff officials during an investigation. The University of Kansas Hospital Authority sued the Board of Wabaunsee County Commissioners for reimbursement of the medical expenses incurred in its treatment of Savala-Quintero. The district court granted summary judgment in favor of the County. The Court of Appeals reversed. The Supreme Court reversed the Court of Appeals, holding that the County was not obligated to pay the medical expenses of Savala-Quintero because, although Savala-Quintero was temporarily detained at the county jail, he was not a prisoner committed to or held in the jail at the time he was injured. View "Univ. of Kan. Hosp. Auth. v. Bd. of Comm'rs " on Justia Law

The plaintiffs in this case were David and Barbara Green, their three children, and the businesses they collectively owned and operated: Hobby Lobby Stores, Inc. and Mardel, Inc. As owners and operators of both Hobby Lobby and Mardel, the Greens organized their businesses with express religious principles in mind. As was particularly relevant to this case, one aspect of the Greens’ religious principles was a belief that human life begins when sperm fertilizes an egg. In addition, the Greens believed it was immoral for them to facilitate any act that caused the death of a human embryo. Plaintiffs brought an action to challenge portions of the Patient Protection and Affordable Care Act (ACA) whereby employment-based group health plans covered by the Employee Retirement Income Security Act (ERISA) were required provide certain types of health services for women that implicated contraceptive methods, sterilization procedures, and patient education and counseling (without cost-sharing by plan participants or beneficiaries) - all "abortifacients" that went against plaintiffs' religious beliefs. Plaintiffs filed suit to challenge the contraceptive-coverage requirement of the ACA under the Religious Freedom Restoration Act (RFRA), the Free Exercise Clause of the First Amendment, and the Administrative Procedure Act. Plaintiffs simultaneously moved for a preliminary injunction on the basis of their RFRA and Free Exercise claims. The district court denied that motion. Plaintiffs appealed the denial of the injunction. After review by the Tenth Circuit Court of Appeals, the Court held that Hobby Lobby and Mardel were entitled to bring claims under RFRA, established a likelihood of success that their rights under statute were substantially burdened by the contraceptive-coverage requirement, and established an irreparable harm. However, the case was remanded back to the district court for further proceedings on two remaining factors governing the grant or denial of a preliminary injunction. View "Hobby Lobby Stores, et al v. Sebelius, et al" on Justia Law

The South Carolina Supreme Court answered certified two questions from the U.S. District Court for the District of South Carolina. The case concerned supplemental health insurance policies, which differ from ordinary health insurance policies in both purpose and operation. The questions were: (1) whether the definition of "actual charges" contained within S.C. Code Ann. 38-71-242 be applied to insurance contracts executed prior to the statute's effective date; and (2) whether the South Carolina Department of Insurance could mandate the application of "actual charges" to policies already inexistence on the statute's effective dates by prohibiting an insurance company from paying claims absent the application of that definition. The South Carolina Supreme Court answered both questions "no." View "Kirven v. Central States" on Justia Law