Justia Government & Administrative Law Opinion Summaries

Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law

LabMD appealed the district court's dismissal of its challenges to the FTC's ability to regulate and conduct enforcement proceedings in the area of healthcare data privacy, arguing that the FTC's enforcement action violates the Administrative Procedure Act (APA), 5 U.S.C. 704; is ultra vires; and is unconstitutional. The court held that the FTC's order denying LabMD's motion to dismiss was not a "final agency action," as required of claims made under the APA and, therefore, those claims were properly dismissed. The court also concluded that LabMD's other claims are intertwined with its APA claim for relief and may only be heard at the end of the administrative hearing. Therefore, the court affirmed the district court's order dismissing the case for lack of subject-matter jurisdiction. View "LabMD, Inc. v. Federal Trade Commission" on Justia Law

Plaintiffs filed suit challenging the constitutionality of New York State's requirement that all children be vaccinated in order to attend public school. The statute provides two exemptions from the immunization mandate: a medical exemption and a religious exemption. Rejecting plaintiffs' substantive due process, free exercise of religion, equal protection, and Ninth Amendment challenges, the court concluded that the statute and regulation are a constitutionally permissible exercise of the State's police power and do not infringe on the free exercise of religion. The court further concluded that plaintiff's remaining arguments are either meritless or waived. Accordingly, the court affirmed the district court's grant of defendants' motion to dismiss. View "Phillips v. City of New York" on Justia Law

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