Justia Government & Administrative Law Opinion Summaries

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

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