Justia Government & Administrative Law Opinion Summaries

PAMC appealed the district court's affirmance of the Secretary's decision denying PAMC its full Medicare Annual Payment Updated for the fiscal year 2009. PAMC claimed that the Department acted arbitrarily and capriciously when it refused to excuse PAMC's late filing of the required Reporting Hospital Quality Data for Annual Payment Updated (RHQDAPU) program data by the admittedly applicable deadline. The court concluded that PAMC neither pointed to any contrary or antithetical decisions by the Department under similar circumstances, nor otherwise demonstrated that the Board acted arbitrary or capriciously when it denied equitable relief. The court rejected PAMC's argument that the Board should have used the contract doctrine of substantial performance to excuse PAMC's failure to submit data at the proper time. The court did not view the Board's adherence to the policy of strict compliance with a deadline as arbitrary and capricious. Accordingly, the court affirmed the judgment of the district court. View "PAMC, LTD. v. Sebelius" on Justia Law

Bryn Mawr Chicago nursing home, a Medicaid provider, is subject to Illinois Department of Public Health (IDPH) inspections. In 2010, IDPH inspected the facility following allegations that a resident had been sexually assaulted. Bryn Mawr was eventually cited for three deficiencies, 42 C.F.R. 488.301, two based on sexual abuse and one based on failure to sufficiently monitor a resident. Bryn Mawr challenged the findings by Informal Dispute Resolution, which involved exchange of written information without a live hearing. IDPH simultaneously conducted internal review and found that the deficiencies based on allegations of sexual abuse were not sufficiently supported by credible evidence, but the third party upheld the deficiency findings. Ultimately IDPH maintained the deficiency findings. Meanwhile, Bryn Mawr also engaged in a parallel process to “correct” deficiencies. At the follow-up inspection, IDPH determined that the deficiencies had been corrected, so that remedies would not be imposed. IDPH passed the deficiency findings on to the Centers for Medicare and Medicaid Services, which published them on its website and factored them into its 5-Star Rating System. Bryn Mawr’s rating was supposed to fall from five to four stars because of the deficiencies, but CMS mistakenly reduced it to two stars. Regardless of a partial correction, Bryn Mawr was displeased that it had not had the opportunity to challenge the findings at a hearing and sued to compel a hearing. The district court granted summary judgment to defendants. The Seventh Circuit affirmed. View "Bryn Mawr Care, Inc. v. Sebelius" on Justia Law

Petitioners, a group of hospitals that serve a significant number of elderly, very low-income patients, filed suit challenging the Secretary's issuance of a rule concerning the "disproportionate share percentage" calculation of supplemental payments for low-income Medicare patients. When the Secretary published reimbursement calculations for FY 2007, petitioners learned that their payments would decrease by tens of millions of dollars per year. The rule change had an enormous financial consequence on hospitals. The court held that the Secretary did not provide adequate notice and opportunity to comment before promulgating its 2004 rule, and so affirmed the portion of the district court's opinion vacating the rule. The court reversed only the portion of the district court's opinion directing the Secretary to recalculate the hospitals' reimbursements using the alternate methodology. View "Allina Health Services, et al. v. Sebelius" on Justia Law

In enacting comprehensive welfare reform in 1996, Congress rendered various groups of aliens ineligible for federal benefits and also restricted states' ability to use their own funds to provide benefits to certain aliens. As a condition of receiving federal funds, Congress required states to limit eligibility for federal benefits, such as Medicaid, to citizens and certain aliens. Plaintiffs filed suit claiming that Basic Health Hawai'i violated the Equal Protection Clause of the Fourteenth Amendment because it provided less health coverage to nonimmigrant aliens residing in Hawai'i (COFA Residents) than the health coverage that Hawai'i provided to citizens and qualified aliens who are eligible for federal reimbursements through Medicaid. The court concluded that Congress has plenary power to regulate immigration and the conditions on which aliens remain in the United States, and Congress has authorized states to do exactly what Hawai'i had done here - determine the eligibility for, and terms of, state benefits for aliens in a narrow third category, with regard to whom Congress expressly gave states limited discretion. Hawai'i has no constitutional obligation to fill the gap left by Congress's withdrawal of federal funding for COFA Residents. Accordingly, the court vacated the district court's grant of a preliminary injunction preventing Hawai'i from reducing state-paid health benefits for COFA Residents because Hawai'i is not obligated to backfill the loss of federal funds with state funds and its decision not to do so was subject to rational-basis review. View "Korab v. Fink" on Justia Law

In 2013, Bryan Skoric, the Park County Attorney, reconsidered the extent of his office’s participation in civil commitment proceedings and decided not to continue to participate in emergency detention hearings under Wyo. Stat. Ann. 25-10-109 or to appear and prosecute the case in chief at involuntary hospitalization hearings under Wyo. Stat. Ann. 25-10-110. Appellants, the West Park Hospital District and Yellowstone Behavioral Health Center, filed a petition for writ of mandamus asking the district court to compel Skoric to proceed in the same way as he had in the past. The district court denied Appellants’ application for the writ. The Supreme Court affirmed, holding (1) the statutes in question do require a county attorney’s office to participate in civil commitment proceedings; but (2) the statutes are ambiguous, and therefore, extraordinary relief was not warranted when Appellants filed their petition. View "State ex rel. West Park Hosp. Dist. v. Skoric" on Justia Law

In 1993, Appellants developed Risperdal, a second-generation, or atypical, antipsychotic medication, which was considered highly beneficial in treating schizophrenia patients. In 2007, the State filed suit against Appellants, alleging that Appellants (1) knowingly made false statements or representations of material fact in their Risperdal label in violation of the Arkansas Medicaid Fraud False Claims Act (“MFFCA”); and (2) violated the Arkansas Deceptive Trade Practices Act (“DTPA”) by distributing a promotional letter to Arkansas healthcare providers that contained “false, deceptive, or unconscionable statements.” A jury found that Janssen violated the MFFCA and the DTPA by failing to comply with federal labeling requirements and imposed civil penalties totaling $11,422,500. The Supreme Court (1) reversed and dismissed the MFFCA claim, as Appellants were not healthcare facilities or applying for certification as described by the statute; and (2) reversed and remanded the DTPA claim, holding that the circuit court abused its discretion in admitting certain hearsay into evidence. View "Ortho-McNeil-Janssen Pharms., Inc. v. State" on Justia Law

In 2008, Shields, an Illinois prisoner was lifting weights and ruptured the pectoralis tendon in his left shoulder. Although he received some medical attention, he did not receive the prompt surgery needed for effective treatment. Due to oversights and delays by those responsible for his medical care, too much time passed for surgery to do any good. He has serious and permanent impairment that could have been avoided. After his release from prison, Shields filed suit under 42 U.S.C. 1983, alleging that several defendants were deliberately indifferent to his serious medical needs and violated his rights under the Eighth Amendment to the Constitution. The district court granted summary judgment in favor of the defendants. The Seventh Circuit affirmed, reasoning that Shields was the victim not of any one person’s deliberate indifference, but of a system of medical care that diffused responsibility for his care to the point that no single individual was responsible for seeing that he timely received the care he needed. As a result, no one person can be held liable for any constitutional violation. Shields’ efforts to rely on state medical malpractice law against certain private defendants also failed. View "Shields v. IL Dep't of Corrs." on Justia Law

Plaintiffs filed suit against the Secretary of Health and Human Services (HHS) and the Commissioner of the Social Security Administration (SSA) raising constitutional challenges to the Patient Protection and Affordable Care Act (ACA), Pub. L. No 111-148, 124 Stat. 119; raising statutory challenges to actions of HHS and the Commissioner relating to the implementation of the ACA and prior Medical legislation; and attacking the failure of defendants to render an "accounting" that would alter the American people to the insolvency towards which Medicare and Social Security programs were heading. On appeal, plaintiffs challenged the district court's dismissal of their claims. The court rejected plaintiffs' claims that 26 U.S.C. 5000A, which was sustained as a valid exercise of the taxing power, violated the Fifth Amendment's prohibition of the taking of private property without just compensation and violated the origination clause. The court concluded that plaintiffs' substantive attack on the Social Security Program Operations Manual System (POMS) provisions was clearly foreclosed by its decision in Hall v. Sebelius, holding that the statutory text establishing Medicare Part A precludes any option not to be entitled to benefits. The court rejected plaintiffs' second statutory claim attacking an interim final rule. Finally, the court concluded that plaintiffs failed to provide a legal argument for their claims against the Commissioner and Secretary, and therefore, the court lacked jurisdiction over plaintiffs' claim to an "accounting." Accordingly, the court affirmed the judgment of the district court. View "Assoc. Amer. Physicians, et al. v. Sebelius, et al." on Justia Law

Daniel Senior Living of Inverness I, LLC, d/b/a Danberry at Inverness successfully appealed to the Court of Civil Appeals a circuit court decision to affirm the issuance by the State Health Planning and Development Agency ("SHPDA") a certificate of need (CON) to STV One Nineteen Senior Living, LLC, d/b/a Somerby at St. Vincent's One Nineteen on an "emergency" basis. The Supreme Court granted Somerby's petition for review of the Court of Appeals, and finding no reversible error, affirmed that court's decision. View "Daniel Senior Living of Inverness I, LLC v. STV One Nineteen Senior Living, LLC" on Justia Law

Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, against Omnicare, alleging that defendants violated a series of FDA safety regulations requiring that penicillin and non-penicillin drugs be packaged in complete isolation from one another. The court concluded that the public disclosure bar did not divest the district court of jurisdiction over relator's FCA claims. The court concluded that once a new drug has been approved by the FDA and thus qualified for reimbursement under the Medicare and Medicaid statutes, the submission of a reimbursement request for that drug could not constitute a "false" claim under the FCA on the sole basis that the drug had been adulterated as a result of having been processed in violation of FDA safety regulations. The court affirmed the district court's grant of Omnicare's motion to dismiss, holding that relator's complaint failed to allege that defendants made a false statement or that they acted with the necessary scienter. The court also concluded that the district court did not abuse its discretion in denying relator's request to file a third amended complaint. View "United States ex rel. Rostholder v. Omnicare, Inc." on Justia Law