Justia Government & Administrative Law Opinion Summaries

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

A Vermont statute requires all "health insurers" to file with the State reports containing claims data and other "information relating to health care." Liberty Mutual sought a declaration that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., preempted the Vermont statute and regulation. The district court granted summary judgment in favor of Vermont. The court held that the reporting requirements of the Vermont statute and regulation have a "connection with" ERISA plans and were therefore preempted as applied. The court's holding was supported by the principle that "reporting" is a core ERISA function shielded from potentially inconsistent and burdensome state regulation. Accordingly, the court reversed and remanded with instructions to enter judgment for Liberty Mutual. View "Liberty Mutual Ins. Co. v. Donegan" on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

Defendant Micah Smith was charged with unauthorized participation in a medical assistance program. The State maintained Smith was excluded from participating in medical assistance programs through the administrative process by the Louisiana Department of Health and Hospitals (DHH) for various allegations of fraud and misconduct. After that exclusion, Smith continued to serve as the billing agent for Medicaid providers, despite his exclusion. Smith filed a motion to quash in which he challenged La. R.S. 14:126.3.1(A)(4) as overbroad because it "prohibit[ed] a substantial amount of free speech and actions which would be protected under the First Amendment." He filed a second motion to quash, challenging La. R.S. 14:126.3.1(A)(3) as "so sweeping in its proscription that it denie[d] a wide range of protected benefits to which a majority of Americans are entitled." The district court denied Smith's first motion by granted the second. The State appealed. After review of the district court record and the applicable law, the Supreme Court reversed the district court's declaration that La. R.S. 14:126.3.1(A)(3) was unconstitutional, and remanded the case for further proceedings. View "Louisiana v. Smith" on Justia Law

In 2007, the Secretary revamped Medicare's Inpatient Prospective Payment System, updating the diagnostic weighting used to calculate reimbursements for hospitals treating the program's beneficiaries. Plaintiffs sought review of the Secretary's decision regarding a downward prospective adjustment for hospital-specific rate payments. The district court concluded that the statutory scheme was ambiguous and deferred to the Secretary's reasonable interpretation of the adjustment provisions. Applying Chevron deference, the court agreed with the district court's conclusion that the statutory scheme was ambiguous and unclear. Accordingly, the court affirmed the judgment of the district court. View "Adirondack Medical Center, et al. v. Sebelius" on Justia Law

The City appealed the district court's grant of plaintiffs' motion for a preliminary injunction enjoining Local Law 17. Local Law 17, inter alia, requires pregnancy services centers to make certain disclosures regarding the services that the centers provide. The court concluded that the law was not impermissibly vague; plaintiffs failed to demonstrate a likelihood of success on the merits with respect to one of the challenged disclosures, which requires pregnancy services centers to disclose if they have a licensed medical provider on staff; plaintiffs have demonstrated a likelihood of success on the merits with respect to other provisions challenged by plaintiffs that require other forms of disclosure and impermissibly compel speech; and because the provisions are severable, the court severed the enjoined provisions from the rest of Local Law 17. Accordingly, the court affirmed in part, vacated in part, and remanded for further proceedings. View "The Evergreen Association, Inc v. City of New York" on Justia Law

Tanisha Bates was indicted for arson. The circuit court found Bates not guilty by reason of insanity. Subsequently, the circuit court concluded that Bates was in need of inpatient hospitalization and committed her to the custody of the Commissioner of Mental Health, Mental Retardation and Substance Abuse Services. The Supreme Court affirmed, holding that the circuit court did not err when it determined that the particular circumstances warranted Bates’ commitment to inpatient hospitalization rather than to conditional release because it correctly applied the standards articulated in Va. Code Ann. 19.2-182.3 and 19.2-182.7 to the present case. View "Bates v. Commonwealth" on Justia Law

The former miner sued in 1992 and an administrative law judge determined that he was not medically qualified for benefits under the Black Lung Benefits Act, 30 U.S.C. 901 and indicated that Arkansas Coals was not the “responsible operator” required to pay benefits. About 17 years later, the miner filed a second claim. After finding that his medical condition had worsened and that he was now disabled, an ALJ awarded benefits and determined that Arkansas Coals was the responsible operator. The Benefits Review Board and the Sixth Circuit affirmed, rejecting the company’s finality, waiver, and collateral estoppel arguments; the miner was entitled to bring a second claim under 20 C.F.R. 725.309(d)(4) and the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim. Substantial evidence supports the determination that Arkansas Coals is the responsible operator. View "Arkansas Coals, Inc. v. Lawson" on Justia Law