Justia Government & Administrative Law Opinion Summaries

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

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