Justia Government & Administrative Law Opinion Summaries

After the Department denied Memorial's application for a Certificate of Need to perform elective percutaneous coronary interventions (PCIs), Memorial filed suit alleging that the PCI regulations were an unreasonable restraint of trade in violation of the Sherman Act, 15 U.S.C. 1, and unreasonably discriminated against interstate commerce in violation of the dormant Commerce Clause and 42 U.S.C. 1983. The court concluded that the requirements did not violate the dormant Commerce Clause where the minimum procedure requirement did not burden interstate commerce and the minimum procedure requirement protected public safety. Accordingly, the court affirmed the district court's dismissal of all of Memorial's remaining claims. View "Yakima Valley Mem'l Hosp. v. Dep't of Health" on Justia Law

The U.S. Department of Health and Human Services approved a 2008 amendment to Pennsylvania’s state plan for administering its Medicaid program. Private nursing facilities that provide services to Medicaid recipients challenged the amendment as violating Title XIX of the Social Security Act, 42 U.S.C. 1396, by adjusting Pennsylvania’s method for determining Medicaid reimbursement rates to private nursing facilities for the 2008-09 fiscal year without considering quality of care, which they claim violates 42 U.S.C. 1396a(a)(30)(A) and without satisfying the public process requirements of 42 U.S.C. 1396a(a)(13)(A). The district court rejected the claims on summary judgment. The Third Circuit affirmed in part, finding the state immune from the requested relief under the Eleventh Amendment. The district court erred in granting summary judgment to the federal defendants. By approving the amendment without any assurance that the amended plan would produce payments that are consistent with quality of care, HHS acted arbitrarily. View "Christ the King Manor, Inc. v. Sec'y, U.S. Dep't of Health & Human Servs." on Justia Law

The issue before the Supreme Court in this case centered on whether defendant professional corporations and a limited liability company were "health care providers" as defined by the state Medical Malpractice Act so as to be able to receive the Act's benefits. The Court of Appeals determined that though Defendants did not literally meet the Act's definition of "health care provider," it nonetheless held that Defendants were health care providers under the Act because a strict adherence to the plain language of the definition would conflict with legislative intent. Although the Court of Appeals reached the same conclusion, the Supreme Court disagreed with the Court's determination that the definition of "health care provider" literally excludes Defendants. The Supreme Court concluded that several provisions in the Act indicated that the Legislature intended professional medical organizations like Defendants to be covered by the Act. Accordingly, the Court affirmed the Court of Appeals but on different grounds. View "Baker v. Hedstrom" on Justia Law

Rival hospice operators challenged the State Department of Health's decision to grant a certificate of need to Odyssey Healthcare Operating B, LP and Odyssey Healthcare Inc. in connection with the settlement of a federal lawsuit. The superior court revoked the certificate; the Court of Appeals reinstated the certificate. The Supreme Court affirmed the Court of Appeals. View "King County Pub. Hosp. #2 v. Dep't of Health" on Justia Law

Louisiana's Patient's Compensation Fund served two objectives: (1) fostering a stable market for affordable insurance and (2) ensuring that victims of malpractice could recover for their injuries. Louisiana's Act 825 provided that any person who performed an abortion was liable to the mother of the unborn child for any damage occasioned or precipitated by the abortion. Plaintiffs, three healthcare providers, challenged the constitutionality of Act 825 facially, as applied to physicians enrolled in the Fund "who face or will face medical malpractice claims related to abortion," and as applied under the circumstances of this case. The court concluded that plaintiffs lacked standing to challenge subsection (A) of Act 825; plaintiffs had standing to challenge subsection (C)(2); the case was not moot; and the Eleventh Amendment did not bar plaintiffs' challenge to subsection (C)(2). On the merits, the court concluded that Act 825 did not violate the Equal Protection Clause of the Fourteenth Amendment where subsection (C)(2) was rationally related to the promotion of informed consent. Accordingly, the court reversed the judgment of the district court striking down subsection (C)(2). The court vacated its judgment regarding subsection (A) and dismissed the claim for want of jurisdiction. View "K. P., et al. v. LeBlanc, et al." on Justia Law

Relators brought a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A) and (B), alleging that the Mayo Foundation and others billed Medicare for surgical pathology services it did not provide. The government intervened and the parties settled. Relators then filed a Second Amended Complaint asserting additional claims. On appeal, relators challenged the district court's dismissal of their additional claim that Mayo fraudulently billed for services it did not provide whenever it prepared and read a permanent tissue slide but did not prepare a separate written report of that service. As a preliminary issue, the court concluded that relators satisfied their burden of showing that the public disclosure bar did not deprive the court of jurisdiction over relators' claim. On the merits, the court concluded that nowhere in the Medicare regulations or in the American Medical Association Codebook has the court found a requirement that physicians using the CPT codes for surgical pathology services must prepare the additional written reports that relators claimed Mayo fraudulently failed to provide. Accordingly, the court affirmed the judgment of the district court. View "Ketroser, et al. v. Mayo Foundation, et al." on Justia Law

Public school students with diabetes who cannot self-administer insulin are entitled under federal law to have it administered to them during the school day at no cost. In 2007, the State Department of Education (Department) issued a legal advisory authorizing unlicensed school personnel to administer insulin. The American Nurses Association and other trade organizations representing registered and school nurses (collectively, Nurses) challenged the document by filing this action seeking declaratory relief and a writ of mandate, asserting that the Department's advice condoned the unauthorized practice of nursing. The superior court declared the advisory invalid to the extent it authorized unlicensed school personnel to administer insulin. The Supreme Court reversed, holding that California law expressly permits trained, unlicensed school personnel to administer prescription medications such as insulin in accordance with the written statements of a student's treating physician and parents and expressly exempts persons who thus carry out physicians' medical orders from laws prohibiting the unauthorized practice of nursing. View "Am. Nurses Ass'n v. Torlakson" on Justia Law

Samuel J.H. was committed to the care and custody of the County Human Services Department. After Samuel's initial placement in outpatient care, the Department transferred him to an inpatient facility because of his erratic and delusional behavior. Samuel petitioned for a review of his transfer and a transfer back to outpatient status, contending that he was entitled to a hearing within ten days of his transfer to the inpatient facility. The circuit court denied Samuel's petitions, concluding (1) a patient is entitled to a hearing within ten days of his transfer to a more restrictive placement only when the transfer is based on a violation of treatment conditions; and (2) Samuel's transfer to the inpatient facility was not based on a violation of his treatment conditions but rather on reasonable medical and clinical judgment. The Supreme Court affirmed, holding that Wis. Stat. 51-35(1)(e) does not require a hearing to be conducted within ten days of a transfer to a more restrictive placement when the transfer is based on reasonable medical and clinical judgment. View "Manitowoc County v. Samuel J. H." on Justia Law

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

States participating in Medicaid in a managed care environment are required to make, at least every fourth month, supplemental “wraparound” payments to federally-qualified health centers (FQHCs) equal to the difference between a rate set by statute multiplied by the number of Medicaid patient encounters, and the amount paid to FQHCs by managed care organizations (MCOs) for all Medicaid-covered patient encounters, 42 U.S.C.1396. Concerned that gaps in FQHC claim verification led to overpayments, the New Jersey Department of Human Services changed its calculation: instead of basing wraparound payments solely on the number of Medicaid encounters and total MCO receipts as self-reported by FQHCs, the state would rely on data reported by MCOs absent receipt of certain additional data from the FQHCs. Because MCOs report only encounters that they have approved and paid, prior MCO payment would be a prerequisite to wraparound reimbursement under the new system. An association of FQHCs sued, claiming that the change violated their due process rights as well as state and federal law, resulting in budget shortfalls. The district court granted the association summary judgment and a preliminary injunction. The Third Circuit affirmed the holding that the requirement that wraparound payments be contingent on prior MCO payment violated the Medicaid statute’s requirement that FQHCs receive timely full wraparound payment for all Medicaid-eligible claims. View "NJ Primary Care Assoc. v. NJ Dep't of Human Servs." on Justia Law