Justia Government & Administrative Law Opinion Summaries

In 2000, Appellant was indeterminately committed as a sexual dangerous person as a result of a series of sex offenses involving teenage girls. Appellant later petitioned for provisional discharge from civil commitment. After weighing the evidence presented by Appellant and the Commissioner of Human Services at a first-phase hearing, the Supreme Court Judicial Appeal Panel dismissed Appellant's petition under Minn. R. Civ. P. 41.02(b). The court of appeals affirmed. The Supreme Court reversed, holding that the Appeal Panel committed reversible error in applying Rule 41.02(b) by failing to view the evidence produced at the first-phase hearing in a light most favorable to Appellant and by weighing the evidence produced during the first phase of the hearing. Remanded. View "Coker v. Jesson" on Justia Law

Respondent was an inmate in the custody of the State Department of Corrections and Correctional Services (DOCCS). In 2010, Respondent undertook a month-long hunger strike, contending that he had ceased eating in order to secure transfer to another DOCCS facility and to bring attention to certain claims of mistreatment. After Respondent had lost 11.6 percent of his body weight, DOCCS commenced this proceeding requesting a court order permitting medical personnel to insert a nasogastric tube and take other reasonable steps necessary to provide hydration and nutrition to Respondent. Supreme Court granted DOCCS' motion. Respondent subsequently resumed eating solid food but nevertheless appealed. The Appellate Division concluded the case was moot except for the issue of whether the State violated Respondent's rights by securing the force-feeding order. On that issue, the Appellate Division ruled in favor of DOCCS, concluding that the force-feeding order did not violate Respondent's right to refuse medical treatment. The Court of Appeals affirmed, holding that Respondent's rights were not violated by the judicial order permitting the State to feed him by nasogastric tube after his health devolved to the point that his condition became life-threatening. View "Bezio v. Dorsey" on Justia Law

Appellant was employed by Employer when he suffered a compensable work-related brain injury. Appellant, who was permanently and totally disabled, filed a workers' compensation claim seeking benefits and also requested benefits for the nursing care services his mother was providing. The workers' compensation commission (Commission) found Appellant's injury was compensable but denied the requested nursing service benefits. Appellant subsequently made a second request for additional benefits in the form of nursing services at Timber Ridge Ranch, an assisted living facility. The Commission denied Appellant benefits, finding that the services at Timber Ridge were not nursing services as defined by the law. The court of appeals affirmed. The Supreme Court reversed, holding that the Commission's findings and conclusions were not supported by substantial evidence and that the services provided at Timber Ridge qualified as nursing services under the applicable statutes. Remanded. View "Pack v. Little Rock Convention Ctr. & Visitors Bureau" on Justia Law

Southwest appealed the district court's dismissal of its claim regarding the Medicare Part D statute, 42 U.S.C. 1395w-101 et seq., for lack of subject matter jurisdiction. Citing Shalala v. Illinois Council on Long Term Care, Southwest argued that its claim provided a narrow exception to 42 U.S.C. 405(h)'s requirement that required a plaintiff to exhaust administrative remedies before filing a claim in federal court. The court concluded that caselaw interpreting the application of section 405(h) to Medicare claims emphasized that the Illinois Council exception was extremely narrow and appropriately applied only in cases where judicial review would be entirely unavailable through the prescribed administrative procedures. Because Southwest has not carried its heavy burden of showing that the Illinois Council exception applied, the court affirmed the district court's order dismissing the suit. View "Southwest Pharmacy Solutions, Inc. v. Centers for Medicare & Medicaid, et al" on Justia Law

Under the Federal Mine Safety & Health Act of 1977, the Secretary of Labor protects the health and safety of miners, acting through the Federal Mine Safety and Health Administration (MSHA). Regulations under the Act require mine operators to report all mine-related injuries and illnesses suffered by employees. In 2010, MSHA acted on a new and broader interpretation and informed 39 mine operators that they would be required to permit MSHA inspectors to review employee medical and personnel records during inspections. Two operators refused to provide the records. MSHA issued citations and imposed penalties. An ALJ and the Review Commission found that the demands and enforcement were lawful under 30 U.S.C. 813(h) and 30 C.F.R. 50.41. Mine employees intervened to raise personal privacy challenges. The Seventh Circuit denied a petition for review, rejecting arguments that MSHA does not have authority for the requirement; that 30 C.F.R. 50.41 is not a reasonable interpretation of the Act and was not properly promulgated; that the requirement infringes operators’ Fourth Amendment right not to be searched without a warrant; that the demands violate the miners’ Fourth Amendment privacy rights in their medical records; and that penalties imposed for noncompliance violate the operators’ Fifth Amendment due process rights. View "Bickett v. Fed. Mine Safety & Review Comm'n" on Justia Law

"At its most basic level, this case presents a policy dispute: whose policy choice concerning health insurance premiums for State employees controls—the General Assembly's or the Budget and Control Board's?" The issue before the Supreme Court centered on "maintaining and enforcing the constitutional and statutory framework through which such issues must be resolved. " Upon review of the arguments of the parties and the applicable case law, the Supreme Court found that the General Assembly had and exercised the power to determine the contribution rates of enrollees for the State's health insurance plan in 2013. The Court held that the Budget and Control Board violated the separation of powers provision by substituting its own policy for that of the General Assembly, entered judgment for the petitioners, and directed the Board to use the appropriated funds for premium increases and return the premium increases previously collected from enrollees. View "Hampton v. Haley" on Justia Law

Under the Medicaid program, the federal government offsets some state expenses for medical services to low-income persons; a state’s plan must cover medical assistance for specific populations, but a state may expand its Medicaid program by obtaining a waiver for an “experimental, pilot, or demonstration project.” In 1993, Tennessee obtained a waiver for TennCare, to cover uninsured and uninsurable individuals. Following approval, hospitals received reimbursement under the umbrella of TennCare. Because hospitals serving large numbers of low-income patients generally incur higher costs than Medicaid flat payment rates reflect, hospitals that treated a disproportionate share of low-income patients could apply for the “DSH” adjustment. A fiscal intermediary processed requests for reimbursement, including DSH adjustment payments. Due to discrepancies between the practices of fiscal intermediaries in different states, the Secretary issued a 2000 rule, providing that eligibility waiver patients were to be included as individuals “eligible for medical assistance” under Medicaid for purposes of DSH adjustment calculations. The 2005 Deficit Reduction Act ratified the rule. Adventist, a not-for-profit hospital network, provided more than 1,200 patient care days to TennCare expansion waiver patients 1995-2000. The fiscal intermediary did not include those days in calculating the adjustment. The Secretary’s Provider Reimbursement Review Board upheld the exclusion. The district court dismissed, concluding that section 1315 provided the Secretary discretion to exclude expansion waiver patient days from the DSH calculation. The Sixth Circuit affirmed. View "Adventist Health Sys./Sunbelt, Inc. v. Sebelius" on Justia Law

The issue before the Supreme Court in this case concerned the scope of Clackamas County's contractual obligation to provide health insurance benefits to command officer retirees of the County Sheriff's Office. A contract between the county and command officers, including Plaintiff Neil James, required the county to use a particular fund to pay for a certain level of benefits to command officers after they retired. The contract added that the obligation to pay benefits was "contingent upon the availability of sufficient funding in said fund to pay for the same." After plaintiff retired, the cost of insurance premiums increased to the point where the fund was and would for the foreseeable future continue to be insufficient to pay for the benefits required. The county entered into a new contract with certain union employees to provide lesser benefits from a more stable fund, and plaintiff (a retired officer, not a union employee) also was provided those lesser benefits. Plaintiff brought an action against the county, asserting breach of contract. He maintained that the first contract required the county to pay him full health insurance benefits and argued that the contingency provision did not apply because of the creation of the new fund, which had sufficient money to pay for those benefits. The trial court entered judgment in favor of plaintiff, but the Court of Appeals reversed. Upon review, the Supreme Court concluded that the new fund was the product of a contract that was separate and independent from the earlier contract. Because the prior fund was insufficient to provide the agreed level of benefits, the county did not breach its contractual obligation to provide that level of benefits. Accordingly, the Court affirmed the appellate court's decision. View "James v. Clackamas County" on Justia Law

MedQuest is a diagnostic testing company that operates more than 90 testing facilities in 13 states. In 2006 a former MedQuest employee, brought a qui tam suit against MedQuest alleging violations of the False Claims Act. The United States intervened and obtained summary judgment ($11,110,662.71) that MedQuest used supervising physicians who had not been approved by the Medicare program and the local Medicare carrier to supervise the range of tests offered at the Nashville-area sites, and after acquiring one facility, MedQuest failed to properly re-register the facility to reflect the change in ownership and enroll the facility in the Medicare program, instead using the former owner’s payee ID number. The Sixth Circuit reversed, stating that the Medicare regulatory scheme (42 U.S.C. 1395x) does not support FCA liability for failure to comply with the supervising-physician regulations. MedQuest’s failure to satisfy enrollment regulations and its use of a billing number belonging to a physician’s practice it controlled do not trigger the hefty fines and penalties created by the FCA. View "United States v. MedQuest Assocs, Inc." on Justia Law

Hospital sought full tax refunds in relation to Hospital's attempt to reclassify certain services from either "inpatient" or "outpatient" hospital services to "physicians' services" for purposes of the West Virginia Health Care Provider Tax Act. The Office of Tax Appeals denied Hospital's request, and the circuit court affirmed. In seeking to reclassify items of overhead as "physicians' services," Hospital focused on its use of certain billing codes that were required by federal law. The Tax Commission argued that Hospital's reliance on these billing codes to identify what qualifies as "physicians' services" under the Act was misplaced. The Supreme Court affirmed, holding that the overhead items at issue did not qualify as "physicians' services" under the Act. View "Wheeling Hosp., Inc. v. Lorensen" on Justia Law