Justia Government & Administrative Law Opinion Summaries

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, collectively, the Affordable Care Act require that most businesses employing 50 or more individuals provide female employees with health-insurance coverage that includes, at no cost to the employee, “such additional preventive care and screenings . . . as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.” 42 U.S.C. 300gg-13(a)(4). Those guidelines require plans to cover “[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.” Eden Foods, Inc., and Potter sought an injunction to prevent federal agencies from enforcing that mandate against them. They contend that offering such contraceptive services to the employees of Eden Foods would substantially burden the plaintiffs’ religious beliefs and contravene protections under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb–2000bb-4 (RFRA). The district court denied relief. The Sixth Circuit affirmed. A for-profit corporation is not a “person” capable of religious exercise as intended by RFRA and individual shareholders/owners of a corporation have no standing to challenge provisions of laws that the corporation must obey. View "Eden Foods, Inc v. Sebelius" on Justia Law

The Office of the Medicaid Inspector General (OMIG) terminated a physician's participation in the Medicaid program on the basis of a Bureau of Professional Medical Conduct (BPMC) consent order, in which the physician pleaded no contest to charges of professional misconduct and agreed to probation. Supreme Court annulled the OMIG's determination. The Appellate Division affirmed, concluding (1) the agency acted arbitrarily and capriciously in barring the physician from treating Medicaid patients when the BPMC permitted him to continue to practice; and (2) the OMIG was required to conduct an independent investigation before excluding a physician from Medicaid on the basis of a BPMC consent order. The Court of Appeals affirmed but for another reason, holding (1) the OMIG is authorized to remove a physician from Medicaid in reliance solely on a consent order between the physician and the BMPC, regardless of whether BPMC chooses to suspend the physician's license or OMIG conducts an independent investigation; but (2) because OMIG did not explain why the BPMC consent order caused it to exclude the physician from the Medicaid program, the agency's determination was arbitrary and capricious. View "Koch v. Sheehan" on Justia Law

In a direct appeal, the issue before the Supreme Court in this case was the constitutionality of legislation mandating a one-time transfer of money from the Medical Care Availability and Reduction of Error Fund to Pennsylvania's General Fund. The Commonwealth faced a budget impasse for the 2009-10 fiscal year that lasted approximately 100 days. An interim budget was passed, and impasse was resolved when the Governor approved a supplemental appropriations bill, as well as implementing legislation making amendments to Pennsylvania's Fiscal Code. One of Act provisions designed to balance the budget directed that $100 million be transferred from the MCARE Fund to the General Fund. Appellees sought a declaration that: (1) the transfer of $100 million from the MCARE Fund to the General Fund extinguished vested rights or constituted an illegal taking in violation of the due process guarantees contained the Commonwealth and federal constitutions; and (2) the transfer violated the Uniformity Clause of the Pennsylvania Constitution. Concerned that the Commonwealth might effectuate the transfer and dissipate the funds, Appellees filed an application for preliminary injunctive relief (a temporary restraining order). After review, the Supreme Court concluded that the October 2009 amendment to the Fiscal Code transferring $100 million from the MCARE Fund to the General Fund implicated the providers' due process rights, but that the question of whether the legislation was finally unconstitutional requires further factual development. Accordingly, the Court reversed the Commonwealth Court's order granting summary relief. View "Geisinger Health System, et al v. Pennsylvania" on Justia Law

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