Justia Government & Administrative Law Opinion Summaries

A VA regional office awarded King disability compensation for residuals of a left knee surgery and right knee arthritis. King later sought disability compensation for disabilities of the back and hips on a direct basis and as secondary to his service-connected knee disabilities. Records revealed no treatment for back or hip problems during King's active duty service 1973-1974. King underwent a VA spine examination in 2000. The examiner diagnosed minimal degenerative joint disease of both hips and lumbosacral spine, related to age. A private physician disagreed. In 2007, the Board of Veterans denied King's appeal. The Veterans Court remanded. Additional evidence was developed and, in 2008, the Board obtained an opinion from a Veterans Hospital Administration orthopedist that it was not likely that King’s back and bilateral hip disabilities were directly caused or permanently worsened by the service-connected knee disabilities. The Board and Court of Appeals for Veterans Claims affirmed the denial. The Federal Circuit affirmed, rejecting an argument that the Veterans Court erred by discounting lay testimony offered by King and his wife. The Veterans Court did not fail to consider the proffered lay evidence, so King’s appeal was merely a challenge to the weight given his evidence.View "King v. Shinseki" on Justia Law

Ruppel sued CBS in Illinois alleging CBS’s predecessor, Westinghouse, caused the mesothelioma from which he suffers. Westinghouse had included asbestos in the turbines it supplied to the U.S. Navy, and Ruppel was allegedly exposed to it during his Naval service and later when he worked on an aircraft carrier as a civilian. CBS removed the case under the federal officer removal statute, which permits removal of certain suits where a defendant that acted under a federal officer has a colorable federal defense, 28 U.S.C. 1442(a)(1). Ruppel moved to remand and, without allowing response, the district court granted the motion. The district court concluded Ruppel only sued CBS for failing to warn about the dangers of asbestos for which there is no federal defense. The Seventh Circuit reversed. CBS’s relationship with Ruppel arises solely out of CBS’s duties to the Navy. It also has a colorable argument for the government contractor defense, which immunizes government contractors when they supply products with specifications approved by the government. View "Ruppel v. CBS Corp." on Justia Law

In 2004, Illinois enacted Hospital Provider Funding Legislation imposing a tax on hospital providers, except for certain categories of exempt hospitals, for fiscal years 2004 and 2005, 305 ILCS 5/5A-2(a). The Centers for Medicare and Medicaid Services disallowed the reimbursement of Medicare expenses (42 U.S.C. 1395f(b)(1)) to a group of Illinois hospitals, finding that the amount of a tax assessment paid by the hospitals was a reasonable cost, but was subject to offset by any payments those hospitals received from an Illinois State fund. The district court and Seventh Circuit affirmed, finding that the decision was not inconsistent with established policy. The court rejected an argument that the hospitals incurred the full cost of the tax, as they were billed by and wrote checks to the state, reasoning that the argument ignored the real net impact of the tax and of Access Payments by the state.View "Abraham Lincoln Mem'l Hosp. v. Sebelius" on Justia Law

The Mississippi Department of Health (DOH) issued a final order in 2011, approving a certificate-of-need (CON) application filed by Vicksburg Healthcare, LLC, doing business as River Region Health System (River Region), for the purpose of renovating space on River Region's west campus and adding twenty acute-care beds designated for the inpatient care of adolescent psychiatric patients. Diamond Grove Center, LLC, (Diamond Grove), appealed the DOH's decision to the Hinds County Chancery Court, which upheld the CON approval. Diamond Grove then appealed to the Supreme Court, maintaining that the DOH was barred from issuing a CON under Mississippi Code Section 41-7-191(4)(a)(iii) (Rev. 2009) because of a previously approved, but never acted upon, CON granted by the DOH to Brentwood Health Management of Mississippi, LLC (Brentwood). Upon review, the Supreme Court affirmed the chancery court. View "Diamond Grove Center, LLC v. Mississippi State Dept. of Health" on Justia Law

Bontrager filed a putative class action complaint challenging Indiana’s $1,000 annual limit for dental services covered by Medicaid, 42 U.S.C. 1396. The district court granted a preliminary injunction, holding that Indiana is required to cover all medically necessary dental services, irrespective of the monetary cap. The Seventh Circuit affirmed. Bontrager has an enforceable federal right capable of redress through Section 1983. The monetary cap, which excludes medically necessary treatment, is not a utilization control procedure, but allows a state to shirk its primary obligation to cover medically necessary treatments. The court acknowledged that Bontrager’s victory may be short-lived if the state decides to end coverage for all dental services. View "Bontrager v. IN Family & Soc. Servs." on Justia Law

Plaintiff filed a complaint with the department of labor against her employer (Employer), alleging a violation of the Connecticut family and medical leave statute, which applies only to employers that employer seventy-five or more employees. Although Employer employed more than 1,000 employees nationwide, the commissioner of labor dismissed the complaint on the ground that the leave statute does not apply to Employer because it does not employ seventy-five or more employees within the state of Connecticut. The trial court sustained Plaintiff's appeal and rendered judgment in Plaintiff's favor, concluding that all employees of a business are to be counted in determining whether the business is an employer under the leave statute. The Supreme Court reversed, holding that section Conn. Agencies Regs. 31-51qq-42, which has the force and effect of a statute, makes clear that only Connecticut employees are to be counted under the leave statute. View "Velez v. Comm'r of Labor" on Justia Law

Until 2003, Hagans worked as a security guard and as a sanitation worker. At 44 years old, Hagans required open-heart surgery. Hagans claims additional medical problems relating to his cerebrovascular and respiratory systems, hypertension and dysphagia, insomnia, and back pain. He has been diagnosed with depression. Hagans began receiving disability benefits as of January 30, 2003. In September, 2004, pursuant to an updated Residual Function Capacity assessment showing his condition had improved, SSA determined that Hagans was no longer eligible for benefits. The ALJ considered several evaluations of Hagans’s condition, most of which were completed in mid-2004, and found that he was capable of engaging in substantial gainful activity, although he could not perform his past relevant work. The Appeals Council denied review; the district court affirmed. The Third Circuit affirmed, after determining that “relatively high” deference should be afforded to SSA’s Acquiescence Ruling interpreting the cessation provision of 42 U.S.C. 423(f) as referring to the time of the SSA’s initial disability determination. SSA correctly evaluated Hagans’s condition as of the date on which the agency first found that Hagans’s eligibility for disability benefits ceased. Substantial evidence supported the conclusion that Hagans was not fully disabled as of that date. View "Hagans v. Comm'r of Soc. Sec." on Justia Law

TriCenturion audited Nichole Medical as a Program Safeguard Contractor under the Medicare Integrity Program, 42 U.S.C. 395ddd(a), and concluded that Nichole “might” be improperly billing for medical equipment; that Nichole had received overpayments; and that it had not maintained sufficient medical records to establish reasonableness or medical necessity. TriCenturion directed Nichole’s carrier, HealthNow, to withhold payments. TriCenturion calculated the actual overpayment of several specific claims, used those as a representative sampling, and extrapolated an overpayment amount for all relevant claims. The Attorney General found no evidence of fraud and refused to prosecute; HealthNow stopped withholding payments. TriCenturion instructed HealthNow’s successor to re-institute the offset. Nichole went out of business, but pursued an appeal. An ALJ determined that Nichole was entitled to reimbursement on some, but not all, appealed claims and found that the process for arriving at the extrapolated overpayment was flawed. The Medicare Appeals Council found that all 39 claims had been reopened and reviewed improperly. The district court dismissed Nichole’s suit against TriCenturion, which alleged torts and breach of the statutory duty of care under 42 U.S.C. 1320c-6(b). The Third Circuit affirmed. Defendants are immune from suit as officers or employees of the Secretary of the Department of Health and Human Services. View "Nichole Medical Equip & Supply, Inc. v. Tricenturion, Inc." on Justia Law

Appellant, a medical doctor practicing medicine in Kansas and Missouri, appealed from the district court's order denying her petition to revoke an administrative subpoena issued by the Kansas Board of Healing Arts. The Supreme Court affirmed the district court's determination that Appellant was not required to exhaust administrative remedies before seeking relief from the district court under Kan. Stat. Ann. 65-2839a(b)(3)(B). On the merits of the appeal, the Court affirmed the district court's denial of Appellant's petition based on its conclusion that the Board had authority under the Kansas Healing Arts Act to investigate and subpoena Appellant, a Kansas licensee who was practicing under the Act, even though the investigation was based upon her practice of medicine in Missouri. View "Ryser v. State" on Justia Law

Claiming anxiety, depression, suicidal tendencies, insomnia, vertigo, migraine headaches, fibromyalgia, carpal tunnel syndrome, and plantar fasciitis, Farrell, then 33 year old, applied for disability insurance benefits. Her initial application was denied, but the Social Security Administration Appeals Council remanded. The Administrative Law Judge again ruled against her, in part because of her failure to establish definitively that she suffered from fibromyalgia. The Appeals Council summarily affirmed this decision, despite new evidence before it that confirmed the fibromyalgia. The district court affirmed. The Seventh Circuit reversed. The Social Security Administration’s regulations require the Appeals Council to consider “new and material evidence.” The ALJ did not adequately deal with competing expert opinions. View "Farrell v. Astrue" on Justia Law