Justia Government & Administrative Law Opinion Summaries

Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded.

This appeal involved a challenge to the 2011 Medicare payment rate set by the Secretary of Health and Human Services for partial hospitalization services. Paladin claimed that the Secretary's use of both hospital-based and community mental health center cost data in establishing and adjusting the 2011 relative payment weights and ultimate payment rate was in excess of her statutory authority. Paladin filed suit in district court without first presenting an administrative claim, alleging jurisdiction was proper under 28 U.S.C. 1331. The court found that Congress expressly precluded judicial review of the Secretary's determinations and that her actions were not a facial violation of a clear statutory mandate. Accordingly, the court affirmed the district court's dismissal for lack of subject matter jurisdiction.

This interlocutory appeal involved two consolidated actions in which the trial court denied competing summary judgment motions. The case arose from University of Mississippi Medical Center's (UMMC) intent to purchase a platform linear accelerator system and to make renovations to its basement to house the new accelerator. UMMC represented that the accelerator would be an important aspect to the planned radiation oncology residency program. UMMC applied for a Certificate of Need (CON) to get the project started. Jackson HMA (HMA) and St. Dominic-Jackson Memorial Hospital (St. Dominic) filed a request for a public hearing in response to UMMC's CON application. The Mississippi State Department of Health (MSDH) thereafter sought an official opinion from the Attorney General (AG) on the issue of the CON statutes' applicability to UMMC. The Attorney General issued an opinion opining that UMMC was not subject to CON laws, and that it did not have to file an application for a CON. The AG issued a second opinion opining that there was no express exemption for UMMC within the CON laws, but that it was within the MSDH's power to make determinations of reviewability under the CON laws which carve out exemptions for equipment and/or services deemed necessary by UMMC. HMA and St. Dominic's filed a complaint with the Chancery Court requesting declaratory relief over the issue of whether the CON statutes applied to UMMC, and that MSDH had no authority to exempt UMMC from obtaining a CON. UMMC countered with its motion for summary judgment, arguing that the Board of Trustees of State Institutions of Higher Learning (IHL) approved the project and had exclusive authority to" manage and control" UMMC, and was not subordinate to the MSDH. Finding genuine issues of material fact existed as to whether the CON statutes applied to UMMC, the chancellor denied both motions. Upon review, the Supreme Court held that the CON statues applied to UMMC and that MSDH does have authority to create a "teaching" exception regarding when UMMC is required to apply for a CON. Therefore, the Court did not reach the question of whether the application of the CON statutes to UMMC unconstitutionally infringed on IHL's constitutionally vested authority to "manage and control" UMMC.

Heinzelman, born in 1971, received a flu vaccine in 2003, and within 30 days, was hospitalized for Guillain-Barre syndrome, a disorder affecting the peripheral nervous system. She was previously employed full-time as a hairstylist earning $49,888 per year. Due to her injury, Heinzelman will never be able to work again and is eligible to receive SSDI benefits of approximately $20,000 per year. In 2007, she sought compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1 to 300aa-34. A special master rejected the government’s argument that her eligibility for SSDI benefits should be considered in determining compensation under the Vaccine Act, finding that SSDI is not a "federal . . . health benefits program" within the meaning of section 300aa-15(g), and awarded $1,133,046.08, plus an annuity to cover future medical expenses. According to the government, Heinzelman's lost earnings award would have been roughly $316,000 less had the special master taken her anticipated SSDI benefits into account. The Claims Court and the Federal Circuit affirmed.

Petitioner Alohacare bid for a health and human services contract under Haw. Rev. Stat. 103F but was denied the contract by Respondent, the Department of Human Services. Petitioner protested and later appealed. The lower courts dismissed Petitioner's appeal for lack of jurisdiction, finding that Petitioner was not entitled to judicial review. The Supreme Court vacated the judgment of the lower courts, holding (1) Petitioner may not appeal the denial of a contract award by Respondent under the procedures set forth in Haw. Rev. Stat. 103D that afford judicial review for bidders denied protests; (2) however, chapter 103F does not prohibit judicial review of the administrative denial of such matters, and review may be afforded under Haw. Rev. Stat. 632; (3) review and denial of a bidder's protest by Respondent as the purchasing agency and subsequent denial of a request for reconsideration by the chief procurement officer housed in a different executive agency do not assuage separation of powers concerns because review is accomplished only in the executive branch of government; and (4) Petitioner was not denied due process or equal protection by chapter 103F, inasmuch as judicial review may be obtained by way of a declaratory judgment action. Remanded.

State Department of Education (DOE) issued a request for proposals to provide health and human services under contracts pursuant to Haw. Rev. Stat. 103F. After the DOE rejected the proposal of Petitioner Alaka'i Na Keiki, Inc., Petitioner brought an action against the DOE. The circuit court granted summary judgment in favor of the DOE. The intermediate court of appeals affirmed, concluding that chapter 103F does not allow for judicial review. The Supreme Court vacated the judgment of the lower courts, holding that the DOE's decisions to reject such proposals were subject to judicial review. The Court then held (1) as construed, chapter 103F was not unconstitutional for violating the separation of powers doctrine; (2) Petitioner's request for a declaratory judgment was moot to the extent the subject contracts had been awarded and their terms expired; (3) Petitioner's claim for negligence by the DOE was barred under the State Tort Liability Act; and (4) Petitioner's claim for injunctive relief, premised on the DOE's alleged faulty administration of the contract process, was moot inasmuch as the Court interpreted such process in chapter 103F as subject to judicial review. Remanded.

The Commission is constitutionally charged with the oversight of all correctional facilities in the state. At issue was the enforceability of a subpoena deuces tecum issued by the Commission commanding Elmhurst, a health care facility operated by HHC, to produce its records respecting its care and treatment of a specified individual, who, at the time of his pre-mortem hospitalization at the Elmhurst facility, was a correctional inmate in the custody of the city. In the proceedings resulting in this appeal, the Commission's subpoena was quashed upon the ground that it sought material shielded from disclosure by the physician-patient privilege. The court held that this was error that the records sought were not properly withheld from the Commission by reason of the asserted privilege and that the subpoena should be enforced.

States both appealed the district court's grants of summary judgment in favor of HHS, which upheld HHS's disallowance of certain Medicaid claims for Federal Financial Participation (FFP) as ineligible for "medical assistance" under the "Institution for Mental Diseases" (IMD) exclusion set forth in section 1905(a) of 42 U.S.C. 1396 et seq. (Medicaid Statute). Because HHS correctly concluded that the disputed claims were not eligible for FFP under the plain language of the IMD exclusion and the under-21 exception, the court affirmed the judgment of the district court.

A doctor filed a qui tam action under the False Claims Act, 31 U.S.C. 3729, against Brigham and Women's Hospital, Massachusetts General Hospital and doctors, claiming violation of the Act by including false statements in a grant application, concerning neurodegenerative illness associated with aging, submitted to the National Institute on Aging in the National Institutes of Health, an agency of the U.S. Department of Health and Human Services, and that defendants, knowing of the falsity, failed to take corrective action. The district court granted defendants summary judgment. The First Circuit vacated. The district court abused its discretion by excluding or failing to consider certain expert testimony and erred by failing to consider statements of the parties and experts as required by the summary judgment standard. The dispute was not about which scientific protocol produces results that fall within an acceptable range of "accuracy" or whether re-measurements, the basis for preliminary scientific conclusions, were "accurate" insofar as they fall within a range of results accepted by qualified experts, but whether there was intentional falsification.

The issue before the Supreme Court was whether the Mississippi Department of Health erred by denying the certificate-of-need (CON) application of St. Dominic-Jackson Memorial Hospital. In its application, St. Dominic sought to relocate seventy-one general acute-care beds from its Jackson location to a new facility in planned to build in Madison County. The Department found that St. Dominic's proposed project was actually a new hospital and not a relocation. Because St. Dominic did not meet the need criteria for a new hospital, the Department denied the request. The Madison County Chancery Court affirmed that decision. St. Dominic raised four issues on appeal. Taking each in turn, the Supreme Court concluded that the Department did not err by finding St. Dominic's project was actually a new hospital. Because St. Dominic could not meet the need criteria for a new hospital, the Department did not err by denying the CON application, and that the chancery court did not err by affirming that decision.