Justia Government & Administrative Law Opinion Summaries

At issue was the relationship between Conn. Gen. Stat. 45a-655(b) and (d) in determining whether a spousal support order previously rendered by the probate court was binding on the Commission of Social Services when calculating the allowance that may be diverted to the support of the community spouse of a Medicaid eligible institutionalized person pursuant to 42 U.S.C. 1396r-5. The Commissioner decided to set a community spouse allowance for Paul Valliere in the amount of $0 with respect to the Medicaid benefit that paid for the long-term residential care of his wife, Majorie Valliere. The trial court sustained the administrative appeal brought by Plaintiffs, Paul and Ellen Shea, conservatrix and executrix of Majorie’s estate. The Supreme Court affirmed, holding that the probate court did not exceed its authority under section 45a-655 by ordering community spouse support in an amount that exceeded that which the Department of Social Services could order pursuant to 42 U.S.C. 1396r-5. View "Valliere v. Commissioner of Social Services" on Justia Law

The North Dakota Department of Human Services appealed a district court judgment reversing the Department's order deciding Sanford HealthCare Accessories received overpayments for medical equipment supplied to Medicaid recipients and ordering recoupment. The North Dakota Supreme Court reversed and remanded, concluding the district court erred in deciding the Department's failure to comply with the statutory time requirement for issuing its final order precluded the Department from acting. View "Sanford Healthcare Accessories, LLC v. N.D. Dep't of Human Services" on Justia Law

In 1990, an Ohio state court ordered Jacobs to pay Collin $13,800 in child-support payments. Jacobs subsequently began to receive social security benefits, but, by January 2014, Jacobs’s arrearage totaled $45,356. The state court directed the Commissioner to garnish Jacobs’s social-security payments, 42 U.S.C. 659. In October 2015, the Commissioner mistakenly terminated the garnishment. A year later Collin asked the court to order the Commissioner to resume the garnishment and to pay a lump sum equal to the amount the Commissioner had failed to garnish. The Commissioner voluntarily resumed the garnishment. The Sixth Circuit affirmed dismissal, holding that Collin’s demand was for “money damages,” so the United States was immune from suit. Section 659(a) provides that moneys payable by[] the United States . . . to any individual . . . shall be subject, in like manner and to the same extent as if the United States . . . were a private person, to withholding . . . to enforce the legal obligation ... to provide child support"; but 5 C.F.R. 581.305(e)(2) states “Neither the United States ... nor any governmental entity shall be liable ... to pay money damages for failure to comply with legal process.” The relief Collin seeks is not enforcement of “the statutory mandate itself” but instead damages for the failure to withhold, for which the government has not waived its immunity. View "Collin v. Commissioner of Social Security" on Justia Law

Biestek, age 54, worked for most of his life as a carpenter and a construction laborer, frequently transporting scaffolding, panels, and other construction materials around work sites. He completed at least one year of college and received additional vocational training as a bricklayer and carpenter. He stopped working in June 2005, allegedly due to degenerative disc disease, Hepatitis C, and depression. Biestek applied for Supplemental Security Income and Disability Insurance Benefits in March 2010, alleging a disability onset of October 2009. A Social Security Administration ALJ denied Biestek’s application. The district court remanded because the ALJ had not obtained necessary medical-expert testimony and did not pose a sufficiently specific hypothetical to the vocational expert. The ALJ subsequently issued a partially favorable decision finding Biestek disabled starting in May 2013, on his fiftieth birthday, the point at which the Agency deems an applicant “closely approaching advanced age” and presumptively disabled under 20 C.F.R. 404. The ALJ found that Biestek was “not disabled” before that date. The Sixth Circuit affirmed. Substantial evidence supported the ALJ’s finding the that Biestek did not meet or medically equal the back-pain-related impairment listed at 20 C.F.R. 404. The ALJ properly evaluated the testimony of medical experts and a vocational expert. View "Biestek v. Commissioner of Social Security" on Justia Law

In 1988, an ALJ awarded Smith supplemental security income (SSI). Smith received benefits until 2004 when he was found to be over the resource limit. Smith filed another SSI application in 2012, alleging additional medical conditions. The application was denied on March 26, 2014. Smith claims that he mailed a request for review on April 24, 2014. On September 21, Smith faxed a correspondence to the Social Security Administration, inquiring about the status of his appeal, with a copy of his request, dated April 24, 2014. A representative informed Smith that his request was not in the “electronic folder,” that if the Council had received the request, it would have mailed a receipt, and that his appeals request was filed as of October 1, 2014. The Council dismissed the request as untimely, finding no good cause to extend the deadline because Smith could not provide evidence that it was sent within the appropriate time. The district court determined that there was no judicial review available because the dismissal did not constitute a final decision and Smith made no colorable constitutional claims. The Sixth Circuit affirmed, rejecting arguments that Smith suffered due process violations because his request was timely submitted, different ALJs presided over his hearing and signed his decision, and the ALJ referenced the 1988 decision but failed to attach a copy as an exhibit. View "Smith v. Commissioner of Social Security" on Justia Law

Under California’s workers’ compensation law, effective in 2013, an injured worker may challenge a decision denying medical treatment by requesting a determination of medical necessity from an independent medical review (IMR) organization. (Labor Code 139.5, 4610.5.1) The IMR organization, which is regulated by the Division of Workers’ Compensation and operates under contract with the Division, designates one or more medical professionals to review pertinent medical records, determine whether the disputed treatment is medically necessary, and prepare a written report including statutorily-required findings. The IMR organization is required to describe the qualifications of the medical professionals who prepare the determination of medical necessity and to keep the names of the reviewers confidential in all communications outside the IMR organization. The determination of the IMR organization is deemed to be the determination of the administrative director and is binding on all parties, subject to appeal on narrow statutory grounds. Zuniga availed himself of the IMR process and then petitioned the Workers’ Compensation Appeals Board to disclose the names of the reviewers. The Board declined to do so. The court of appeal upheld that decision. IMR determinations are not testimonial in character; IMR reviewers are not workers’ adversaries and are not subject to cross-examination. View "Zuniga v. Workers' Compensation Appeals Board" on Justia Law

The Supreme Judicial Court vacated the judgment entered by the superior court upholding the final agency decision of the Department of Health and Human Services denying Appellant’s application for food supplement benefits.The Department denied Appellant’s application for food benefits based on language in the public law not present within the statutory text. The language at issue contained a fiscal limitation of $261,384 and a temporal limitation - June 30, 2015 - on the availability of funding for benefits for persons otherwise eligible under Me. Rev. Stat. 22, 3104-A(1)(D) (Paragraph D). The Supreme Judicial Court concluded that the Legislature intended for Paragraph D to be a permanent exception to the general ineligibility of noncitizen for food assistance under section 3104-(A)(1) and that the temporal and fiscal limitations contained in P.L 2013, ch. 368, section 00-14 applied only to the fiscal years ending June 30, 2013, June 30-2015, and June 30, 2015 and not beyond June 30, 2015. View "Manirakiza v. Department of Health & Human Services" on Justia Law

In 2005, the State of Mississippi filed suit against more than eighty prescription drug manufacturers alleging, among other things, that each committed common-law fraud and violations of the Mississippi Consumer Protection Act. The allegations primarily focused on whether the prescription-drug manufacturers inflated reported prices, which caused the Mississippi Division of Medicaid to reimburse pharmacies at inflated rates. The cases were eventually severed; this appeal involved only Watson Laboratories, Inc., Watson Pharma Inc., and Watson Pharmaceuticals, Inc. (collectively “Watson”). Following a bench trial, the Chancery Court concluded that Watson had committed common-law fraud and had violated the Mississippi Consumer Protection Act. As a result, the chancery court awarded the State a total of $30,262,052 in civil penalties, compensatory damages, and punitive damages. The chancery court also awarded post-judgment interest of three percent on the compensatory and punitive damages. Watson appealed, challenging the chancery court’s decision; the State also filed a cross-appeals relating to damages. After review, the Mississippi Supreme Court affirmed the chancery court’s judgment in favor of Mississippi Medicaid. Further, the Court affirmed the ruling on the State’s cross-appeal. View "Watson Laboratories, Inc. v. Mississippi" on Justia Law

Cullinan unsuccessfully sought Disability Insurance Benefits and Supplemental Security Income based on several impairments, most of which arose after she suffered a stroke: anxiety, depression, peripheral blindness in one eye, diabetes, obesity, and sleep apnea. An administrative law judge determined that although Cullinan has several impairments, she is not disabled. The Seventh Circuit vacated. The ALJ’s decision to discredit Cullinan’s testimony and that of her treating psychologist was unsupported by the record because the ALJ’s examples of Cullinan’s daily activities and social interactions did “not remotely describe a ‘very active’ lifestyle.” The ALJ did not adequately explain the conclusion that the doctor’s notes were inconsistent with his opinion and did not consider Cullinan’s daily extended naps and frequent debilitating headaches in determining her residual functional capacity. No evidence contradicted Cullinan’s testimony about those limitations. The vocational expert said that needing to take a two-hour nap every day would rule out all work. The ALJ has the burden to develop the record and assess whether symptoms are disabling. View "Cullinan v. Berryhill" on Justia Law

Ebanks sought veterans benefits for service-connected posttraumatic stress disorder, hearing loss, and arthritis. His claim for an increased disability rating was denied by the VA Regional Office (RO) in October 2014; in December he sought Board of Veterans Appeals review, with a video-conference hearing (38 U.S.C. 7107). Two years later, the Board had not scheduled a hearing. Ebanks sought a writ of mandamus. The Veterans Court denied relief. While his appeal was pending, the Board held his hearing in October 2017. The Federal Circuit vacated, finding the matter moot so that it lacked jurisdiction. The delay is typical and any Board hearings on remand are subject to expedited treatment under 38 U.S.C. 7112. Congress has recently overhauled the review process for RO decisions, so that veterans may now choose one of three tracks for further review of an RO decision, Given these many contingencies, Ebanks has not shown a sufficiently reasonable expectation that he will again be subjected to the same delays. Even if this case were not moot, the court questioned “the appropriateness of granting individual relief to veterans who claim unreasonable delays in VA’s first-come-first-served queue.” The “issue seems best addressed in the class-action context,.” View "Ebanks v. Shulkin" on Justia Law