Justia Government & Administrative Law Opinion Summaries

Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law

Thomas applied for Supplemental Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable impairments as degenerative changes in her back and left shoulder, Graves’ disease, and dysthymic disorder (a form of chronic depression), but concluded that the impairments did not impose more than minimal limitations on Thomas’s ability to work and denied her application. The Seventh Circuit reversed and remanded. The ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion that she has no severe impairments were not supported by substantial evidence. Thomas’s doctors’ lack of specialization in rheumatology was not an acceptable basis for discounting their assessments. View "Thomas v. Colvin" on Justia Law

The issue before the New Jersey Supreme Court in this case was whether the 2011 suspension of State pension cost-of-living adjustments (COLAs) contravened a term of the contract right granted under the earlier enacted non-forfeitable right statute, L.1997, c.113 (codified as N.J.S.A.43:3C-9.5). Qualifying members of the State's public pension systems or funds were granted a non-forfeitable right to receive benefits as provided under the laws governing the retirement system or fund. By codifying that non-forfeitable right to receive benefits, the Legislature provided that the benefits program, for any employee for whom the right has attached, could not be reduced. Whether COLAs were part of the benefits program protected by N.J.S.A. 43:3C-9.5 depended on whether the Legislature, in enacting N.J.S.A. 43:3C-9.5(a) and (b), intended to create a contractual right to COLAs. The Supreme Court found in this instance, proof of unequivocal intent to create a non-forfeitable right to yet-unreceived COLAs was lacking. Although both plaintiff retirees and the State advanced plausible arguments on that question, "the lack of such unmistakable legislative intent dooms plaintiffs' position." The Court concluded that the Legislature retained its inherent sovereign right to act in its best judgment of the public interest and to pass legislation suspending further COLAs. Having determined that there was no contract violation, and because the additional arguments advanced by plaintiffs were not meritorious, the Court reversed the Appellate Division's judgment holding to the contrary. View "Berg v. Christie" on Justia Law

Caring Hearts Personal Home Services, Inc. provided physical therapy and skilled nursing services to “homebound” Medicare patients. It sought reimbursement from Medicare for services provided. The definition of who qualified as "homebound" or what services qualified as "reasonable and necessary" was unclear, even to the Centers for Medicare & Medicaid Services (CMS). CMS has developed its own rules on both subjects that had been repeatedly revised and expanded over time. In an audit, CMS purported to find that Caring Hearts provided services to at least a handful of patients who didn’t qualify as “homebound” or for whom the services rendered weren’t “reasonable and necessary.” As a result, CMS ordered Caring Hearts to repay the government over $800,000. It was later found that in reaching its conclusions CMS applied the wrong law: the agency did not apply the regulations in force in 2008 when Caring Hearts provided the services in dispute. Instead, it applied considerably more onerous regulations the agency adopted years later, "[r]egulations that Caring Hearts couldn’t have known about at the time it provided its services." The Tenth Circuit found that Caring Hearts "[made] out a pretty good case that its services were entirely consistent with the law as it was at the time they were rendered" when CMS denied Caring Hearts' request for reconsideration. The Tenth Circuit reversed the district court's judgment affirming CMS' denial to Caring Hearts for reimbursement, and remanded for further proceedings. View "Caring Hearts v. Burwell" on Justia Law

In 2008, Joseph Gerdon was seriously injured in a motor vehicle accident that arose out of and in the course of his employment. He was a passenger in a vehicle being driven by a coworker, who drove off the road. The Industrial Commission awarded Gerdon benefits. Gerdon requested a hearing to determine whether he was also entitled to benefits for a compensable psychological injury. That issue was heard before a referee, who issued proposed findings of fact, conclusions of law, and a recommendation that Gerdon had failed to prove that he was entitled to additional psychological care. The Commission adopted the referee’s proposed findings of fact and conclusions of law and issued an order. Gerdon appealed to the Idaho Supreme Court. Because the Commission’s decision was based upon its constitutional right to weigh the evidence and determine the credibility of conflicting expert opinions, the Supreme Court affirmed the Commission's order. View "Gerdon v. Con Paulos, Inc." on Justia Law

Attorneys employed by the Franklin County Public Defender sought membership and service credit in the Ohio Public Employees Retirement System for their years of service prior to January 1999, and challenged a decision the Ohio Public Employees Retirement Board’s denial of service credit. Persons hired by the Franklin County Public Defender on or before December 31, 1984, are public employees entitled to PERS benefits; effective January 1, 1999, the Franklin County Public Defender’s employees have been enrolled in and considered to be members of PERS. During the intervening years, pursuant to the Ohio Public Defender Act (R.C. Chapter 120), the Franklin County Public Defender Commission and its employees paid Social Security taxes on wages and did not consider the office to be a county agency. The Court of Appeals denied relief. The Supreme Court of Ohio granted a writ of mandamus to compel the board to award service credit, rejecting an argument that “there was no person holding the office of Franklin County Public Defender between 1985 and 1999 because a person was appointed as the ‘Director’ of the corporation. The plain language in R.C. 120.14(A)(1) indicates that the attorneys were employed by a public official, and hence, were public employees. View "Altman-Bates v. Pub. Emps. Retirement Bd." on Justia Law

A class of Tennessee residents who applied for Medicaid sought declaratory and injunctive relief, alleging that the delays they have experienced in receiving eligibility determinations on their applications violate 42 U.S.C. 1396a(a)(8) of the Medicaid statute, and that the state’s failure to provide a fair hearing on their delayed applications violates that statute and the Due Process Clause. Regulations implementing the statute provide that “the determination of eligibility for any applicant may not exceed” 90 days for those “who apply for Medicaid on the basis of disability” and 45 days for all other applicants. The district court certified a class and granted a preliminary injunction, which requires the state to grant a fair hearing on delayed applications to class members who request one. The Sixth Circuit affirmed the preliminary injunction, holding that the matter is not moot and that the federal government is not a required party. The court noted that the federal government submitted an amicus brief, supporting plaintiffs’ position. Despite the passage of the Affordable Care Act, states remain ultimately responsible for ensuring their Medicaid programs comply with federal law. View "Wilson v.Gordon" on Justia Law

Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law

Plaintiff, the beneficiary of a testamentary trust, entered a long-term care facility in 2012, at which time she applied for financial and medical assistance under Medicaid. The Department of Social Services denied the application for Medical benefits, finding that Plaintiff’s assets, including the trust, exceeded the relevant asset limits. A hearing officer upheld the department’s denial. Plaintiff appealed, arguing that the trust was not an asset available to her as defined by relevant Medicaid regulations. The trial court dismissed Plaintiff’s appeal. The Supreme Court reversed, holding that the testator intended to create a discretionary, supplemental needs trust and, therefore, the trust corpus and income may not be considered to be available to Plaintiff for the purpose of determining eligibility for Medicaid benefits. View "Pikula v. Dep’t of Social Servs." on Justia Law

Via Christi seeks an upward adjustment of the capital-asset depreciation reimbursement paid to its predecessor hospitals under a since curtailed Medicare regulation. Via Christi argues that it received St. Francis’s and St. Joseph’s assets at a lower value, i.e., more depreciated, than was reflected in the Secretary’s earlier depreciation reimbursements. As the hospitals’ successor-in-interest, Via Christi thus seeks additional reimbursements to cover the proportional Medicare share of the depreciation. The court concluded that the Secretary reasonably interpreted the bona fide sale requirement as limited to arm’s length transactions between economically self-interested parties. The Secretary concluded that St. Francis’s transfer of its assets to Via Christi was not an arm’s-length transaction in which each party sought to maximize its economic benefit. The court concluded that the Secretary's determination was supported by substantial evidence, and was not arbitrary, capricious or otherwise unlawful. In this case, Via Christi is not entitled to additional depreciation reimbursement in the absence of a qualifying transaction. View "Via Christi Hosp. Wichita v. Burwell" on Justia Law