Justia Government & Administrative Law Opinion Summaries

At issue in this case was services that Maine Medical Center provided to Medicare/Medicaid “dual-eligible” patients, that is, patients covered by both Medicare and the state-administered Medicaid insurance program, MaineCare. The Secretary for the Department of Health and Human Services denied Maine Medical’s claim for partial federal reimbursement of “bad debt” for the fiscal years 2002 and 2003. A “bad debt” is an amount considered to be uncollectible for covered services that may be eligible for federal reimbursement under certain conditions. The Secretary denied reimbursement because Maine Medical had not acquired from MaineCare a state-issued remittance advice to use as proof. The district court affirmed. The First Circuit affirmed, holding that it was not arbitrary and capricious for the Secretary (1) to demand that Maine Medical provide documentation from the State confirming the identity of Medicaid-eligible beneficiaries and qualified Medicare beneficiaries, the amount that is the State’s to pay, and the State’s refusal to pay; and (2) to deny Maine Medical’s reimbursement claims that were unsupported by such documentation. View "Me. Med. Ctr. v. Burwell" on Justia Law

Brian Shaffer, who had severe autism and chemical sensitivities, resided with his mother, Delores Shaffer, who was paid to provide private duty nursing (PDN) care to Brian. In 2011, Brian’s Medicaid coverage was transferred to Coventry Health Care of Nebraska, Inc. When Coventry determined that the nursing services were not medically necessary, Shaffer requested a State fair hearing with the Nebraska Department of Health and Human Services. Coventry participated in the administrative proceedings, at which a hearing officer concluded that the PDN services were not medically necessary. Delores sought judicial review of the order, but the petition did not name Coventry as a respondent. The district court reversed the order of the Department, finding the PDN services that Delores provided to Brian were medically necessary. Coventry appealed. The Supreme Court vacated the order of the district court, holding that Coventry was a “party of record” at the State fair hearing and therefore a necessary party in the subsequent appeal to the district court, and the failure to make Coventry a party to the appeal deprived the district court of jurisdiction.View "Shaffer v. Neb. Dep’t of Health & Human Servs." on Justia Law

Duarte joined the California State Teachers’ Retirement System (CalSTRS) in 1993. He earned 2.023 years of service. He took unpaid personal leave for Duarte for the 1995-1996 school year and unpaid educational leave for 1996-1997 and 1997-1998. Duarte worked one season as a forest firefighter, attended law school, and worked as a paralegal. In 2003, Duarte returned to teaching in Oakland. On his second day he was assaulted and threatened by students. Duarte has not returned to teaching. In 2004, Duarte filed a worker’s compensation claim. After four evaluations, he entered into a stipulated settlement that indicated a “serious dispute” regarding the scope of Duarte’s disability. In 2006, Duarte sought social security disability benefits; it was determined that he was disabled from the date of the 2003 incident and became eligible for monthly disability benefits in 2005. Duarte’s student loans were forgiven. In 2008, Duarte sought CalSTRS disability retirement benefits. CalSTRS repeatedly asked Duarte to submit medical records and other documents. An ALJ upheld denial of Duarte’s application because he refused to complete the independent medical evaluation ordered under Education Code 24103 (b),. The trial court and court of appeal affirmed, rejecting an argument that the doctrine of collateral estoppel bars CalSTRS from relitigating his disability because several other state agencies have found him to be disabled.View "Duarte v. CA. State Teachers' Ret. Sys." on Justia Law

This case stemmed from plaintiffs' request for tuition assistance for their daughter under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. Plaintiffs filed suit challenging the State Review Officer's (SRO) decision to deny reimbursement for private schooling and the district court reversed in part and ordered the school district to reimburse plaintiffs for May 1, 2009 to May 31, 2009, and for the 2009-2010 school year. Because the court deferred to the SRO's determination that plaintiffs did not meet their obligation to demonstrate the appropriateness of their daughter's placement, plaintiffs cannot recover under the IDEA for any portion of the time she was placed at Family Foundation. Accordingly, the court reversed the judgment of the district court and remanded for entry of an order affirming the SRO's decision.View "Hardison v. Bd. of Ed. Oneonta City Sch. Dist." on Justia Law

Plaintiffs, parents of nine-year-old E.L., who has autism, initiated an administrative complaint against the school board under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. An ALJ determined that the school board violated the IDEA by failing to provide E.L. with required speech therapy but, in all other respects, she was provided an appropriate special education program. The school board appealed and the state review officer reversed the ALJ's conclusion regarding the speech therapy. Plaintiffs then filed a civil action seeking judicial review of the administrative proceedings. The court concluded that E.L. did not exhaust her administrative remedies and that the school board did not violate the IDEA where the review officer's conclusion that E.L. received the speech therapy mandated by her individualized education program is supported by the evidence. Accordingly, the court affirmed the judgment.View "E. L. v. Chapel Hill-Carrboro Board of Education" on Justia Law

Dillip Mullings owned a NAPA auto-parts store in Seward called Resurrection Bay Auto Parts, Inc. Mullings hired Dennis Alder to be the store manager, a position Alder held from 2006 to 2010, when he was terminated. Alder did not keep a time card, but it was undisputed that he typically worked from 6:30 a.m. to 6:30 p.m. Monday through Friday. The extent of Alder’s overtime was not at issue on appeal; Mullings conceded that Alder worked over 40 hours a week. It was also undisputed that Alder was paid a salary and did not receive overtime pay. Once terminated, Alder sought unemployment compensation from the State. The Department of Wage and Hour determined that Alder was entitled to overtime pay, and attempted to negotiate a settlement on his behalf with Resurrection Bay. Alder later sued seeking overtime pay. The employer claimed the Alder was exempt from the overtime laws, but the superior court found he was not and awarded overtime pay and liquidated damages. The employer appealed. Because the employer failed to show that the manager satisfied all four requirements of the overtime laws’ exemption for executive employees, the Supreme Court affirmed the finding that the manager was owed overtime pay under Alaska and federal law. Furthermore, the Court affirmed the superior court’s award of liquidated damages, because the employer failed to carry his burden of demonstrating by clear and convincing evidence that he acted in good faith.View "Resurrection Bay Auto Parts, Inc. v. Alder" on Justia Law

Respondent Kimberly Legette was employed by Appellant Nucor Corporation from 1998, through 2010. Nucor terminated Legette's employment after she failed a random on-site drug test in violation of Nucor's drug policy. Although Legette obtained an independent drug test, which tested negative for drugs, she was fired from her job at Nucor based on the two positive drug test results. Legette subsequently applied for unemployment benefits. Nucor requested that Legette be denied unemployment benefits, contending she was statutorily ineligible to receive them because she was fired for violating Nucor's drug policy by testing positive for drugs. This direct appeal from the Administrative Law Court (ALC) presented for the Supreme Court's review a threshold procedural challenge to appealability, and substantively, to the awarding of unemployment benefits to an employee terminated for failing a drug test administered by a laboratory that was not properly certified. Because this appeal arose from a final resolution of all issues, the Court found the matter is appealable. The Court affirmed the ALC.View "Nucor v. SCDEW" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits, asserting that she had difficulty breathing and painful joints. The court concluded that the ALJ did not err in giving greater weight to a medical expert's testimony than to the testimony of other experts; the ALJ did not err in not seeking clarifications to plaintiff's expert's opinion where the ALJ expressly refused to give the expert opinion "great weight" and then explaining its reasons for doing so; the ALJ's decision was based on substantial evidence; the ALJ considered plaintiff's obesity and made findings about the demands of her prior work as a file clerk; and the ALJ did not err in relying on the vocational expert's testimony that plaintiff's mental and physical condition, age, and education support her ability to perform "unskilled occupations." Accordingly, the court affirmed the denial of benefits.View "Grable v. Colvin" on Justia Law

Plaintiffs had been firefighters for the city of Portland when they suffered disabling injuries. The city's charger required it to provide disability benefits to its police and fire employees who suffer injuries in the course of their employment that render them “unable to perform [their] required duties,” with a minimum disability benefit of 25 percent of the employee’s base pay, “regardless of the amount of wages earned in other employment.” The city originally determined that plaintiffs’ disabilities made them unable to perform their “required duties” and paid them disability benefits. Years later, however, the city created new job assignments that included some of the duties within the job classifications that plaintiffs had held when they were injured. Because the city gave the new job assignments the same job classifications that plaintiffs had previously held, the city maintained that plaintiffs were no longer disabled. The city therefore required plaintiffs to return to work and discontinued paying them the minimum disability benefit. Plaintiffs sued the city for breach of contract, and the circuit court granted summary judgment for the city. The Court of Appeals affirmed in part and reversed in part. After its review, the Supreme Court concluded the city charter’s use of the term “required duties” meant core duties. Because there was a genuine issue of material fact as to whether the duties of plaintiffs’ new job assignments were the “required duties” for the job classifications that plaintiffs previously held, the Court further concluded that the circuit court erred in granting summary judgment in favor of the city.View "Miller v. City of Portland" on Justia Law

To address economic conditions and projections demonstrating a severely underfunded plan, the Colorado General Assembly approved measured designed to protect present and future retirees by providing an adequately pension program. This appeal centered on changes made to the annual cost of living (COLA) that applied to increase each retiree's vested base retirement benefit. Plaintiffs in this case were retired public employees who contended that they had a contract with the State entitling each of them, upon retirement, to have their base pension benefit annually adjusted by the specific COLA formula in existence at the time they were eligible to retire, for the rest of their lives without change. The district court ruled they had no such contract right to an unchangeable COLA formula. The court of appeals disagreed, finding the retirees had a contract right to the formula in place at the time of eligibility for retirement or actual retirement based on the so-called "public policy exception," and remanded for further review to determine whether the legislature's act violated the Contract Clauses of the federal and state constitutions. The Colorado Supreme Court disagreed with the court of appeals, and agreed with the district court. The appellate court's judgment was reversed that the district court's judgment reinstated.View "Justus v. Colorado Public Employee's Retirement Association Pension Plan" on Justia Law