Justia Government & Administrative Law Opinion Summaries

The issues this case presented for the Supreme Court were whether ORS 243.303(2) (which requires local governments to make available to retired employees, "insofar as and to the extent possible," the health care insurance coverage available to current officers and employees of the local government,) created a private right of action for the enforcement of that duty; or, if not, whether the Court should (under its common-law authority) provide such a right of action. The Court of Appeals held that the statute did not expressly or impliedly create a private right of action, and it considered that conclusion to be dispositive of plaintiffs' claim for relief. The Supreme Court also concluded that the statute did not expressly or impliedly create a private right of action for its enforcement. However, where a statute imposes a legal duty, but there is no indication that the legislature intended to create (or not to create) a private right of action for its enforcement, courts must (if such relief is sought) determine whether the judicial creation of a common-law right of action would be consistent with the legislative provision, appropriate for promoting its policy, and needed to ensure its effectiveness. Analyzing the duty imposed on local governments by ORS 243.303(2) under that standard, the Court declined to create an additional common-law right of action for its enforcement because: (1) plaintiffs failed to identify a cognizable common-law claim for relief whose creation is appropriate and necessary to effectuate the legislature's purpose; (2) a declaratory judgment and supplemental relief were adequate to enforce the statutory duty; and (3) a significant change in existing law would result from judicial creation of a tort claim permitting the recovery of noneconomic damages in the circumstances here, and there is no other need to create a common-law tort claim. View "Doyle v. City of Medford" on Justia Law

Petitioner Scott Anderson appealed a superior court order granting summary judgment to respondents, the Executive Director of the New Hampshire Retirement System (NHRS) and the State, and denying summary judgment to Anderson and three other petitioners. Anderson was a retired Plaistow police officer who was a member of the NHRS, and the only petitioner who appealed. After retiring, he worked part-time as a police officer in Plaistow, Atkinson, and Hampstead. When he retired, RSA 100-A:1, XXXIV provided that "[p]art-time," for the purposes of employing a NHRS retiree meant, "employment by an [NHRS] employer" of no more than "32 hours in a normal calendar week," or if the work hours in some weeks exceeded thirty-two hours, then no more than "1,300 hours in a calendar year." Anderson understood that provision "to mean [he] could work potentially up to 32 hours per week for Plaistow, up to 32 hours per week for Atkinson, and up to 32 hours per week for Hampstead." In 2012, the legislature amended RSA 100-A:1, XXXIV to provide that "[p]art-time," for the purposes of employing a NHRS retiree, "means employment during a calendar year by one or more employers of the retired member which shall not exceed 32 hours in each normal calendar week," or if the work hours in some weeks exceed thirty-two hours, then no more than 1,300 hours in a calendar year. In August 2012, Anderson and three other NHRS retirees petitioned for declaratory and injunctive relief. Anderson contended that to apply the 2012 amendment to him violated Part I, Article 23 of the New Hampshire Constitution. Specifically, he asserted that, as a result of the 2012 amendment, he would be "restored to service" under RSA 100-A:7 (2013) and, thus, lose his retirement benefits if he worked more than "[p]art-time" as defined in RSA 100-A:1, XXXIV. Under RSA 100-A:7, when a retiree is "restored to service," his "retirement allowance shall cease," and he "shall again become a member of the [NHRS] and . . . shall contribute" to that system. Anderson contended that the 2012 amendment substantially impaired his vested right because its effect is to restore him to service if he works more than thirty-two hours per week or 1,300 hours per year for any combination of NHRS employers, even if he did not work full-time hours for any single NHRS employer. Thereafter, the petitioners moved for summary judgment, and the State cross-moved for summary judgment. The trial court ruled in the State's favor, and Anderson's appeal followed. Finding no reversible error, the Supreme Court affirmed. View "Anderson v. Executive Director, New Hampshire Retirement System" on Justia Law

Darlene Devlin had been married for more than 40 years when her husband died, then a civilian federal employee for nearly six years, entitling Darlene to Basic Employee Death Benefits (BEDB), 5 U.S.C. 8442(b)(1)(A), 8466(b). However, Darlene died before she could sign or file an application for BEDB. Her son, Devlin, completed, signed, and filed an application for BEDB on her behalf. The Office of Personnel Management (OPM) denied the application, concluding that Darlene was not entitled to BEDB because she failed to submit an application for those benefits before her death. Devlin argued that his appointment as a co-administrator of his mother’s estate permitted him to sign and file the application for BEDB on her behalf. The e Merit Systems Protection Board and Federal Circuit affirmed the denial.View "Devlin v. Office of Pers. Mgmt." on Justia Law

Charlotte Perkins appealed a Circuit Court’s decision to dismiss her appeal claiming the Mississippi Department of Human Services (DHS) wrongly deprived her of receiving food stamps and that such deprivation was the result of a DHS hearing in which Perkins was deprived of procedural safeguards. The appeal was dismissed for lack of jurisdiction. The circuit court found no statutory authority created a right of appeal to the circuit court from an administrative decision by DHS regarding food-stamp qualification(s) or disqualification(s). The Supreme Court found that the circuit court was correct in dismissing the case for lack of jurisdiction. Mississippi caselaw provides, however, that where there is no statutory scheme for appeal from an agency decision and the injured party does not have a full, plain, complete and adequate remedy at law, the chancery court has jurisdiction for judicial review of the agency decision. Accordingly, the case was reversed and remanded with instructions to the circuit court to transfer the case to the Monroe County Chancery Court. View "Perkins v. Mississippi Department of Human Services" on Justia Law

Groups of hospitals in the Cincinnati area and in rural Iowa, challenged the Secretary of Health and Human Services’ calculation of how much to pay those hospitals for inpatient services under Medicare Part A. The hospitals objected to the agency’s decision to include in the calculation the hours associated with a short-term disability program paid from a hospital’s general funds through its payroll system and a program offering a full-time salary for part-time weekend work. The district court entered summary judgment for the Secretary. The Sixth Circuit affirmed, finding the agency’s interpretation was not arbitrary or capricious and referring to “the most completely impenetrable texts within human experience,” statutes and regulations that “one approaches ... at the level of specificity herein demanded with dread.” View "Atrium Medical Ctr. v. U.S. Dep't of Health & Human Servs." on Justia Law

This appeal related to petitioner Linda Hendron's third application for disability benefits. She filed the first in 1999 and was denied on the merits. She applied again in 2001, and was denied on res judicata grounds. This latest application was filed in 2009, claiming a disability onset date of November 1, 1995. After the Social Security Administration denied the claim on res judicata grounds, requested a hearing before an administrative law judge (ALJ). The ALJ heard testimony from petitioner, and considered 19 medical exhibits that had not been submitted in petitioner's previous applications. The ALJ issued a written decision finding that petitioner was not disabled before the expiration of her insured status. The Appeals Council denied review, and petitioner took her appeal to the district court, which concluded the ALJ failed to develop a sufficient record on which to base a disability decision. The Commissioner appealed the district court's decision. Finding ample evidence in the record that the ALJ developed the record on which he denied petitioner's claim, the Tenth Circuit reversed and remanded the case for entry of judgment in favor of the Commissioner. View "Hendron v. Colvin" on Justia Law

Relator filed a qui tam action against Planned Parenthood, alleging that it violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, and the Iowa False Claims Act (IFCA), Iowa Code Ann. 685.1-.7, by submitting false or fraudulent claims for Medicaid reimbursement. The district court dismissed the complaint under Rule 9(b). The court concluded that relator has pled sufficiently particularized facts to support her allegations that Planned Parenthood violated the FCA by filing claims for (1) unnecessary quantities of birth control pills, (2) birth control pills dispensed without examinations or without or prior to a physician's order, (3) abortion-related services, and (4) the full amount of services that had already been paid, in whole or in part. The court affirmed the dismissal of relator's claim that Planned Parenthood violated the FCA by instructing patients who experienced abortion-related complications to give false information to medical professionals at other hospitals, causing those medical professionals to unknowingly file claims for services performed in connection with abortions. Because relator failed to provide a factual basis for her knowledge of these alleged false claims, the court was unable to infer that false claims were submitted. Further, the court affirmed the dismissal of relator's upcoding claim. The court's holding with respect to the Rule 9(b) issue, however, should not be read as in any way expressing a view on Planned Parenthood's Rule 12(b)(6) arguments. View "Thayer v. Planned Parenthood" on Justia Law

Scrogham, then age 53, applied for disability benefits under the Social Security Act, submitting medical conditions including degenerative discs, spinal stenosis, sleep apnea, hypertension, arthritis, atrial fibrillation and restless leg syndrome. An ALJ denied the application and the Appeals Council denied his request for review. The district court affirmed, holding that the ALJ did not err in giving less weight to the opinion of a treating physician than to the opinions of nontreating physicians, that the ALJ permissibly found Scrogham not to be credible and that the ALJ’s decision otherwise was supported by substantial evidence. The Seventh Circuit reversed and remanded. The ALJ impermissibly ignored a line of evidence demonstrating the progressive nature of Scrogham’s degenerative disc disease and arthritis and inappropriately undervalued the opinions of Scrogham’s treating physicians, whose longitudinal view of Scrogham’s ailments should have factored prominently into the ALJ’s assessment of his disability status. Even considering only “the snapshots of evidence that the ALJ considered,” that limited evidence does not build the required logical bridge to her conclusions. The ALJ apparently misunderstood or at least considered only partially some of the evidence about Scrogham’s daily activities, rehabilitation efforts and physicians’ evaluations. View "Scrogham v. Colvin" on Justia Law

Two nurses, formerly employed by Momence, alleged that, during their employment at Momence, they uncovered evidence that Momence knowingly submitted "thousands of false claims to the Medicare and Medicaid programs” in violation of the False Claims Act (FCA) and Illinois Whistleblower Reward and Protection Act. They filed a qui tam action on behalf of the government and alleged that Momence retaliated against them for reporting its fraud. A jury awarded the government more than $3 million in compensatory damages and imposed about $19 million in fines for the qui tam claims. Pursuant to the FCA, the compensatory damages were trebled to more than $9 million. The district court set aside the fines as violating the Excessive Fines Clause of the Eighth Amendment. The jury also awarded the nurses $150,000 and $262,320, respectively, on their retaliation claims. The Seventh Circuit vacated. Both claims failed as a matter of law. Rejecting claims of “worthless services” and false certification, the court stated that, at best, a reasonable jury might be able to say that some of Momence’s claims were false, but that is not enough to satisfy the burden of proof. The employment of one nurse was not terminated, the other’s employment was terminated for an unrelated matter. View "Absher v. Momence Meadows Nursing Ctr., Inc." on Justia Law

An MRI had revealed plaintiff’s herniated disc in 1998. The medical record is blank from then until 2007, when she complained to an emergency room physician that she had been suffering from lower-back pain. She mentioned the herniated disc, and was prescribed Vicodin. Almost a year later she was examined by an anesthesiologist who specializes in pain management, who prescribed Lyrica. The plaintiff subsequently sought disability benefits and testified that her pain, combined with the drowsiness induced by the pain medication, limited her daily activities to eating, caring for her dogs, taking naps, and watching television. The anesthesiologist opined that the plaintiff was “unable to work” because of “lumbar disc protrusion.” Another anesthesiologist reviewed her records, and concluded that she was able to work full time despite the diagnoses of lumber disk herniation, lumbar radiculopathy, and myofascial pain, and a Social Security field officer’s observation that “she had a hard time sitting in the chair during the interview.” He did not identify evidence supporting his conclusion. The district court affirmed the agency’s denial of benefits. The Seventh Circuit remanded, stating that the plaintiff deserves a more careful evaluation than she has received to date. The ALJ’s critical error was failure to obtain a medical report on the results of a 2010 MRI. View "Goins v. Colvin" on Justia Law