Justia Government & Administrative Law Opinion Summaries

Two certified questions came before the Delaware Supreme Court in this case. The questions centered on whether lease provisions for apartments of a public housing authority that restrict when residents, their household members, and guests may carry and possess firearms in the common areas violate the right to keep and bear arms guaranteed by Article I, Section 20 of the Delaware Constitution. The United States Court of Appeals for the Third Circuit found no violation of the Second Amendment or the Delaware Constitution. The certified questions were: (1) whether, under the Delaware Constitution, a public housing agency such as the WHA could adopt a firearms policy; and (2) whether under the Delaware Constitution, a public housing agency could require its residents, household members, and guests to have available for inspection a copy of any permit, license, or other documentation required by state, local, or federal law for the ownership, possession, or transportation of any firearm or other weapon, including a license to carry a concealed weapon. The Delaware court answered both questions in the negative. View "Doe, et al. v. Wilmington Housing Authority, et al." on Justia Law

Plaintiffs filed suit against the Secretary of Health and Human Services (HHS) and the Commissioner of the Social Security Administration (SSA) raising constitutional challenges to the Patient Protection and Affordable Care Act (ACA), Pub. L. No 111-148, 124 Stat. 119; raising statutory challenges to actions of HHS and the Commissioner relating to the implementation of the ACA and prior Medical legislation; and attacking the failure of defendants to render an "accounting" that would alter the American people to the insolvency towards which Medicare and Social Security programs were heading. On appeal, plaintiffs challenged the district court's dismissal of their claims. The court rejected plaintiffs' claims that 26 U.S.C. 5000A, which was sustained as a valid exercise of the taxing power, violated the Fifth Amendment's prohibition of the taking of private property without just compensation and violated the origination clause. The court concluded that plaintiffs' substantive attack on the Social Security Program Operations Manual System (POMS) provisions was clearly foreclosed by its decision in Hall v. Sebelius, holding that the statutory text establishing Medicare Part A precludes any option not to be entitled to benefits. The court rejected plaintiffs' second statutory claim attacking an interim final rule. Finally, the court concluded that plaintiffs failed to provide a legal argument for their claims against the Commissioner and Secretary, and therefore, the court lacked jurisdiction over plaintiffs' claim to an "accounting." Accordingly, the court affirmed the judgment of the district court. View "Assoc. Amer. Physicians, et al. v. Sebelius, et al." on Justia Law

Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, against Omnicare, alleging that defendants violated a series of FDA safety regulations requiring that penicillin and non-penicillin drugs be packaged in complete isolation from one another. The court concluded that the public disclosure bar did not divest the district court of jurisdiction over relator's FCA claims. The court concluded that once a new drug has been approved by the FDA and thus qualified for reimbursement under the Medicare and Medicaid statutes, the submission of a reimbursement request for that drug could not constitute a "false" claim under the FCA on the sole basis that the drug had been adulterated as a result of having been processed in violation of FDA safety regulations. The court affirmed the district court's grant of Omnicare's motion to dismiss, holding that relator's complaint failed to allege that defendants made a false statement or that they acted with the necessary scienter. The court also concluded that the district court did not abuse its discretion in denying relator's request to file a third amended complaint. View "United States ex rel. Rostholder v. Omnicare, Inc." on Justia Law

Mary Bell was a disabled person who drew Social Security Insurance benefits and participated in a federally-funded, community-based program operated by the Cabinet for Health and Family Services. When Thomas Bell, Mary’s father, retired and began to draw his Social Security benefits, Mary became eligible for Old Age, Survivor and Disability Insurance. Consequently, Mary was charged $60 per month for her continued program participation. Thomas filed an administrative appeal on Mary’s behalf. The matter ultimately reached the circuit court, which held that Mary could not be charged to participate in the program. Thereafter, the circuit court (1) awarded attorney’s fees against the Cabinet due to the Cabinet’s “egregious government behavior,” and (2) ordered the Cabinet to disclose the personal information of all other participants in the program. The court of appeals reversed. The Supreme Court affirmed, holding that the trial court erred by (1) ordering the payment of attorney’s fees solely for egregious conduct without statutory authorization or a contract providing for such fees; and (2) ordering the disclosure of records of all persons participating in the program without the other persons having filed claims and no class action being certified. View "Bell v. Commonwealth" on Justia Law

In consolidated appeals, petitioners, both recipients of home-based long-term care benefits through Vermont's Medicaid-funded Choices for Care (Choices) program, appealed decisions of the Human Services Board disallowing deductions for personal care services from their patient-share obligation under federal and state Medicaid laws. Upon review of the cases, the Supreme Court concluded that to the extent the services in question were medically necessary, expenses for those services must be deducted from petitioners’ patient-share obligation even if they are of a type generally covered by Medicaid. Furthermore, the Court rejected the State’s claim that the decision of the Department of Disabilities, Aging and Independent Living not to provide the personal care services in question under the Choices program constituted a conclusive finding that the services were not medically necessary. View "In re Brett" on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

The Attorney General for the State of Louisiana brought an action against the defendant pharmaceutical companies alleging, among other things, violations of the Louisiana Medical Assistance Programs Integrity Law (MAPIL). The district court entered a judgment upon the jury's verdict in favor of the Attorney General, finding the defendants' alleged misconduct in marketing certain drugs had violated provisions of MAPIL as it read in November 2003, and awarding civil penalties of $257,679,500.00, $70,000,000.00 in attorney fees, and $3,000,200.00 in costs. The court of appeal affirmed the district court's judgment. After its review, the Supreme Court found the Attorney General failed to establish sufficient facts to prove a cause of action against the defendants under MAPIL because no evidence was presented that any defendant made or attempted to make a fraudulent claim for payment against any Louisiana medical assistance program within the scope of MAPIL. Accordingly, the Court reversed the district court's judgment in favor of the Attorney General. View "Caldwell v. Janssen Pharmaceutical, Inc." on Justia Law

In 2007, the Secretary revamped Medicare's Inpatient Prospective Payment System, updating the diagnostic weighting used to calculate reimbursements for hospitals treating the program's beneficiaries. Plaintiffs sought review of the Secretary's decision regarding a downward prospective adjustment for hospital-specific rate payments. The district court concluded that the statutory scheme was ambiguous and deferred to the Secretary's reasonable interpretation of the adjustment provisions. Applying Chevron deference, the court agreed with the district court's conclusion that the statutory scheme was ambiguous and unclear. Accordingly, the court affirmed the judgment of the district court. View "Adirondack Medical Center, et al. v. Sebelius" on Justia Law

Four cases challenged the constitutionality of Senate Bill (SB) 822, which was passed by the 2013 Legislative Assembly during its regular session, and SB 861, passed during a special session in October 2013. Both bills changed certain statutory provisions of the Public Employees Retirement System (PERS) and, in doing so, affected the retirement benefits of some current and former public employees. Central Oregon Irrigation District (the District), an intervenor in these proceedings, filed a motion to disqualify the sitting judges of the Oregon Supreme Court from hearing these cases. The District also filed a separate motion to disqualify the circuit judge appointed by the Supreme Court to serve as a special master for purposes of conducting evidentiary proceedings and preparing recommended findings of fact. Because disqualification would leave petitioners without a tribunal to decide their claims, and in light of the legislature's express grant of jurisdiction to the Supreme Court to decide challenges to the 2013 PERS legislation, the Court concluded that the rule of necessity applied and that the members of Court were not disqualified from deciding these cases because of any interest in the proceeding. Further, the application of the rule of necessity in these circumstances was not a denial of due process. Central Oregon Irrigation District's motions to disqualify the members of the Supreme Court and the Special Master on this matter was denied. View "Moro v. Oregon" on Justia Law

Arnold and Vesta Melby were trustors of separate irrevocable trusts. Both Arnold and Vesta received Medicaid benefits. After the Melbys’ deaths, the Iowa Department of Human Services notified Arnold’s estate that it would seek reimbursement for all Medicaid expenses it had paid on behalf of Arnold and Vesta. The Department then filed an application in the estate seeking a judgment declaring the Melbys had interests in the corpus of their trusts that should be counted as assets available for repayment of the Department’s Medicaid claim. The district court concluded (1) the Melbys’ interests in the trusts were limited to their right to receive the net income from the trusts’ assets, and (2) the Department’s right to recover the Medicaid payments could be enforced against such income, but not against the corpus of the trusts. The Supreme Court reversed, holding (1) the Department’s right to recover Medicaid payments under the facts of this case extended beyond the Melbys’ net income interests; and (2) the district court erred in determining the scope of medical assistance for which recovery was authorized by the general assembly. Remanded. View "In re Estate of Melby" on Justia Law