Justia Government & Administrative Law Opinion Summaries

The Department of Veterans Affairs promulgated a rule that purported to eliminate certain procedural and appellate rights for veterans appearing before the Board of Veterans’ Appeals. The National Organization of Veterans’ Advocates (NOVA) sought review. During the course of review it became clear that the new rule was invalid; the VA made assurances to NOVA and to the Federal Circuit about how the matter would be handled pending resolution. It later became clear that these assurances were not honored by the VA. The Federal Circuit ordered the VA to show cause why it should not be sanctioned. The VA, conceding error, provided a detailed remedial plan. After clarifications, NOVA indicated its satisfaction with, and agreement to, the plan, under which the VA agreed to notify relevant claimants before the Board, to vacate the affected Board decisions, and to provide affected claimants with a new hearing even if relevant deadlines would otherwise have expired. The Federal Circuit approved the plan and did not enter sanctions. View "Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs" on Justia Law

Mingo Logan challenged the award of benefits to claimant under the Black Lung Benefits Act (BLBA), 30 U.S.C. 921(c)(4). Because the court concluded that the ALJ did not in fact apply rebuttal limitations to Mingo Logan, and the Board affirmed the ALJ's analysis, the court did not reach Mingo Logan's challenge to the standard announced by the Board to rebut the section 921(c)(4) presumption of entitlement to benefits. The court affirmed the Board's award of benefits because it also found that Mingo Logan's other challenges to the ALJ's factual findings lacked merit. Accordingly, the court denied the petition for review. View "Mingo Logan Coal Co. v. Owen" on Justia Law

Claimant was awarded benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901-945. At issue was whether the awards of attorneys' fees properly reflected market-based evidence of counsel's hourly rate, as required by the lodestar analysis in Hensley v. Eckerhart. The court held that neither the ALJ nor the BRB abused its discretion in concluding that counsel provided sufficient market-based evidence of rates, and that the number of hours billed for attorneys' services reasonably reflected the work completed. The court also held that the award of fees for work performed by certain legal assistants was not supported fully by the record, and modified that award accordingly. View "Eastern Associated Coal Corp. v. DOWCP" on Justia Law

Plaintiff, a recipient of Supplemental Security Income (SSI) benefits, appealed from the district court's judgment sua sponte dismissing his amended complaint under 28 U.S.C. 1915(e)(2)(B). Plaintiff sought an Order to Show Cause, a temporary restraining order, and a preliminary injunction enjoining defendants from levying against his SSI benefits to enforce a child support order. At issue was whether 42 U.S.C. 659(a) authorized levy against SSI benefits provided under the Social Security Act, 42 U.S.C. 301 et seq., to satisfy the benefits recipient's child support obligations. The court concluded that SSI benefits were not based upon remuneration for employment within the meaning of section 659(a); section 659(a) did not preclude plaintiff's claims; and the Rooker-Feldman doctrine and the exception to federal jurisdiction for divorce matters did not preclude the district court from exercising jurisdiction over the matter. Accordingly, the court vacated the judgment to the extent the district court dismissed plaintiff's claims against the agency defendants and remanded for further proceedings. However, the court affirmed the portion of the judgment dismissing plaintiff's claims against Bank of America because his complaint had not alleged facts establishing that the bank was a state actor for purposes of 42 U.S.C. 1983. View "Sykes v. Bank of America" on Justia Law

After the court reversed and remanded for an award of social security disability benefits to plaintiff, plaintiff moved for an award of attorney's fees and costs under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The court concluded that the district court abused its discretion in denying the fees where the government's underlying action was not substantially justified in this case. Accordingly, the court reversed the district court's denial of plaintiff's motion and remanded for an award of fees and costs. View "Meier v. Colvin" on Justia Law

Gentiva, a provider of home healthcare services, contended that the Secretary violated the Medicare statute, 42 U.S.C. 1395ddd(f)(3), by delegating to an outside contractor the authority to determine whether Gentiva's Medicare reimbursement claims exhibited a "sustained or high level of payment error." The court affirmed the district court's decision to defer, under Chevron deference, to the Secretary's reasonable interpretation of section 1395ddd(f)(3). The court also agreed with the district court that section 1395ddd(f)(3) precluded the court from reviewing the merits of the "sustained or high level of payment error" determination. Accordingly, the court affirmed the judgment in its entirety. View "Gentiva Healthcare Corp. v. Sebelius" on Justia Law

Plaintiff appealed the denial of her application for Social Security disability benefits, disability insurance benefits, and supplemental security income. The court concluded that substantial evidence supported the ALJ's determination that plaintiff's doctor's opinion was inconsistent with the treatment record and thus not entitled to controlling weight; substantial evidence supported the ALJ's determination that plaintiff's impairments did not meet or equal a medical listing; because the residual functioning capacity (RFC) finding was supported by substantial evidence, it was proper for the ALJ to consider testimony of a vocational expert that was premised on the RFC; and the ALJ did not err in determining plaintiff's credibility. Accordingly, the court affirmed the district court's affirmance of the denial of benefits. View "Myers v. Astrue" on Justia Law

Oaks, a nursing facility, initiated contempt proceedings against the government because the government failed to abide by the district court's order enjoining the government from acting in accordance with a Notice of Termination relative to Oak's Medicare and Medicaid Provider Agreement. The court vacated the finding of contempt and reversed the judgment of the district court, concluding that the government complied with the injunction by delaying effectuation of the termination notice. View "Oaks of Mid City Resident Council v. Sebelius, et al." on Justia Law

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

States participating in Medicaid in a managed care environment are required to make, at least every fourth month, supplemental “wraparound” payments to federally-qualified health centers (FQHCs) equal to the difference between a rate set by statute multiplied by the number of Medicaid patient encounters, and the amount paid to FQHCs by managed care organizations (MCOs) for all Medicaid-covered patient encounters, 42 U.S.C.1396. Concerned that gaps in FQHC claim verification led to overpayments, the New Jersey Department of Human Services changed its calculation: instead of basing wraparound payments solely on the number of Medicaid encounters and total MCO receipts as self-reported by FQHCs, the state would rely on data reported by MCOs absent receipt of certain additional data from the FQHCs. Because MCOs report only encounters that they have approved and paid, prior MCO payment would be a prerequisite to wraparound reimbursement under the new system. An association of FQHCs sued, claiming that the change violated their due process rights as well as state and federal law, resulting in budget shortfalls. The district court granted the association summary judgment and a preliminary injunction. The Third Circuit affirmed the holding that the requirement that wraparound payments be contingent on prior MCO payment violated the Medicaid statute’s requirement that FQHCs receive timely full wraparound payment for all Medicaid-eligible claims. View "NJ Primary Care Assoc. v. NJ Dep't of Human Servs." on Justia Law