Justia Government & Administrative Law Opinion Summaries

Plaintiff, the Chapter 7 trustee for the bankruptcy estate of BioniCare Medical Technologies, contested determinations of the Medicare Appeals Council (MAC) refusing to provide coverage for the BIO-1000, a device to treat osteoarthritis of the knee. Plaintiff alleged that the Secretary improperly used the adjudicative process to create a policy of denying coverage for the BIO-1000, that the MAC's decisions were not supported by substantial evidence, and that the MAC's decisions were arbitrary and capricious on account of a variety of procedural errors. The court rejected those contentions and affirmed the judgment of the district court.

The Employment Appeal Board (Board) denied Willie Hall's application for unemployment insurance benefits. Hall filed a petition for judicial review. The district court affirmed the decision of the Board and assessed costs against Hall. The court of appeals affirmed. The Supreme Court reversed the portion of the judgment as it related to court costs, holding (1) pursuant to Iowa Code 96.15(2), any individual claiming benefits shall not be charged fees of any kind, including court costs, in a proceeding under the statute by a court or an officer of the court; and (2) therefore, the district court erred by requiring that Hall pay court costs.

A psychologist challenged the government's claim that he had over-billed Medicare and owed the government more than $600,000 in overpayments. At a hearing on the claim, the doctor presented extensive evidence, but the government neither appeared nor presented argument or advocacy, either written or in person. The ALJ concluded that the overpayment was actually $5,434.48. The doctor moved, under the Equal Access to Justice Act, 5 U.S.C. 504(a)(1), to recoup tens of thousands of dollars in attorneys' fees and expenses incurred in fighting the claim. His request was denied by an administrative appeals council and the district court based on their conclusion that the hearing before the ALJ was not an adversary adjudication, as is required for a fee award under the EAJA. The Third Circuit affirmed denial, finding that the government did not engage in purposeful advocacy.

This case addressed the effect of a pooled special-needs trust created by an over-65-year-old beneficiary on his medicaid benefits. The Center for Special Needs Trust Administration appealed a summary judgment in favor of the North Dakota Department of Human Services. Invoking 42 U.S.C. 1983 and the Constitution's Supremacy Clause, the Center alleged that North Dakota's demand for reimbursement and its state regulations violated a paragraph of the Medicaid Act, 42 U.S.C. 1396p(d)(4)(C). The court held that the district court properly determined that section 1396p(d)(4)(C) afforded the Center a right of action under section 1983; that North Dakota did not waive its claim to recover for reimbursements and should not be estopped from making that claim; that the Center's claim was without merit; and that preemption did not apply.

Plaintiff appealed the district court's decision affirming the Commission's denial of her application for disability insurance benefits and supplemental security income under the Social Security Act (SSA), 42 U.S.C. 301 et seq. The court held that the ALJ did not err in weighing the evidence as she did or finding that plaintiff's testimony regarding the severity of her impairment was not credible. Although the ALJ erred in failing to give germane reasons for rejecting the lay witness testimony, such error was harmless given that the lay testimony described the same limitations as plaintiff's own testimony, and the ALJ's reasons for rejecting plaintiff's testimony applied with equal force to the lay testimony. Applying the principles set forth in the court's social security cases, as well as in Shinseki v. Sanders, the court upheld the ALJ's decision as supported by substantial evidence.

This appeal arose from the district court's order granting final judgment to the United States upon equitable claims of payment by mistake of fact and unjust enrichment against Tuomey arising out of alleged violations of the Social Security Act, 42 U.S.C. 1395nn, (the Stark Law), and awarding damages plus pre- and post-judgment interest. Because the court concluded that the district court's judgment violated Tuomey's Seventh Amendment right to a jury trial, the court vacated the judgment and remanded for further proceedings. Because the court was remanding the case, the court also addressed other issues raised on appeal that were likely to recur upon retrial.

Pooled Advocate Trust, Inc. (PATI), the managing corporation for a Medicaid pooled trust, brought a declaratory judgment action on Medicaid eligibility issues associated with the trust and named the South Dakota Department of Social Services (DSS) as a necessary party. The circuit court granted declaratory judgment for PATI. Fred and Gladys Matthews transferred assets to the pooled trust. When the Matthews subsequently applied for Medicaid long-term care benefits, DSS imposed a penalty period because they were over age sixty-five at the time of the transfers. PATI petitioned for further relief, seeking a declaration that DSS could not impose penalty periods for transfers made by pooled trust beneficiaries age sixty-five or older. The circuit court granted PATI's petition. The Matthews also appealed DSS's application of a penalty period, but an ALJ upheld the decision and another circuit court affirmed. DSS appealed the circuit court's order granting PATI's petition and the Matthews appealed the other circuit court's affirmance of the ALJ's ruling. The Supreme Court affirmed the administrative appeal and reversed the declaratory judgment, holding that transfers of assets into pooled trusts by beneficiaries age sixty-five or older may be subject to a transfer penalty period for Medicaid eligibility purposes.

Plaintiff appealed the district court's order affirming the Commissioner's denial of his application for supplemental security income benefits. Specifically, he objected to the ALJ's finding, without considering the testimony of a vocational expert, that plaintiff was able to engage in gainful activity. The court concluded that the ALJ erred by relying solely on the guidelines to determine plaintiff was "not disabled." Because the ALJ determined that plaintiff suffered from severe mental impairments, the ALJ should have consulted a vocational expert in determining whether plaintiff had the residual functional capacity to perform other jobs that existed in significant number in the national economy. Accordingly, the court reversed and remanded for further proceedings.

Alabama sued CMS claiming that it violated the federal Administrative Procedures Act (APA), 5 U.S.C. 500-596, 701-706, by issuing - without notice and an opportunity for public comment - an October 28, 2008 letter to state health officials (SHO letter). The district court held that the SHO letter constituted a substantive administrative rule issued without the notice-and-comment procedures mandated by the APA. Because the district court did not abuse its discretion in denying injunctive relief in addition to vacating the SHO letter, and because Alabama's remaining claims were unripe, the district court's judgment was affirmed.

A civilian employee of the Department of Defense retired in 2007 then served as a re-employed annuitant for a two-year term ending January 3, 2009. Like many Department employees, he was subject to the National Security Personnel System, and eligible for performance-based bonuses and salary increases until the system was repealed in 2009. He qualified in 2008, but was ineligible for a salary increase because of his two-year contract; by regulation, the effective date of any salary increase would be the first day of the first pay period on or after January 1. The Department denied a bonus, arguing that the effective date was the same as the effective of a salary increase. The employee argued that the effective date should be either the end of the appraisal period (September 30, 2008) or the first day of the following year. In his class action under the Little Tucker Act, 28 U.S.C. 1346, the district court ruled in favor of the Department. The Federal Circuit affirmed, holding that the court had jurisdiction under the Act and deferring to the agency's interpretation of its own regulation.