Justia Government & Administrative Law Opinion Summaries

Appellant Valerie Joy Tronnes appealed a judgment that affirmed the Job Service of North Dakota's decision to deny her claim for unemployment benefits. In 2002, Appellant began working part-time at the Wal-Mart Vision Center. In 2010, Appellant received her paycheck (via a debit-card style card), and purchased a few items at Wal-Mart's customer service center. The amount of the purchase was mistakenly credited to Appellant's account by a different employee rather than deducted, which resulted in a substantial benefit to Appellant. Appellant met with the vision center manager about the extra money on her card, but later testified she believed the amount to be correct. The store gave Appellant the option of resigning as a result of her spending the extra money, but believed the paid time off she was given ( a "D-day"-- so named to give Appellant a day to decide whether to remain employed at Wal-Mart) meant she would be fired soon. Store management negotiated a payment plan for Appellant to repay the amount she was credited and allowed her to return to work. Ultimately the "repayment plan" took the form of the store withholding Appellant's subsequent paychecks to cover the indebtedness. Appellant did not report to work after that payday, and subsequently filed for unemployment benefits. The Job Service determined Appellant was ineligible for benefits because she voluntarily quit her job. Upon review, the Supreme Court concluded the evidence in the record supported the Job Service's denial of benefits to Appellant.

In 2007, the HHS Office of Inspector General conducted a nationwide audit to determine whether states were complying with the requirements to reimburse the federal share of recovered AFDC overpayments made before October 1, 1996. The audit found that the Pennsylvania DPW had recovered $10,598,095 in AFDC overpayments from October 1, 1996 through June 30, 2006, but had not reimbursed ACF for the federal share of $5,609,572. DPW appealed a reimbursement request, challenging HHS authority to conduct the audit, but not the audit findings. The appeals board and district court upheld the HHS determination, rejecting an argument that the Personal Responsibility and Work Opportunity Reconciliation Act, 42 U.S.C. 601, designates a procedure established by the Single Audit Act, 31 U.S.C. 7501-7507 as the exclusive audit procedure. Under the SAA, "[e]ach non-Federal entity" that expends at least $300,000 of federal awards in a fiscal year "shall have either a single audit or a program-specific audit made for such fiscal year in accordance with the requirements of this chapter." The Third Circuit affirmed, also rejecting claims under FOIA and that DPW was entitled to retain the federal share of the AFDC overpayment recoveries under substantive law.

This case arose when plaintiffs filed a class action complaint under 42 U.S.C. 1983, alleging that the District was violating the Medicaid Act, 42 U.S.C. 1396 et seq. Since 1993, a consent decree has governed how the District provides "early and periodic screening, diagnostic, and treatment services" under the Act. The District has now asked the district court to vacate that decree on two grounds: that an intervening Supreme Court decision has made clear that plaintiffs lack a private right of action to enforce the Medicaid Act, and that in any event, the District has come into compliance with the requirements of the Act. Because the court concluded that the district court's rejection of one of the District's two arguments did not constitute an order "refusing to dissolve [an] injunction[]" within the meaning 28 U.S.C. 1292(a)(1), the court dismissed the appeal for lack of jurisdiction.

Medicaid recipient John Doe and the State appealed a trial court's decision allowing the State to partially recover the amount of its lien against Doe's settlement with a third party. In 1992 when Doe was nine years old, he was catastrophically injured and paralyzed in an automobile accident.  Due to Doe's injuries, his mother applied for Medicaid on his behalf in 1994.  Doe later brought suit in New York Supreme Court against the alleged third-party tortfeasors.  He also sued New York State Transit Authority (NYSTA) in the New York Court of Claims.  The State of Vermont notified Doe in January 2001 that it claimed a lien against any award, judgment, or settlement stemming from the accident.  In 2001, Doe settled the lawsuit against the third parties for $8.75 million. Doe's suit against NYSTA went to trial, and in 2004, the Court of Claims awarded Doe approximately $42 million and allocated approximately $2.9 million to Doe's past medical expenses from the date of injury to the date of trial. Between the 2001 and 2006 settlements, the State paid approximately $771,111 in medical expenses for Doe's care, in addition to the medical expenses paid up to the date of the first settlement.  The State claimed a lien on the 2006 settlement for $506,810, which was the difference between the amount the State paid for Doe's medical care under Medicaid and the State's share of litigation expenses. Doe sued the State of Vermont, seeking a declaratory judgment that he satisfied the State's lien by partial payment.  On summary judgment, the court concluded that it would not undo the 2001 settlement because it was an accord and satisfaction of all claims paid for medical expenses incurred to that point in time. The State argued on appeal to the Supreme Court that the trial court should have reduced the Court of Claims' findings of future economic damages to present value before making its lien allocation. Upon review, the Supreme Court concluded the parties' agreement resolved the issues surrounding the State's lien on Doe's first settlement, while leaving open the possibility that Doe would obtain a judgment against or settlement with the NYSTA.. On these facts, the Court agreed with the trial court that there was an accord and satisfaction, and that the State accepted $594,209.03. The case was reversed and remanded to recalculate the State's lien against $771,111 in medical expenses and reasonable attorney's fees, but affirmed in all other respects. 

Olivia, born in 2000, apparently healthy, became ill after her first vaccinations. Her condition required extensive hospitalization; she still requires a ventilator and a wheelchair. Her parents filed a petition with the National Vaccine Injury Compensation Program, 42 U.S.C. 300aa-1 to34. Olivia's injuries are not covered by a table of injuries presumed to be caused by vaccines, so the parents were required to show that one of the administered vaccines caused or significantly aggravated her condition. They submitted two reports by experts. The special master identified unanswered questions, but the parents took the position that it was unreasonable to require such detail at the pre-hearing stage. Based on failure to submit a supplemental report and failure to identify a clear theory of causation, the special master dismissed. The claims court affirmed. The Federal Circuit reversed. The special master did not appropriately review the evidence of causation under the summary judgment standard.

The Court granted certiorari in these cases to decide whether Medicaid providers and recipients could maintain a cause of action under the Supremacy Clause to enforce a federal Medicaid law. Since the Court granted certiorari, however, the relevant circumstances have changed. The federal agency in charge of administering Medicaid, CMS, approved the state statutes as consistent with the federal law. In light of the changed circumstances, the Court believed that the question before it was whether, once the agency approved the state statutes, groups of Medicaid providers and beneficiaries could still maintain a Supremacy Clause action asserting that the state statutes were inconsistent with the federal Medicaid law. Given the present posture of the cases, the Court did not address whether the Ninth Circuit properly recognized a Supremacy Clause action to enforce the federal law before the agency took final action. To decide whether these cases could proceed under the Supremacy Clause now that the agency has acted, it would be necessary on remand to consider at least the matters addressed by the Court. Accordingly, the Court vacated the judgment and remanded for further proceedings.

Appellant appealed the district court's affirmance of the Social Security Commissioner's decision to deny him disability benefits and supplemental security income (SSI) under the Social Security Act, 42 U.S.C. 423, 1382. On appeal, defendant claimed that the district court should have found that he submitted a medical report from Dr. Mary Ellen Ziolko to the Appeals Council that was not considered and this case should therefore have been remanded to the Appeals Council for consideration of the new and material evidence. The court agreed that the district court should have determined whether appellant submitted the new evidence under 20 C.F.R. 404.970(b), and thus the court remanded to the district court to make that determination.

Claimant Katherine St. Martin appealed the Employment Security Board's determination that she voluntarily left her job without good cause, disqualifying her from receiving unemployment benefits. She argued on appeal that her decision to quit her job was with good cause because she reasonably believed she would not receive a paycheck for her work. Claimant worked for almost two years for her employer as an assistant financial supervisor, which required her to prepare payroll information weekly. At some point, her employer began to have financial difficulties, and the payroll submission day was moved back to later in the week. The president of Claimant’s employer told claimant not to submit payroll because there were inadequate funds to cover the checks. The president then attempted to borrow money to meet the payroll, which ultimately proved "fruitless." The chief of operations persuaded the president to close the business and pay the employees. Claimant submitted the payroll after being given permission to do so by the president. She then printed the checks, and distributed them to the employees. After the president told claimant that the checks would bounce due to lack of funds, Claimant quit. Upon review, the Supreme Court held that Claimant should not have been penalized for leaving her job when she was told not to expect a paycheck. The president's statement amounted to "good cause."

Mrs. T. was the mother of C.T., a fifteen-year-old boy with severe disabilities. At issue in this case was C.T.'s eligibility for the Department of Health and Human Services' home and community-based waiver program. C.T. was approved for the waiver program but was not receiving services under the waiver when the Department instituted a new regulation that closed the program to children but grandfathered children who were already receiving services. Mrs. T. subsequently filed a grievance with the Department seeking to have C.T. declared waiver-eligible. The Commissioner of the Department accepted the recommendation of an administrative hearing officer that denied the grievance. The superior court affirmed. Mrs. T. appealed, contending that the Department was equitably estopped from denying services because she reasonably relied to her detriment on misinformation she received that C.T. was eligible. The Supreme Court affirmed, holding that because Mrs. T. did not meet her burden to prove that her reliance on the misinformation given to her by the Department caused any detriment to C.T., the hearing officer did not err in finding that the Department was not equitably estopped from declaring C.T. ineligible for a waiver.

ESBC, billing agent for the Fire Department, determined that each of the individual defendants owned a vehicle involved in a collision to which the Fire Department responded and each had insurance coverage, and billed response costs incurred for each collision. The defendants refused to pay and ESBC sought a declaration that defendants were liable under the Comprehensive Environmental Response, Compensation, and Liability Act, 42 U.S.C. 9601. Under CERCLA, the owner of a “facility” from which hazardous substances have been released is responsible for response costs that result from the release. Insurer-defendants counterclaimed for injunctive relief from ESBC’s billing practices and alleging violation of the Fair Debt Collection Practices Act, 15 U.S.C. 1692, unjust enrichment, unlawful fee collection, fraud, constructive fraud, and insurance fraud. The district court granted defendants judgment on the pleadings and dismissed counterclaims without prejudice. The Seventh Circuit affirmed. Motor vehicles for personal use fall under the "consumer product in consumer use” exception to CERCLA’s definition of facility