Justia Government & Administrative Law Opinion Summaries

Howard Back filed this suit alleging that Secretary of Heath and Human Services Kathleen Sebelius violated her duties under the Medicare Act and the Due Process Clause by failing to provide an administrative process for beneficiaries of hospice care to appeal a hospice provider's refusal to provide a drug prescribed by their attending physician. The district court granted the Secretary's motion for judgment on the pleadings because Back had not exhausted his administrative remedies. The Ninth Circuit Court of Appeals vacated the district court's judgment and dismissed the appeal as moot, holding that although the government led Back to believe there was no appeal process, such a process did exist. Accordingly, no controversy existed and the appeal was moot.

Plaintiff-Appellant Valinda Kornhauser filed suit to challenge the decision of the Commissioner of Social Security that denied her claim for disability benefits. The District Court referred the case to a Magistrate Judge for a report and recommendation ("R&R"). After receiving and considering memoranda on the matter, the Magistrate Judge issued an R&R recommending that the District Court vacate the Commissioner's decision and remand the case to the Commissioner for further proceedings. In his R&R, the Magistrate Judge, in addition to explaining why Plaintiff was entitled to a vacatur, observed that the memorandum her attorney had submitted failed to comply with Middle District of Florida Local Rule 1.05(a). The non-compliance, according to the Magistrate Judge, consisted of "smaller margins than authorized" by the rule and "footnotes . . . smaller than ten-point type." In a footnote to this observation, he stated: "These intentional violations would justify striking the memorandum. However, this sanction would unfairly punish the plaintiff. Consequently, I propose that, when plaintiff's counsel seeks attorney's fees, that the typical request for a cost-of-living increase be denied." Following the entry of judgment, Plaintiff petitioned the District Court for an award of attorney's fees under the Equal Access to Justice Act ("EAJA"). The parties stipulated to the amount of attorney fees, but after its consideration of the petition, the Magistrate Judge issue an R&R recommending that the district court award a lower amount in fees as have been stipulated because of Plaintiff's brief being submitted with small margins and unacceptable font sizing. Plaintiff's attorney filed an objection to the R&R, asking the district court not to adopt it because she did not intend to violate the local rule. Finding that the sanction was a reasonable exercise of the Magistrate Judge's disciplinary authority, the district court adopted the R&R with the sanction. Plaintiff appealed the imposition of the sanction. Upon review, the Eleventh Circuit vacated the sanction, finding "no procedural rule that sanctions the conduct involved" in this case.

The State Department of Labor and Industry appealed a district court's order that reversed the Department's decision regarding Petitioner Sheila Callahan & Friends, Inc. (SC&F). SC&F, a radio broadcasting company entered into a one-year contract with Joni Mielke. During the term of employment, SC&F evaluated Mielke as being an excellent radio personality and announcer but as underperforming other responsibilities because she either did not want to do them or preferred announcing-related duties. Mielke elected not to renew her contract with SC&F, and on an exit interview form, Mielke indicated her reason for leaving was that she "quit." After Mielke left her employment with SC&F, she was hired by another radio station. After a brief employment with this subsequent employer, she was laid off and filed for unemployment benefits in October 2009. The Department of Labor sent a Notice of Chargeability Determination to SC&F assessing a pro rata share of the costs of Mielke’s unemployment insurance benefits to SC&F’s experience rating account. The Department administratively determined that Mielke was employed for SC&F on a contract basis during her base period of employment and that SC&F’s account was chargeable for a portion of benefits drawn by Mielke. SC&F requested a redetermination, arguing that Mielke had voluntarily left her employment. The Department issued a Redetermination affirming the initial Determination. An administrative hearing was then conducted by telephone; the hearing officer determined that Mielke neither voluntarily quit nor was discharged for misconduct and affirmed the decision to charge SC&F’s account. On appeal, the Department argued the District Court improperly failed to defer to the Board’s findings of facts. Upon review, the Supreme Court concluded that the error of the Board was primarily premised upon application of legal standards, in the nature of a conclusion of law. Given the inapplicability of the imputation rules to the situation here, the District Court properly concluded that the evidence did not support the Board’s determination that Mielke’s work separation was involuntary.

Plaintiff Lisa R. Chapo appealed a district court's order upholding the Commissioner of Social Security's denial of her application for disability and supplemental security income benefits. The Administrative Law Judge (ALJ) denied benefits at the last step of the five-step process for determining disability. At step five the ALJ found Plaintiff not disabled because, "[c]onsidering [her] age, education [high school], work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that [she] can perform," namely the jobs of appointment clerk, escort vehicle driver, and office helper identified by the vocational expert (VE) who testified at the evidentiary hearing. On appeal to the Appeals Council, Plaintiff challenged the ALJ’s decision in several respects, in particular the ALJ’s treatment of the opinion evidence in the record. Upon review of the record, the Tenth Circuit concluded that ALJ’s handling of a testifying doctor's findings was erroneous and, as a result, the dispositive hypothetical inquiry put to the VE was fatally defective. "Indeed, that hypothetical did not even include a restriction (to 'simple' work) that the ALJ himself recognized in his decision." The Court concluded that this matter be remanded for further proceedings, "wherein the ALJ must either obtain a mental RFC determination from an examining source to oppose [the doctor], articulate some other adequate basis for discounting [his] findings, or come back to the VE with a proper hypothetical including those limitations (and his own restriction to 'simple' work, should the ALJ find it appropriate to re-impose such a restriction in the RFC determined on remand)."

Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded.

Plaintiffs brought a putative class action challenging 62 Pa. Stat. 1414, which was enacted to regulate special needs trusts. The comprehensive Medicaid eligibility rules enacted by Congress generally mandate that trusts be counted as assets of those seeking Medicaid, but exempt special needs trusts, which are intended to provide disabled individuals with necessities and comforts not covered by Medicaid. Plaintiffs allege Section 1414 is preempted by 42 U.S.C. 1396p(d)(4). The district court held that all but one of the challenged provisions of Section 1414 was preempted, finding that plaintiffs had a private right of action under both Section 1983 and the Supremacy Clause. The court also held that Section 1414 was severable, certified a class, and appointed class counsel. The Third Circuit affirmed in part, agreeing that the case is justiciable and that plaintiffs have a private right of action. Section 1414's 50% repayment provision, "special needs" provision, expenditure provision, and age restriction are all preempted by federal law. The enforcement provision of Section 1414, however, when used to enforce provisions not otherwise preempted, is a reasonable exercise of the Commonwealth's retained authority to regulate trusts.

Plaintiff appealed an order of the district court affirming the Commissioner's final decision denying her disability benefits under Title II of the Social Security Act (SSA), 42 U.S.C. 401-434. At issue, among other things, was whether the district court should have considered evidence plaintiff did not submit to the ALJ but submitted for the first time to the Appeals Council, which accepted and considered the new evidence but declined to review the ALJ's decision. The court held that when a claimant submitted evidence for the first time to the Appeals Council, which considering that evidence in denying review of the ALJ's decision, the new evidence was part of the administrative record, which the district court must consider in determining whether the Commissioner's decision was supported by substantial evidence. Considering the record as a whole, the court concluded that the Commissioner's decision was not supported by substantial evidence. Accordingly, the court reversed and remanded for an immediate award of benefits.

Reeves served as a heavy mortar crewman during combat offensives, 1942-1945, and was awarded three Bronze Stars. In 1981, Reeves filed a claim seeking service-connected disability benefits, with a medical opinion, stating that Reeves had bilateral, nerve-type hearing loss in 1962, attributable to noise exposure or to treatment with quinine for malaria. He also submitted records of an audiogram and statements from officers with whom he had served. The board denied the claim, stating that hearing loss documented in 1962 was too remote from active service. Reeves did not appeal. In 2004, the board granted an application to re-open, citing new evidence of treatment from 1946 to 1954, and awarded him service-connected disability benefits, effective 2002. In 2006, Reeves sought revision to an earlier effective date. The board denied the motion. The Veterans Court affirmed, rejecting an assertion that the evidence of record in 1983 was such that the board had no choice but to resolve in his favor that his hearing disability was incurred in service. Reeves died in 2011; the Federal Circuit substituted his widow and reversed. The Veterans Court misinterpreted 38 U.S.C. 1154(b) in rejecting the clear and unmistakeable error claim.

Heinzelman, born in 1971, received a flu vaccine in 2003, and within 30 days, was hospitalized for Guillain-Barre syndrome, a disorder affecting the peripheral nervous system. She was previously employed full-time as a hairstylist earning $49,888 per year. Due to her injury, Heinzelman will never be able to work again and is eligible to receive SSDI benefits of approximately $20,000 per year. In 2007, she sought compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1 to 300aa-34. A special master rejected the government’s argument that her eligibility for SSDI benefits should be considered in determining compensation under the Vaccine Act, finding that SSDI is not a "federal . . . health benefits program" within the meaning of section 300aa-15(g), and awarded $1,133,046.08, plus an annuity to cover future medical expenses. According to the government, Heinzelman's lost earnings award would have been roughly $316,000 less had the special master taken her anticipated SSDI benefits into account. The Claims Court and the Federal Circuit affirmed.

Petitioner, J.S., was a thirteen-year-old boy who suffered from cerebral policy. Through his mother, J.S. submitted an authorization request for a power wheelchair with fifty-five accessories to the respondent, the state department of health and human resources (DHHR), which administers the Medicaid program in West Virginia. DHHR denied Petitioner's request on the basis that it exceeded the Medicaid policy of providing only the most economical equipment to meet a recipient's basic health care needs. The DHHR board of review upheld the denial. The circuit court upheld the decision. The Supreme Court reversed, holding that the circuit court applied an erroneous standard of review to the decision of the DHHR board of review. Remanded to the circuit court with direction to make an independent review of both the law and the facts of this case.