Justia Health Law Opinion Summaries

Max and Peggy Lancaster transferred approximately $3.8 million in property to a family LLC owned by their adult children, receiving a promissory note and other loan-related documents in exchange. They subsequently applied for Medicaid benefits in Oklahoma but were found ineligible due to their financial resources exceeding Medicaid’s asset limit. The Lancasters challenged this determination in federal court, arguing that the Oklahoma Department of Human Services and the Oklahoma Health Care Authority violated 42 U.S.C. § 1396a(a)(8) of the Medicaid Act, which requires prompt provision of benefits to eligible individuals. They sued under 42 U.S.C. § 1983, contending that the Agencies’ asset calculation was erroneous and deprived them of a federally protected right.The United States District Court for the Western District of Oklahoma granted the Agencies’ motion to dismiss. The court found that the promissory note received from the LLC was a countable resource under state law and not a bona fide loan. As a result, the court concluded the Lancasters were not eligible for Medicaid benefits because their assets exceeded the threshold set by law. The Lancasters appealed this decision to the United States Court of Appeals for the Tenth Circuit.While the appeal was pending, the Supreme Court decided Medina v. Planned Parenthood South Atlantic, which clarified the standard for determining whether provisions of the Medicaid Act confer individually enforceable rights under § 1983. The Tenth Circuit held that, under Medina, 42 U.S.C. § 1396a(a)(8) does not clearly and unambiguously confer a private right enforceable via § 1983. Therefore, the court affirmed the district court’s dismissal of the Lancasters’ claims, holding that there is no individually enforceable right under § 1396a(a)(8) for the purposes of this lawsuit. View "Lancaster v. Cartmell" on Justia Law

Kevin Clay and his associate founded a pharmaceutical sales company that marketed compounded prescriptions directly to patients, promising them a share of the insurance reimbursements for each prescription filled. The company partnered with a pharmacy willing to pay a portion of the insurance proceeds and recruited employees from a local business whose health plan covered these prescriptions. Patients were directed to a doctor who readily prescribed the creams, resulting in millions of dollars in reimbursements over two years. Clay established a public charity to reduce his tax burden but used its funds for personal expenses and failed to comply with nonprofit requirements.The United States District Court for the Northern District of Ohio oversaw Clay’s trial. A jury convicted him of conspiracy to commit healthcare fraud, healthcare fraud, and making a false statement to the IRS, but acquitted him of a separate tax charge. The court sentenced Clay to 51 months’ imprisonment and ordered restitution totaling nearly $7 million to both Fiat Chrysler and the IRS. Clay appealed his convictions, sentence, and restitution orders.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court affirmed Clay’s convictions and rejected his challenges to the jury instructions and evidentiary rulings. However, it found error in the district court’s restitution orders and the application of a sentencing enhancement. Specifically, the Sixth Circuit held that restitution should not include payments for medically necessary prescriptions and that the apportionment of restitution must consider each defendant’s contribution and economic circumstances. The court also determined the restitution order to the IRS was not properly substantiated and included acquitted conduct. Finally, the case was remanded for further proceedings on restitution and for clarification or reconsideration of the leadership sentencing enhancement. View "United States v. Clay" on Justia Law

A patient was admitted to a hospital for liver disease and, while in an altered mental state, fell while accompanied by a caregiver. She suffered a fractured hip, requiring surgery, and was later discharged. The patient filed a negligence lawsuit against the hospital, alleging a failure to prevent or appropriately respond to her fall. During discovery, she requested all incident reports related to her fall. The hospital identified an Incident Report and a Root Cause Analysis but refused to produce them, invoking federal and state privileges that protect certain internal analyses and reports of medical errors.The McCracken Circuit Court ordered the hospital to produce the Incident Report and to provide the Root Cause Analysis with redactions for portions covered by federal privilege. The trial court found that the Incident Report and parts of the Root Cause Analysis contained factual information not otherwise available in the patient's medical records and ruled that such information should be discoverable. The Court of Appeals reviewed the trial court's order after the hospital sought a writ of prohibition. It held that the Incident Report was not privileged under federal or state law but concluded the Root Cause Analysis was fully protected by federal privilege, even its factual portions, and thus could not be disclosed.Upon review, the Supreme Court of Kentucky affirmed the Court of Appeals. The court held that the federal Patient Safety and Quality Improvement Act privilege protected the entire Root Cause Analysis from disclosure, with no exception for factual information within the document. However, it held that the Incident Report was not protected by either the federal or state privileges because it was generated in compliance with regulatory obligations, not as part of the hospital's privileged peer review or patient safety evaluation system. As a result, the Incident Report was discoverable, while the Root Cause Analysis was not. View "BAPTIST HEALTHCARE SYSTEM, INC. V. KITCHEN" on Justia Law

The case centers on Kristal Glover-Wing, who founded and operated Angel Care Hospice (ACH) in Louisiana, a Medicare-certified hospice provider. ACH’s business model involved recruiting local physicians as medical directors who referred patients and certified them as terminally ill, even when evidence showed many patients maintained active lifestyles inconsistent with terminal illness. Glover-Wing instructed staff to emphasize patients’ worst conditions in records and resisted discharging patients who no longer qualified, sometimes directing staff to falsify records or reenroll patients after hospitalizations. An investigation revealed that, for at least twenty-four patients, hospice services were provided and Medicare reimbursed ACH over $1.5 million, despite the patients not meeting eligibility criteria.Following a whistleblower complaint and investigation, a federal grand jury in the United States District Court for the Western District of Louisiana indicted Glover-Wing and two physicians for conspiracy to commit healthcare fraud and three counts of healthcare fraud. During trial, the jury asked if the conspiracy charge could include ACH employees as coconspirators, leading to a dispute over jury instructions. Glover-Wing requested judicial estoppel to prevent the government from expanding the conspiracy beyond named defendants, arguing she relied on prior government representations. The district court denied her requests, and the jury convicted Glover-Wing on all counts while acquitting the physicians. Post-trial, the district court denied Glover-Wing’s motions for acquittal and a new trial.The United States Court of Appeals for the Fifth Circuit reviewed Glover-Wing’s sufficiency-of-evidence and judicial estoppel claims. The court held that sufficient evidence supported all convictions, as a rational jury could find Glover-Wing knowingly participated in fraud and conspiracy. It further held that judicial estoppel did not apply because the government’s positions were not plainly inconsistent, nor accepted by the court, and Glover-Wing failed to show unfair detriment. The Fifth Circuit affirmed the district court’s judgment. View "United States v. Glover-Wing" on Justia Law

Congress enacted a law in 2025 that withholds Medicaid funding for one year from certain abortion providers that meet four criteria, which in effect covers most Planned Parenthood affiliates and two other organizations. The statute also withholds funding from subsidiaries, successors, clinics, and “affiliates” of such entities, even if those affiliates do not themselves meet all four criteria. Some Planned Parenthood entities qualified for defunding under the law (“Qualifying Members”), while others did not (“Non-Qualifying Members”), but the latter still risked losing funding due to the ambiguous “affiliate” provision. Concerned about the impact on their ability to provide healthcare, Planned Parenthood Federation of America, a Qualifying Member, and a Non-Qualifying Member sued to enjoin enforcement, alleging the law was an unconstitutional bill of attainder, imposed unconstitutional conditions on their right of association, and violated equal protection.The United States District Court for the District of Massachusetts granted a temporary restraining order and then preliminary injunctions, finding that the plaintiffs were likely to succeed on all three claims. The court reasoned that the law punished Planned Parenthood in violation of the Bill of Attainder Clause, impermissibly conditioned Medicaid funding on disassociation from other affiliates in violation of the First Amendment, and failed equal protection review because it targeted Planned Parenthood for its associations. The government appealed these orders.The United States Court of Appeals for the First Circuit vacated the district court’s orders. The court held that the statute did not inflict punishment as understood in bill of attainder case law, but instead established new conditions prospectively on Medicaid funding. The court also held that the “affiliate” provision is best read to cover only entities under common corporate control, avoiding constitutional problems, and thus does not burden associational rights. Finally, the court found that the law is subject only to rational basis review and is rationally related to Congress’s objectives. The preliminary injunctions were vacated and the case remanded. View "Planned Parenthood Federation of America, Inc. v. Kennedy" on Justia Law

Troy Williams pleaded guilty to various federal offenses, including drug trafficking, firearm possession by a felon, and money laundering, and was sentenced to 198 months in prison, which was below the applicable sentencing guideline range. Williams has a history of serious medical conditions—thrombophilia and recurrent deep vein thrombosis—that require ongoing management, including regular blood testing and medication. Nearly ten years into his sentence, Williams sought compassionate release, asserting that inadequate medical care at his current facility placed him at risk of severe health complications or death.After Williams filed his pro se motion for compassionate release in the United States District Court for the Northern District of Ohio, counsel was appointed to supplement his arguments. Williams claimed the Bureau of Prisons was not providing sufficient medical care, particularly after his transfer to FCI Coleman, where he alleged infrequent blood testing and interruptions in medication. He also argued the sentencing factors under 18 U.S.C. § 3553(a) favored his release. The district court reviewed his medical records and expert testimony from the prison’s clinical director, ultimately finding that Williams’s care was not so deficient as to amount to extraordinary and compelling circumstances. The district court further concluded that, even if such circumstances were present, the sentencing factors did not support early release. Williams timely appealed.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s denial for abuse of discretion, considering legal questions de novo and factual findings for clear error. The Sixth Circuit held that the district court did not clearly err in finding that Williams’s medical care was adequate and that his situation did not present extraordinary and compelling circumstances under the relevant Sentencing Commission policy statement. Accordingly, the Sixth Circuit affirmed the denial of Williams’s motion for compassionate release. View "United States v. Williams" on Justia Law

A group of Texas hospitals challenged a 2023 regulation issued by the Secretary of Health and Human Services. The regulation excluded certain patients, who received benefits under Texas’s uncompensated care pool demonstration project, from the Medicaid fraction calculation for Disproportionate Share Hospital (DSH) payments. This change threatened to reduce the hospitals’ Medicare DSH payments and make some hospitals ineligible for the 340B drug discount program, which relies on the DSH percentage.The hospitals initially sought a hearing before the Provider Reimbursement Review Board (PRRB), arguing the new regulation was unlawful. The PRRB determined it lacked jurisdiction because there was no “final determination” regarding a specific hospital’s payment amount, as required for PRRB review. The hospitals then filed suit in the United States District Court for the Northern District of Texas, which reached the merits, granted summary judgment for the hospitals, and vacated the regulation. The Secretary of Health and Human Services appealed this decision.The United States Court of Appeals for the Fifth Circuit reviewed the case and concluded that the district court lacked subject-matter jurisdiction. The Fifth Circuit held that claims arising under the Medicare statute must first be presented to the agency for a “final decision” before judicial review is available, consistent with 42 U.S.C. § 405(g). Because the hospitals had not presented their claims through the required administrative process—specifically, by submitting cost reports and receiving a final reimbursement determination—they failed to satisfy the nonwaivable presentment requirement. The court also rejected the argument that the channeling requirement did not apply or that it amounted to a complete preclusion of judicial review. Accordingly, the Fifth Circuit reversed the district court’s judgment and remanded the case. View "Baylor All Saints Med Ctr v. Kennedy" on Justia Law

A New Jersey physician wished to provide medical aid in dying to terminally ill patients, including nonresidents seeking this service under New Jersey’s law that permits doctor-assisted suicide. The relevant statute allows only New Jersey residents, with a prognosis of six months or fewer to live, to request and obtain a prescription for life-ending medication. Patients must demonstrate residency through various documents and satisfy several procedural safeguards. The plaintiff, a physician, challenged the law’s residency requirement after two terminally ill nonresidents who had joined the suit died during the course of litigation.The United States District Court for the District of New Jersey dismissed the complaint. The court reasoned that the right to receive medical aid in dying was neither a fundamental privilege nor a fundamental right requiring extension to nonresidents under the Privileges and Immunities Clause or the Equal Protection Clause. It further found the law was not economic protectionism and survived rational-basis review. The plaintiff appealed this decision.The United States Court of Appeals for the Third Circuit affirmed the District Court’s dismissal. It held that New Jersey’s restriction of doctor-assisted suicide to its own residents does not violate the Privileges and Immunities Clause because there is no longstanding tradition making such access a fundamental privilege, nor does it violate the Equal Protection Clause, as there is no fundamental right to assisted suicide or to interstate travel for this purpose. The Third Circuit also determined that the law does not offend the dormant Commerce Clause since it is a moral rather than commercial regulation and does not discriminate against out-of-state economic interests. The court concluded that New Jersey’s residency requirement is constitutionally permissible, justified by the state’s interests in protecting doctors, avoiding interstate friction, and safeguarding patients. View "Bryman v. Murphy" on Justia Law

The case involves a woman, M.S., who was the subject of a petition filed by the State in May 2024, alleging she was mentally ill and dangerous under Nebraska law. The petition was supported by statements from M.S.’ daughter, who described recent concerning behavior, including M.S. bringing a gun to her daughter’s home, appearing paranoid, and exhibiting signs of being out of touch with reality. M.S. was admitted to a psychiatric facility pending commitment proceedings, and a hearing was held before the Mental Health Board of the Fourth Judicial District. During the proceedings, M.S. was represented by counsel and objected to certain testimony on confrontation and hearsay grounds.The Mental Health Board overruled M.S.’ motion for a continuance and proceeded with the commitment hearing, where it heard testimony from a psychiatrist, M.S.’ daughter, and M.S. herself. The Board found, by clear and convincing evidence, that M.S. suffered from bipolar I disorder, manic with psychosis, and was dangerous to herself and others. The Board ordered inpatient treatment and authorized forced medication. M.S. appealed to the District Court for Douglas County, arguing that her rights to confrontation were violated, that inadmissible hearsay was admitted, and that the evidence was insufficient to support her commitment. The district court affirmed the Board’s decision, ruling that any errors in admitting certain evidence were harmless because the facts were otherwise established in the record.On further appeal, the Nebraska Supreme Court reviewed the district court’s decision. It held that confrontation rights under both the U.S. and Nebraska Constitutions, as extended by statute to mental health commitment proceedings, are trial rights that do not apply to pretrial hearings. The court further found that the challenged statements by family members were admissible under the medical purpose exception to the hearsay rule. The court concluded that clear and convincing evidence supported the findings that M.S. was mentally ill and dangerous, and that the treatment ordered was the least restrictive alternative. The district court’s order was affirmed. View "In re Interest of M.S." on Justia Law

A pharmacist in Florida, serving as the pharmacist-in-charge at a pharmacy called NH Pharma, was indicted for conspiracy to commit health-care fraud and several counts of health-care fraud. The indictment alleged that he defrauded Medicare by billing for drugs different than those he dispensed and for prescriptions never filled. The pharmacy’s owner cooperated with the government after pleading guilty to conspiracy. At trial, the prosecution presented evidence that the pharmacist and the owner prepared compounded medications using unreimbursable ingredients while billing Medicare for more expensive, reimbursable ones, and attempted to cover up the discrepancies during audits. There was also evidence, including video and witness testimony, that the pharmacist had stolen about $200,000 in cash from the pharmacy. Three Medicare beneficiaries testified that they never received or believed they were prescribed the medications billed in their names.The United States District Court for the Middle District of Florida admitted evidence of the uncharged cash theft, ruling it was intrinsic to the case. The court also excused a potential defense witness, a part-owner and pharmacy technician, from testifying after she invoked her Fifth Amendment right against self-incrimination, and declined to recommend immunity for her. After a jury found the pharmacist guilty on all counts, he moved for a new trial based on statements made by the pharmacy owner in her own sentencing memorandum, arguing they constituted newly discovered evidence. The district court denied this motion.The United States Court of Appeals for the Eleventh Circuit affirmed the convictions. It held that the district court did not abuse its discretion by denying a new trial because the statements were not new evidence, nor material, nor likely to produce a different result. The appellate court also found no abuse of discretion in admitting the theft evidence, declining to compel witness immunity, and not conducting an in-camera hearing, and rejected constitutional claims raised by the defendant. View "USA v. Beasley" on Justia Law