Justia Health Law Opinion Summaries

A pilot, who was injured in an airplane crash in 1985, sought medical benefits for a 2016 spinal surgery and subsequent treatment, as well as for diabetes treatment related to his spinal treatment. The Alaska Workers’ Compensation Board denied his claim, concluding that the 1985 injury was not a substantial factor in the pilot’s spinal problems. The Board also excluded the testimony of the pilot’s biomechanics expert due to non-compliance with Board regulations. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision, finding substantial evidence in the record to support the Board’s decision and that the Board had not abused its discretion in its procedural rulings.The Supreme Court of the State of Alaska affirmed the Commission’s decision. The court found that substantial evidence supported the Board's decision that the 1985 injury was not a substantial factor in the pilot's spinal problems. The court also found that the Board did not abuse its discretion by excluding the testimony of the pilot's biomechanics expert due to non-compliance with Board regulations. The court further held that the Board did not have an obligation to secure the testimony of a particular witness, and that the pilot's failure to secure a witness's testimony did not create an obligation for the Board to do so. View "Jespersen v. Tri-City Air and Alaska Insurance Guaranty Company" on Justia Law

The case revolves around the interpretation of the term "home" in the context of Medicaid eligibility. The applicants, Clyde and Dorothy Burt, sold their house to their daughter and son-in-law, Linda and Robby Wallace, and moved into a rental property owned by the Wallaces. Later, they moved into a skilled-nursing facility. After moving into the facility, the Burts used their cash assets to buy an undivided one-half interest in the house they had previously sold to the Wallaces. They then executed a Lady Bird deed in favor of the Wallaces, granting their newly acquired one-half interest back to the Wallaces, reserving an enhanced life estate. The Burts then applied for Medicaid assistance, but the Texas Health and Human Services Commission denied their claim, arguing that the property interest was not excluded from the calculation of resources for Medicaid eligibility.The trial court reversed the agency’s determination, and the court of appeals affirmed the trial court's decision. The court of appeals held that a property interest created after admission to a skilled-nursing facility can be excluded from the resources used to determine Medicaid eligibility if the applicant states an intent to live at the property in the future.The Supreme Court of Texas disagreed with the lower courts' interpretation. The court held that a “home” is the applicant’s principal place of residence before the claim for Medicaid assistance arises, coupled with the intent to reside there in the future. A property interest purchased with qualifying resources after the applicant moves to a skilled-nursing facility is an available resource for determining Medicaid eligibility under federal eligibility rules, as the property was not the applicant’s principal place of residence at the time the claim for benefits arose. The court reversed the judgment of the court of appeals and rendered judgment in favor of the Commission. View "TEXAS HEALTH AND HUMAN SERVICES COMMISSION v. ESTATE OF CLYDE L. BURT" on Justia Law

The case involves a dispute over whether a hospital that supplies and administers a drug that causes harm can be considered a "seller" under Oregon's strict product liability statute, ORS 30.920(1). The plaintiffs, Brown and Gomez, are the parents of a child who suffered irreparable heart defects as a result of in utero exposure to the drug Zofran, which Providence Health System - Oregon administered to Gomez. The plaintiffs sued Providence, asserting a claim for strict liability under ORS 30.920, alleging that Providence was a "seller" of Zofran and that the drug was "unreasonably dangerous and defective."The trial court granted Providence's motion for summary judgment, concluding that the statute was inapplicable under the circumstances. The Court of Appeals reversed the trial court's decision, disagreeing with the trial court’s interpretation of the statute. The Supreme Court of Oregon granted review.The Supreme Court of Oregon affirmed the decision of the Court of Appeals. The court concluded that the legislature did not intend to exclude hospitals from the scope of ORS 30.920(1); a hospital that supplies and administers a dangerously defective drug in conjunction with providing a healthcare service can be a "seller" that is "engaged in the business of selling" for purposes of liability under ORS 30.920; and, consequently, the trial court erred in granting the motion for summary judgment. The court reversed the trial court’s judgment and remanded the case for further proceedings. View "Brown v. GlaxoSmithKline, LLC" on Justia Law

A Mexican national, J.R., who worked seasonally in Sully County, South Dakota, required emergency medical treatment for appendicitis. He was taken to Avera St. Mary’s Hospital in Hughes County, where he received treatment and incurred medical bills totaling over $75,000. J.R. had no health insurance, few assets, and returned to Mexico without paying the bills. Avera sought reimbursement from Sully County under county poor-relief statutes.The Sully County Board of Commissioners denied Avera's application for reimbursement, citing J.R.'s status as a nonresident of Sully County. Avera appealed this decision to the circuit court, which remanded the case back to the Commission for a more detailed factual record. After a hearing, the Commission again denied Avera's claim, determining that J.R. was indigent by design and was not in distress in Sully County at the time the county was notified. Avera appealed this decision to the circuit court, which affirmed the Commission's decision.The Supreme Court of the State of South Dakota affirmed the lower court's decision. The court found that the county's obligation to support poor persons is statutory, not common law. The court interpreted the poor-relief statutes to require every county to support all poor and indigent persons who have established residency therein. However, the parties agreed that J.R. was not a resident of Sully County. The court found that the county had no statutory obligation to reimburse Avera for J.R.'s emergency medical services, as he was a nonresident indigent who had left Sully County before the Commission learned he was in distress. The court concluded that in these circumstances, where temporary relief had already been administered to the nonresident indigent by a third party in another county, Sully County had no statutory obligation to reimburse Avera for J.R.'s emergency medical services. View "Avera St. Mary’s Hospital V. Sully County" on Justia Law

The case involves Asif Sayeed and three associated healthcare companies who were found liable for violating the Anti-Kickback Statute and False Claims Act, resulting in a nearly $6 million judgment. Sayeed owned a healthcare management company, Management Principles, Inc. (MPI), which managed two smaller companies that provided home-based medical services to Medicare recipients in Illinois. Sayeed's companies received a significant amount of their business from the Healthcare Consortium of Illinois. In December 2010, Sayeed devised a scheme to bypass the Consortium’s referral process by directly soliciting its clients for additional services. MPI signed a Management Services Agreement with the Consortium, which gave MPI full access to its clients’ healthcare data. MPI used this information to identify and directly solicit Medicare-eligible seniors who might want or need additional healthcare services.The district court held a bench trial in July 2019 and found that Sayeed and his companies had not violated the Anti-Kickback Statute or False Claims Act because they had paid the Consortium with the intent to obtain information, not patient referrals. The plaintiff appealed, and the court of appeals reversed the decision, concluding that the defendants' conduct qualified as a form of indirect referral giving rise to an unlawful kickback scheme.On remand, the district court found the defendants liable under both the Anti-Kickback Statute and False Claims Act. The court imposed $5,940,972.16 in damages, which it calculated by trebling the value of the Medicare claims it deemed false and then adding a per-claim penalty of $5,500. The defendants appealed, challenging both the damages award and the underlying finding of liability. The United States Court of Appeals for the Seventh Circuit affirmed the judgment of liability but reversed in part to permit the district court to clarify which Medicare claims, all or some, resulted from the defendants’ illegal kickback scheme. View "Stop Illinois Health Care Fraud, LLC v. Sayeed" on Justia Law

The case involves Terrence Jordan and Damara Sanders, who were pulled over by a state trooper for speeding. During the stop, the trooper noticed inconsistencies in their travel plans and observed Jordan's heavy breathing, which raised his suspicion. He called for a canine unit, which detected the presence of drugs. A subsequent search of the vehicle and the defendants revealed marijuana, pill presses, digital scales, plastic baggies, firearms, and a significant quantity of pills containing a fluorofentanyl-fentanyl mixture.The defendants were charged with possessing a firearm as a felon, possessing a controlled substance with the intent to distribute, and possessing firearms in furtherance of drug trafficking. They sought to suppress the evidence obtained from the traffic stop, arguing that the trooper lacked reasonable suspicion to extend the stop. The District Judge denied the motion. The defendants also proposed a lesser-included-offense instruction for simple possession of a controlled substance, which the court rejected, citing the quantity of drugs and distribution paraphernalia as evidence of intent to distribute.The United States Court of Appeals for the Sixth Circuit affirmed in part, vacated in part, and remanded for further proceedings. The court held that the trooper had reasonable suspicion to extend the stop, based on the defendants' suspicious travel plans, Sanders's implausible explanations, and Jordan's heavy breathing. The court also agreed with the district court's decision not to give a lesser-included-offense instruction, given the substantial evidence of the defendants' intent to distribute drugs. However, the court vacated the defendants' convictions for possessing firearms in furtherance of drug trafficking due to an error in the jury instructions. The case was remanded for further proceedings consistent with the court's opinion. View "United States v. Jordan" on Justia Law

The case revolves around Gracie and Jeff Richardson, the legal guardians of their adult son, JMR, who suffers from severe developmental and intellectual disabilities. JMR requires full-time care and receives the highest level of Medicaid benefits offered through the Home and Community Based Services Waiver Program (HCBS Program) administered by the Wyoming Department of Health. The HCBS Program offers numerous services to participants like JMR to meet their individually assessed needs. In 2017, the Department entered into a settlement agreement with the Richardsons to establish an individual plan of care for JMR that permitted him to spend his individual budget amount on adult day services, residential habilitation services (community living services), and respite services.In 2021, the Department reviewed JMR’s individual plan of care pursuant to a quality improvement review. The Department discovered JMR’s providers had been billing for respite services at the same time JMR had been receiving community living services. Under the Department’s Comprehensive and Supports Waiver Service Index (the Index), providers are not authorized to bill for both the daily rate of community living services and the fifteen-minute units of respite services. The Department, relying on the Index, notified the Richardsons that it was required to remove respite services from JMR’s individual plan of care. The Richardsons requested an administrative hearing, which upheld the Department’s decision. The Richardsons appealed to the district court, which affirmed the decision. The Richardsons then appealed to the Supreme Court of Wyoming.The Supreme Court of Wyoming affirmed the lower court's decision. The court found that the Department acted in accordance with law when it removed respite services from JMR’s individual plan of care. The court held that the Index, which was incorporated by reference in the Department’s Medicaid regulations, constituted a rule with the force and effect of law. The court also found that the Department’s quality improvement review, which was used to identify the billing deemed erroneous under the Index, was not considered a “rule” under the Wyoming Administrative Procedure Act and therefore did not require the rulemaking process before implementation. Finally, the court concluded that the Department’s removal of respite services from JMR’s individual plan of care did not violate the parties’ 2017 Settlement Agreement. View "Richardson v. State of Wyoming, Ex Rel. Wyoming Department of Health" on Justia Law

The case involves a man, Dominic N., who was involuntarily committed for mental health treatment. Dominic N. has a history of being charged with sexual abuse of a minor and has been deemed incompetent to stand trial multiple times. He has been diagnosed with numerous mental health and behavioral conditions, including major depressive disorder, selective mutism, and borderline intellectual functioning. In 2021, he was again charged with sexual abuse of a minor and found mentally incompetent to stand trial. While at the Alaska Psychiatric Institute (API) for competency restoration, he was diagnosed with additional disorders, including antisocial personality disorder.The Superior Court of the State of Alaska, Third Judicial District, Anchorage, held a competency hearing and found Dominic mentally incompetent. The court ordered his commitment to API for further evaluation and restoration. The State petitioned for an order authorizing Dominic’s evaluation to determine whether he was mentally ill and likely to cause harm to others. The court granted the petition, and API staff filed a petition for 30-day civil commitment. After a hearing, the court found that Dominic was mentally ill and likely to cause harm to others, and ordered his commitment to API for 30 days.Dominic appealed to the Supreme Court of the State of Alaska, arguing that the State failed to prove that he was mentally ill as defined by statute and that his diagnoses were the type of intellectual and developmental disabilities excluded from the definition. The Supreme Court affirmed the superior court’s order, concluding that there was clear and convincing evidence that Dominic suffered from mental illness that is more than his excluded disabilities. The court found that Dominic’s impulse control disorder and pedophilic disorder were distinct from his intellectual and developmental disabilities, satisfying the statutory definition of mental illness. View "In re Hospitalization of Dominic N." on Justia Law

Dr. Ryan Kime, an emergency medicine physician, applied for privileges in the emergency department of two hospitals owned by Dignity Health, Inc. (Dignity) while he was under disciplinary proceedings by the Medical Board of California. The proceedings resulted in a public reprimand. Dignity stopped processing Kime’s application a few days after the reprimand took effect. Kime sued Dignity for injunctive relief and damages, alleging that Dignity violated his common law and statutory rights by denying his application without offering him a hearing. Dignity moved for summary judgment, arguing that it had a policy not to consider applicants with disciplinary histories for emergency department privileges, and that no hearing is required when privileges are denied due to such a policy. The trial court granted Dignity’s motion for summary judgment and denied Kime’s motion for summary adjudication.The Court of Appeal of the State of California First Appellate District affirmed the trial court's decision. The court found that Dignity's policy of not considering applicants with disciplinary histories for emergency department privileges was a quasi-legislative decision, which did not require a hearing under the common law right to fair procedure. The court also found that Dignity's decision to deny Kime's application did not require a hearing under the statutory right set forth in the Business and Professions Code, as the decision was not made by a peer review body and did not require the filing of a report under section 805 of the Code. The court concluded that Kime had no right to a hearing under either the common law or statutory law. View "Kime v. Dignity Health, Inc." on Justia Law

The case involves Alice Chu, who was indicted in September 2019 and convicted of one count of conspiracy to commit health care fraud and five counts of health care fraud. Chu's trial was initially set for February 22, 2021, but due to the COVID-19 pandemic, the Chief Judge of the District of New Jersey issued multiple standing orders that delayed trials and excluded these delays from Speedy Trial Act (STA) calculations. Chu's trial eventually commenced on March 1, 2022.Chu moved to dismiss multiple times on STA grounds, arguing that the delays denied her right to a speedy trial under the Sixth Amendment and that the government abused the grand jury process causing inexcusable delay. The District Court denied these motions. After her conviction, Chu filed two motions for a new trial, claiming she was unfairly prejudiced by trial testimony about prior bad acts and that newly discovered evidence could change the probability of a conviction at trial. The District Court denied both motions.The United States Court of Appeals for the Third Circuit affirmed the District Court's decisions. The Court of Appeals agreed with the District Court that the exclusions resulting from the COVID-19 pandemic did not violate defendants’ rights under the STA. The Court also found no clear error in the District Court’s adoption of the factual findings contained within the COVID Standing Orders. The Court of Appeals further agreed with the District Court that Chu failed to show that the government’s “sole or dominant purpose” was to impermissibly delay her trial. The Court of Appeals concluded that the District Court did not abuse its discretion in denying Chu's motions for a new trial and that the evidence at trial was sufficient to prove Chu’s knowledge and intent to commit health care fraud. View "United States v. Chu" on Justia Law