Justia Health Law Opinion Summaries

The defendant operated two companies that provided durable medical equipment, both of which were enrolled as Medicare providers under the names of her mother and nephew. The defendant orchestrated a scheme where patient information was used to submit fraudulent claims for unnecessary medical equipment and repairs, with the assistance of other employees and marketers. Over a ten-year period, the companies submitted more than $24 million in claims, of which Medicare paid approximately $13 million.The United States District Court for the Central District of California presided over the case. The defendant was indicted and, after a second trial, convicted by a jury of conspiracy to launder monetary instruments, healthcare fraud, and aggravated identity theft under 18 U.S.C. § 1028A(a)(1), based on the use of her relatives’ names during the commission of health care fraud. The district court sentenced her to a total of 180 months in custody, including a mandatory consecutive two-year term for aggravated identity theft. The defendant appealed her convictions for aggravated identity theft.The United States Court of Appeals for the Ninth Circuit reviewed the case. The main issue on appeal was whether the use of her relatives’ names constituted aggravated identity theft under the standard clarified in Dubin v. United States, 599 U.S. 110 (2023). The Ninth Circuit held that the government failed to show that the use of the relatives’ names was “at the crux” of the fraud—meaning that the use itself was fraudulent or deceitful and critical to the scheme’s success, as required by Dubin. The court vacated the defendant’s sentence for aggravated identity theft and remanded the case to the district court for resentencing. The healthcare fraud and other convictions were not in dispute. View "USA V. MOTLEY" on Justia Law

A man was admitted to a long-term healthcare facility by his wife, who signed all required admission documents, including an arbitration agreement. The arbitration agreement stated that all disputes related to the facility’s care would be resolved by binding arbitration, but it was not a condition of admission or continued care. After the man’s death, his wife, individually and on behalf of his wrongful death beneficiaries, sued the facility and two nurses, alleging improper care and treatment resulting in his death.The defendants moved to compel arbitration, contending there was a valid agreement and that the wife had the authority to enter into it as her husband’s healthcare surrogate, since he allegedly lacked capacity at admission. The wife countered that there had been no proper determination of her husband’s incapacity at the time of admission and, regardless, that signing an arbitration agreement was not a healthcare decision. The Hinds County Circuit Court denied the motion to compel arbitration, relying on precedent holding that a healthcare surrogate’s authority is limited to healthcare decisions, and that an arbitration agreement is not a healthcare decision unless it is an essential part of receiving care. The court found that, since arbitration was not a condition of admission or care, the wife lacked authority to bind her husband.On appeal, the Supreme Court of Mississippi reviewed the denial de novo. The Court reaffirmed that under Mississippi law, a surrogate’s authority extends only to healthcare decisions, and an arbitration agreement is only such a decision if required for admission or care. Because the arbitration agreement in this case was not a condition of admission or care, the wife lacked authority to execute it. The Supreme Court of Mississippi affirmed the trial court’s denial of the motion to compel arbitration and to stay proceedings, holding the arbitration agreement invalid and unenforceable. View "Manhattan Nursing and Rehabilitation Center, LLC v. Hawkins" on Justia Law

The defendant is incarcerated for murder and has been diagnosed with schizoaffective disorder, bipolar type. She has spent most of her sentence in an inpatient psychiatric treatment program and has been largely unresponsive to medications administered under an involuntary medication order. After other treatments failed, the acting warden petitioned for authorization to administer electroconvulsive therapy (ECT), as her condition persisted and she lacked the capacity to provide informed consent. Both parties stipulated to her incapacity to consent to ECT, and she conceded on appeal that ECT is medically necessary.The Superior Court of San Bernardino County held an evidentiary hearing and granted the warden’s petition, authorizing ECT for six months, the maximum period allowed by statute. On appeal, the defendant did not challenge the medical necessity of ECT but argued that the statutory requirement for “no less onerous alternatives” to ECT should include procedural alternatives, specifically the possibility of obtaining informed consent from a surrogate decisionmaker under Welfare and Institutions Code section 5326.7.The Court of Appeal of the State of California, Fourth Appellate District, Division Two, reviewed the statutory interpretation de novo. It held that the “no less onerous alternatives” language in Penal Code section 2679 refers to medical alternatives to ECT, not alternative procedural methods such as surrogate consent. The court found that the statutory scheme intentionally excludes ECT from expedited surrogate decision-making provisions, requiring judicial authorization instead. The court rejected the argument that the warden must seek surrogate consent before judicial authorization and affirmed the trial court’s order authorizing ECT. View "P. v. T.B." on Justia Law

A Louisiana pharmacy owned by a licensed pharmacist was investigated by the Drug Enforcement Administration after allegations arose that the pharmacy was filling prescriptions for itself and for patients with “red flags” indicating possible misuse or diversion of controlled substances. The DEA’s investigation focused on several prescriptions, including combinations of opioids and benzodiazepines for various patients, out-of-pocket payments for controlled substances, and a prescription filled by the pharmacist herself written by her physician father, which violated state law prohibiting physicians from prescribing controlled substances to immediate family.Following an agency hearing before an administrative law judge, the DEA’s Administrator adopted the ALJ’s recommendation and revoked the pharmacy’s federal registration to dispense controlled substances. The Administrator concluded that the pharmacy had violated federal regulations and Louisiana law by filling prescriptions without adequately resolving red flags and by filling a prescription written in violation of state law. The pharmacy petitioned for review in the United States Court of Appeals for the Fifth Circuit.The Fifth Circuit found that the DEA misinterpreted and misapplied its own regulations and state law. The court held that 21 C.F.R. § 1306.04(a) requires a pharmacist to “knowingly” fill an invalid prescription, which the DEA had not shown, and that a violation of the state-law standard of care is not, by itself, a violation of federal regulations. The court also held that the Louisiana law at issue did not apply to pharmacies. Because the DEA’s order rested on erroneous interpretations of governing regulations and state law, the Fifth Circuit vacated the deregistration order and remanded the matter for further proceedings. View "Neumann's Pharmacy v. Drug Enforcement Administration" on Justia Law

During a contentious divorce and custody dispute, Amanda Hovanec, who had returned to Ohio from South Africa with her children, conspired with Anthony Theodorou, her romantic partner, to kill her husband, T.H. After failed attempts to hire hitmen in South Africa, Theodorou, at Hovanec’s direction, obtained and shipped etorphine, a dangerous animal tranquilizer, to the United States. Hovanec ultimately used the drug to fatally inject T.H. at her mother Anita Green’s home. Green assisted after the murder by helping to select a burial site, driving the others to dig a grave, and later transporting them and the body for burial. The group also undertook efforts to conceal the crime, including disposing of T.H.’s belongings and misleading authorities. All three were arrested after an investigation revealed dashcam footage of the crime.In the United States District Court for the Northern District of Ohio, Hovanec pleaded guilty to multiple controlled-substance offenses resulting in death, and Green pleaded guilty to being an accessory after the fact. Hovanec received a 480-month sentence; Green received 121 months and was ordered to pay restitution for psychological care for T.H.’s and Hovanec’s children. Both defendants appealed their sentences and, in Green’s case, the restitution order.The United States Court of Appeals for the Sixth Circuit affirmed the sentences for both Hovanec and Green. The appellate court upheld the denial of a sentencing reduction for Green based on her lack of candor regarding knowledge of the murder plan. The court also affirmed the sentencing enhancements for Hovanec’s leadership role and obstruction of justice. However, the court reversed the restitution order against Green, holding that under federal law, restitution for psychological care requires evidence of bodily injury, defined as physical harm or physical manifestations of psychological harm, and remanded for further factual findings on this issue. View "United States v. Green" on Justia Law

At a psychiatric hospital, employees were exposed to violent behavior from disturbed patients. Following a tip, the Occupational Safety and Health Administration (OSHA) investigated and cited the hospital for failing to implement measures that could have protected staff from workplace violence. These measures included reconfiguring nurses’ stations, providing communication devices, fully implementing existing safety programs, maintaining adequate staffing, securing patient belongings, hiring specialized security staff, and investigating each incident of workplace violence. The hospital did not contest the necessity of some measures but challenged the citation overall.An administrative law judge with the Occupational Safety and Health Review Commission conducted a hearing, upheld the citation, and imposed a fine. The judge’s decision became the final decision of the Review Commission when it declined further review. The hospital then petitioned the United States Court of Appeals for the Tenth Circuit for judicial review, arguing that another federal agency, the Centers for Medicare and Medicaid Services, had exclusive authority over hospital safety, that the Secretary of Labor should have deferred to other regulatory bodies, and that the Secretary’s methods and notice were insufficient.The United States Court of Appeals for the Tenth Circuit held that the Secretary of Labor had the authority to enforce the Occupational Safety and Health Act’s general duty clause in this context, as the cited agency did not actually regulate employee safety regarding workplace violence. The court found that the Secretary provided fair notice, acted within statutory authority, and permissibly used adjudication rather than rulemaking. The court also concluded that the abatement measures were feasible, supported by substantial evidence, and that the imposed sanctions for failure to preserve video evidence were appropriate. The Tenth Circuit denied the hospital’s petition for review, upholding the citation and penalty. View "Cedar Springs Hospital v. Occupational Health and Safety" on Justia Law

ARcare, Inc., a nonprofit community health center receiving federal funding, suffered a data breach in early 2022 when an unauthorized third party accessed confidential patient information, including names, social security numbers, and medical treatment details. After ARcare notified affected individuals, several patients filed lawsuits alleging that ARcare failed to adequately safeguard their information as required under federal law. Plaintiffs reported fraudulent invoices and that their information was found for sale on the dark web.The actions were removed to the United States District Court for the Eastern District of Arkansas, where six class actions were consolidated. ARcare sought to invoke absolute immunity under 42 U.S.C. § 233(a) of the Federally Supported Health Centers Assistance Act (FSHCAA), which provides immunity for damages resulting from the performance of “medical, surgical, dental, or related functions.” ARcare moved to substitute the United States as defendant under the Federal Tort Claims Act, arguing the data breach arose from a “related function.” The district court denied the motion, finding that protecting patient information from cyberattacks was not sufficiently linked to the provision of health care to qualify as a “related function” under the statute.On appeal, the United States Court of Appeals for the Eighth Circuit reviewed the statutory immunity issue de novo. The court affirmed the district court’s denial of immunity, holding that the FSHCAA’s language does not extend statutory immunity to claims arising from a health center’s data security practices. The court reasoned that “related functions” must be activities closely connected to the provision of health care, and data security is not such a function. Therefore, ARcare is not entitled to substitute the United States as defendant, and the denial of statutory immunity was affirmed. View "Hale v. ARcare, Inc" on Justia Law

A man with a significant mental health history was taken to the hospital by his mother after being found confused and unresponsive. At the hospital, a licensed social worker assessed him to determine whether to recommend involuntary mental health evaluation and treatment. During this assessment, the social worker identified herself as a crisis interventionist and advised him that their conversation could be disclosed in subsequent legal proceedings related to involuntary treatment. Based on her observations, she applied for an involuntary evaluation and emergency admission. After further evaluation by a medical director, a petition for court-ordered treatment was filed.Before the hearing on the petition for involuntary treatment in the Superior Court in Maricopa County, the patient sought to prevent the social worker from testifying as an acquaintance witness, arguing that their interaction created a privileged behavioral health professional-client relationship under Arizona law. The State opposed this, noting that the social worker had clearly warned the patient that the conversation would not be confidential. After the hearing, the Superior Court denied the patient’s motion to preclude the social worker’s testimony and granted the petition for court-ordered treatment.The Arizona Court of Appeals, Division One, vacated the Superior Court’s order, holding that the social worker’s testimony was subject to privilege and confidentiality rules, and no valid exception or waiver applied. The Supreme Court of the State of Arizona reviewed the case and concluded otherwise. The Supreme Court held that under Arizona’s statutory framework, the behavioral health professional-client privilege only applies if a confidential relationship exists, as defined by legal standards analogous to the attorney-client relationship. Given the facts—brief interaction, clear warning about non-confidentiality, and no pre-existing relationship—the Court found no objectively reasonable belief of a confidential relationship. Thus, the privilege did not apply. The Supreme Court vacated the Court of Appeals’ opinion and affirmed the Superior Court’s ruling. View "IN RE: MH2023-004502" on Justia Law

The petitioner received a Prevnar 13 pneumococcal conjugate vaccine and soon after began experiencing symptoms that ultimately led to a diagnosis of Guillain-Barré Syndrome (GBS). He sought compensation under the National Vaccine Injury Compensation Program, alleging that the vaccine caused his condition. To support his claim, he presented expert testimony advancing a molecular mimicry theory, arguing that components of the vaccine could trigger an autoimmune response resulting in GBS. The government countered with its own expert, disputing this causation theory.A special master in the United States Court of Federal Claims evaluated the evidence and found that the petitioner failed to prove, by a preponderance of the evidence, that the vaccine can cause GBS. The special master determined that key elements of the petitioner’s expert’s theory lacked support from reliable scientific literature and that the evidence did not sufficiently establish a causal connection. As a result, the special master denied compensation. The United States Court of Federal Claims reviewed and affirmed the special master’s decision.The United States Court of Appeals for the Federal Circuit reviewed the case. It held that the special master did not require the petitioner to provide direct medical literature establishing causation, which would have been contrary to the standard set forth in Althen v. Secretary of Health & Human Services, 418 F.3d 1274 (Fed. Cir. 2005). Instead, the special master properly considered the absence of supporting literature as one factor in evaluating the reliability of the causation theory, consistent with governing law. The Federal Circuit affirmed the Claims Court’s decision, noting concern about inconsistent outcomes among special masters on similar facts but finding no legal error in this case’s resolution. View "GAMBOA-AVILA v. HHS " on Justia Law

Several pharmaceutical manufacturers and a trade association challenged a Louisiana statute, Act 358, which restricts drug manufacturers from interfering with the delivery of federally discounted drugs through contract pharmacies. The statute was passed in response to manufacturers’ efforts to limit the distribution of discounted drugs under the federal 340B Program, particularly through arrangements with contract pharmacies serving vulnerable populations. The plaintiffs argued that the Louisiana law was preempted by federal law and violated several constitutional provisions, including the Takings Clause, the Contracts Clause, and the Due Process Clause’s prohibition on vagueness.The United States District Court for the Western District of Louisiana considered three related cases together. It denied the manufacturers’ motions for summary judgment and instead granted summary judgment for the State of Louisiana and the Louisiana Primary Care Association (LPCA) on all claims. The district court also allowed LPCA to intervene in each case, over the objection of one plaintiff.On appeal, the United States Court of Appeals for the Fifth Circuit reviewed the case de novo. The court held that Act 358 is not preempted by federal law. It found that the federal 340B statute does not occupy the field of pharmacy regulation and does not conflict with or frustrate federal objectives, as it is silent on the use of contract pharmacies and leaves room for state regulation. The court also concluded that Act 358 does not effect a physical or regulatory taking, does not substantially impair contract rights under the Contracts Clause, and is not unconstitutionally vague. However, the Fifth Circuit reversed the district court’s order permitting LPCA to intervene in AbbVie’s case, finding that LPCA’s interests were adequately represented by the State and it did not show it would present a distinct defense. The court affirmed summary judgment for Louisiana on all claims. View "AstraZeneca v. Murrill" on Justia Law