Justia Health Law Opinion Summaries

The defendant was charged in connection with a large-scale health care fraud scheme involving Arbor Homecare Services LLC, a company she controlled. Over several years, Arbor fraudulently billed Massachusetts’ Medicaid program, MassHealth, for more than $99 million. The government alleged that the defendant orchestrated the scheme, laundered proceeds through domestic and Kenyan financial accounts, and used the funds to acquire properties and businesses. After an initial mistrial, the defendant was retried and convicted by a jury on charges of conspiracy to commit health care fraud, health care fraud, and money laundering. She was sentenced to 144 months in prison, fined $250,000, and ordered to pay restitution.Prior to the retrial, the defendant cycled through numerous attorneys, at times expressing a desire to proceed without counsel and at other times seeking to hire new counsel if her assets were released from civil forfeiture. The United States District Court for the District of Massachusetts conducted multiple Faretta colloquies, warning her of the risks of self-representation. Ultimately, the court found her waiver of counsel to be knowing, intelligent, and voluntary, and permitted her to proceed pro se with standby counsel. The court also denied her motion to suppress evidence obtained from her cell phone during a border search, finding the search supported by reasonable suspicion.On appeal to the United States Court of Appeals for the First Circuit, the defendant argued that her conviction should be reversed due to alleged violations of her right to counsel and due process, and that the cell phone evidence should have been suppressed. She also challenged the calculation of her sentence, disputing the loss amount and the application of a sophisticated-means enhancement. The First Circuit affirmed the district court’s decisions, holding that her waiver of counsel was constitutionally valid, her suppression argument was waived, and her sentencing challenges were either waived or without merit. View "US v. Newton" on Justia Law

The defendant was stopped by Columbus police for driving with a broken headlight and found to be driving on a suspended license related to a prior OVI offense. After arresting him, police conducted an inventory search of his car, which revealed heroin, cocaine, and ammunition. Subsequent searches of his residence and his grandmother’s home, both conducted pursuant to warrants, uncovered additional drugs, cash, and firearms. The defendant was implicated in a long-running drug-trafficking organization operated by his uncle and another individual, and was charged in a federal indictment with conspiracy and various drug and firearm offenses.Before trial, the defendant moved to suppress evidence from all three searches, arguing, among other things, that the impoundment and search of his car were improper and that the warrants for the residences lacked probable cause. The United States District Court for the Southern District of Ohio denied all suppression motions. During trial, the government discovered that most of the cocaine from the car was powder, not crack, and successfully moved to amend Count Two of the indictment to reflect this. The jury convicted the defendant of conspiracy and several drug offenses, acquitting him on firearm counts. The district court denied post-verdict motions and sentenced him to concurrent terms of imprisonment.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s decisions. It affirmed the denial of all suppression motions, finding the searches lawful and either properly supported by probable cause or covered by the good-faith exception. The appellate court also affirmed the admission of alleged hearsay, ruling it fell within the co-conspirator exception. The court upheld the conviction for conspiracy, determining that sufficient evidence supported the jury’s verdict. However, the court held that the mid-trial amendment to Count Two of the indictment constituted an actual amendment in violation of the Fifth Amendment's Presentment Clause and vacated the conviction on that count, remanding for further proceedings. View "United States v. Johnson" on Justia Law

A group of Facebook users who interacted with an optical retailer’s website alleged that the company installed a Meta Pixel tracking tool on its site, which collected and transmitted users’ sensitive health-related information—such as browsing for prescription eyewear, entering prescription details, and scheduling eye exams—to Meta Platforms, Inc. without their consent. The users claimed this information qualified as individually identifiable health information under federal law and should not have been shared without authorization. The plaintiffs divided themselves into two groups: those who browsed or scheduled appointments (“Search Plaintiffs”) and those who entered prescription information to purchase eyewear (“Prescription Plaintiffs”).The United States District Court for the Northern District of Texas initially found that the plaintiffs had standing but dismissed their first complaint for failure to state a claim, allowing them to amend. After the plaintiffs filed their amended complaint, the district court again dismissed the case with prejudice. It held that the Search Plaintiffs had not adequately alleged they shared any protected health information with the defendant, and that the Prescription Plaintiffs had failed to show any such information was actually disclosed to Meta through the Pixel.On appeal, the United States Court of Appeals for the Fifth Circuit reviewed the dismissal de novo. The Fifth Circuit concluded that the unauthorized disclosure of the plaintiffs’ health information to Meta constituted a concrete and particularized injury, affirming that the plaintiffs had standing. The court held that both groups of plaintiffs adequately alleged that their individually identifiable health information was transmitted to Meta without their consent. The Fifth Circuit therefore reversed the district court’s dismissal and remanded the case for further proceedings. View "Rand v. Eyemart Express" on Justia Law

Several patients brought class action lawsuits against Indiana health care providers, alleging that their medical information was improperly shared with Facebook through the use of the Meta Pixel embedded in online patient portals. The plaintiffs asserted state law claims including breach of implied contract, unjust enrichment, and violations of the Indiana Deceptive Consumer Sales Act and Indiana Wiretapping Act. The health care providers had established these online portals to comply with federal regulations encouraging electronic health records, which offered incentive payments and imposed penalties for non-compliance.The health care providers removed the cases from Indiana state court to the United States District Court for the Southern District of Indiana, arguing that federal jurisdiction was proper under 28 U.S.C. § 1442(a)(1). They claimed they were “acting under” the Department of Health and Human Services when creating and maintaining their portals. District courts in multiple consolidated cases rejected this argument, finding that the providers did not meet the statutory requirements for removal under § 1442(a)(1). The courts concluded that while the providers were highly regulated and incentivized by federal policies, their actions did not amount to performing basic governmental tasks or operating under the direction of a federal officer.The United States Court of Appeals for the Seventh Circuit reviewed the consolidated appeals de novo. It held that compliance with federal regulations and incentives for patient portals did not constitute “acting under” a federal officer. The court found that the health care providers’ relationship to the federal government lacked the unusually close supervision and delegation required for federal officer removal. The court affirmed the district courts’ remand orders, holding that federal subject matter jurisdiction was not established under § 1442(a)(1). View "Chiaro v Methodist Hospitals, Inc." on Justia Law

A chiropractor who owned and operated a clinic in Louisiana was found to have carried out a scheme to defraud a private health insurer over three and a half years. The fraudulent scheme involved submitting reimbursement claims for services that were either not rendered as described, not medically necessary, or not performed or supervised by a licensed provider as required. Testimony from employees revealed that the owner pressured staff to fabricate treatment notes, and that many records showed signs of copying and pasting with little differentiation between patients. Some employees and patients testified that certain billed services were not actually provided, while massage therapists stated they performed generic massages rather than medically necessary treatments.A jury in the United States District Court for the Eastern District of Louisiana convicted the clinic owner of six counts of health care fraud and one count of wire fraud, but acquitted him of making a false statement to federal agents. At sentencing, the district court accepted that the intended loss equaled the actual payments made by the insurer, but declined to exclude payments for claims the defendant asserted were legitimate, finding the fraud so pervasive that it was not feasible to separate legitimate from fraudulent claims. The court sentenced the defendant to 84 months in prison, below the calculated guideline range, and explained that the loss calculation was based on the evidence of a widespread fraudulent scheme.The United States Court of Appeals for the Fifth Circuit reviewed only the district court’s finding that the fraud was pervasive. Applying clear error review, the Fifth Circuit held that the district court’s finding was at least plausible given the trial evidence and affirmed the sentence. The holding is that, where fraud is pervasive and separating legitimate from fraudulent claims is not reasonably practicable, the district court may treat all claims as fraudulent for loss calculation purposes. View "USA v. Tekippe" on Justia Law

Lucas Warner, a young man with a history of seizures and cerebrovascular disease, died after taking a single dose of Aimovig, a biologic drug manufactured by Amgen and approved by the FDA to prevent migraines. His mother, acting as representative of his estate, argued that the drug’s label was inadequate because it failed to disclose that the clinical trials excluded people with histories of seizures and neurological disorders, and did not warn of specific risks for such patients. She contended that this omission was especially relevant to Lucas’s medical circumstances.After Warner filed a wrongful death claim in Massachusetts state court, Amgen removed the case to the United States District Court for the District of Massachusetts. Amgen moved to dismiss the complaint, arguing federal law preempted Warner’s state law claims because Amgen was required to use the FDA-approved label and Warner had not shown Amgen could have unilaterally changed it. At the hearing, Warner sought leave to amend her complaint, alleging newly available studies could have permitted Amgen to update the label using FDA’s Changes Being Effected (CBE) procedure. The district court dismissed the complaint as preempted and denied leave to amend, finding the studies insufficient and the amendment futile.The United States Court of Appeals for the First Circuit reviewed the case. It affirmed the dismissal of Warner’s original complaint, holding that federal law preempted the claim because Amgen could not unilaterally alter the label during FDA approval, and the FDA would have rejected Warner’s proposed label changes. However, it reversed the denial of leave to amend, holding Warner plausibly alleged that certain studies constituted newly acquired information under the CBE process. The case was remanded for further proceedings limited to Warner’s claims based on this post-approval labeling theory. View "Warner v. Amgen Inc." on Justia Law

A former Michigan Department of Corrections prisoner with asthma and an alleged allergy to dogs experienced allergic reactions while incarcerated at multiple facilities that housed dogs for training purposes. He reported symptoms such as asthma attacks and respiratory infections to prison officials, who provided prescribed treatments but did not confirm a specific dog allergy. After pursuing the prison’s grievance process, he was moved within the facility but still encountered dogs during required programming. Subsequently, he requested an ADA accommodation to be housed away from dogs, but this was denied due to lack of medical documentation. He later filed suit, alleging violations of the Eighth Amendment, the ADA, the Rehabilitation Act, and state laws.The United States District Court for the Western District of Michigan granted summary judgment in favor of the defendants. The court found that prison officials were not deliberately indifferent to his medical needs under the Eighth Amendment, as they consulted medical staff who did not recommend a transfer based on his condition. For the ADA and Rehabilitation Act claims, the court determined that inadequate medical treatment was not actionable under those statutes and that the plaintiff had not demonstrated denial of prison services or programs due to his disability. The court also declined to exercise supplemental jurisdiction over the state-law claims.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s decision de novo. The appellate court affirmed the grant of summary judgment, holding that the prison counselor was entitled to qualified immunity because no clearly established law required the transfer of prisoners with asthma to facilities without dog programs. The court also found that the plaintiff failed to provide sufficient medical documentation to support the necessity of the requested accommodation under the ADA and Rehabilitation Act and did not establish discriminatory animus. The district court’s refusal to exercise supplemental jurisdiction over state-law claims was also affirmed. View "Miles-El v. Michigan" on Justia Law

Two individuals who were enrolled in a health insurance plan administered by a company alleged that their sensitive health information was disclosed without their authorization. In August 2023, the company sent each of them a letter explaining that an associate had mistakenly emailed a spreadsheet containing their private health information—including names, provider details, dates of service, and amounts billed or paid—to one or more other plan members. The plaintiffs asserted that they had entrusted this information to the company based on explicit and implicit promises of confidentiality and that the company’s privacy policy reinforced those expectations. They claimed the company’s unauthorized disclosure deprived them of the benefit of their bargain and diminished the value of the contracted services.Reviewing the case, the United States District Court for the District of Idaho dismissed the plaintiffs’ class action lawsuit on the grounds that they had not suffered an “injury in fact” necessary for Article III standing. The district court reasoned that disclosure of private information, without more, did not constitute a concrete injury and that the plaintiffs had not shown a substantial likelihood of future harm.On appeal, the United States Court of Appeals for the Ninth Circuit reviewed the dismissal de novo. The court held that the plaintiffs’ alleged harm—the unauthorized disclosure of sensitive health information entrusted on the basis of confidentiality—was analogous to the common law actions for breach of confidence and breach of contract, both of which were historically recognized as sufficient to support lawsuits. The court further noted that congressional judgment, as reflected in federal statutes like HIPAA, underscored the sensitivity of such information. Accordingly, the Ninth Circuit concluded that the plaintiffs had adequately alleged an injury sufficient for Article III standing, reversed the district court’s dismissal, and remanded the case for further proceedings. View "BLACK V. IEC GROUP, INC." on Justia Law

Needy children in Texas receive orthodontic care through Medicaid, which is administered by the Texas Health and Human Services Commission (HHSC). HHSC contracted with Conduent State Healthcare, LLC (formerly known as Xerox Corporation and ACS State Healthcare, LLC) to review and approve prior-authorization requests for these services. After Conduent allegedly approved requests without adequately assessing medical necessity, legal disputes arose. The State of Texas pursued civil penalties against Conduent for violating Medicaid policy, resulting in a settlement. Separately, dentists, including Diana Malone, DDS; Scott Malone, DDS; and M&M Orthodontics, PA, settled Medicaid-fraud claims by paying $2 million. Subsequently, these dentists sued Conduent and the State, alleging tortious conduct by Conduent in approving requests without proper review.In Travis County District Court, the State’s plea to the jurisdiction based on sovereign immunity was granted, dismissing it from the case. Conduent’s plea to the jurisdiction, which invoked derivative sovereign immunity and the election-of-remedies provision in the Texas Tort Claims Act, was denied. Conduent appealed this interlocutory order. The Court of Appeals for the Third District of Texas affirmed the district court’s denial of Conduent’s plea, addressing Conduent’s immunity arguments on the merits. A dissenting justice argued that the appeal should have been dismissed for lack of appellate jurisdiction.The Supreme Court of Texas reviewed whether the court of appeals had jurisdiction to hear Conduent’s interlocutory appeal. It held that Conduent, as a private contractor, is not a “governmental unit” under the relevant statutory definitions, and thus cannot utilize Section 51.014(a)(8) or Section 51.014(a)(5) to appeal the denial of its jurisdictional plea. The Supreme Court vacated the court of appeals’ opinion and judgment and remanded the case to the district court. View "CONDUENT STATE HEALTHCARE, LLC v. M&M ORTHODONTICS, PA" on Justia Law

Federal law enforcement officers executed a search warrant at a residence in Dayton, Ohio, after learning that Nathan Goddard was storing large quantities of fentanyl and cocaine in the basement. Goddard, his associate Cahke Cortner, and others were present when officers entered. Goddard, using a pistol acquired and equipped with a laser sight with Cortner's help, fired at Officer Jorge Del Rio, fatally wounding him. Cortner, armed, retreated to a back room. Both men surrendered after the incident. Evidence showed Goddard’s long history of drug trafficking and that Cortner had participated in drug-related communications and activities.The United States District Court for the Southern District of Ohio reviewed pretrial motions, including Goddard’s motion to suppress evidence from the search, which it denied, and granted the government’s motion to exclude evidence concerning the DEA’s operational plan. Combs, a co-defendant, pled guilty; Goddard and Cortner proceeded to trial. The jury convicted both on all counts, including conspiracy to possess and distribute drugs, possession with intent to distribute, and, for Goddard, murder of a federal officer and intentional killing during a drug-trafficking offense. Cortner was convicted of intentional killing under Pinkerton liability. Both received life sentences.The United States Court of Appeals for the Sixth Circuit affirmed the convictions and sentences. It held that probable cause supported the search warrant, the exclusion of operational-plan evidence was not an abuse of discretion, and sufficient evidence supported all convictions. The court found Pinkerton liability applicable to Cortner’s intentional killing charge and rejected arguments about procedural and substantive unreasonableness in sentencing. The court’s main holdings were to affirm the convictions and sentences for both defendants, upholding the district court’s rulings and jury findings. View "United States v. Goddard" on Justia Law