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In April 2009, E.O. visited a pediatrician for his six-month visit and received several vaccinations. That night, Mrs. Oliver found E.O. seizing in his bed and called 9-1-1. At the emergency room, E.O. presented with a fever, red eyes with discharge, and a runny nose. The next day, E.O.’s pediatrician diagnosed E.O. with “complex febrile seizure and conjunctivitis.” E.O. did not have any health issues or seizures for two months but had several seizures over the summer and began to experience prolonged seizures in March 2010. Each seizure resulted in an emergency room visit. A pediatric neurologist diagnosed E.O. with an SCN1A gene defect. E.O. exhibited developmental delay. A pediatric neurologist performed examinations, which demonstrated “intractable, symptomatic childhood absence and complex partial seizures of independent hemisphere origin secondary to SCN1A gene defect (borderline SMEI syndrome) and encephalopathy characterized by speech delay.” E.O.’s family sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-2–300aa-33, alleging that E.O. developed Dravet syndrome as a result of the vaccinations. The Claims Court and Federal Circuit affirmed the rejection of their claim. The government’s expert provided strong evidence that Dravet syndrome will develop in children with the SCN[1]A mutation, whether or not they receive vaccinations; the Olivers failed to establish that their theory has garnered widespread acceptance, as evidenced by an extensive discussion of articles with contradictory findings. View "Oliver v. Secretary of Health and Human Services" on Justia Law

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In 2017, R.M. and C.W., were committed to the South Mississippi State Hospital (SMSH) to be treated for mental illness. As required under the commitment statute, both R.M. and C.W. were evaluated by court-appointed physicians, one a medical doctor, the other a psychologist. In the cases of both individuals, the evaluating physicians were the same two physicians. And in both cases, the physicians’ recommendations were the same: the medical doctor found that both individuals were, to some degree, mentally ill and thus needed treatment; the psychologist found that both individuals were not mentally ill and did not need treatment. The issue this case presented for the Mississippi Supreme Court’s review centered on whether Mississippi Code Section 41-21-77 allows a director of a state hospital independently to override a commitment order of a chancery court for treatment of mental illness. The Court held it does not. Because this statutory question came to the Court by way of a citation of contempt, this case also required the Court to review the citation of contempt to determine whether the chancery court’s classification of the contempt was correct and whether correct procedures were followed in the finding of contempt. To this, the Court found the chancery court erred in its contempt determination. Accordingly, the Court reversed the chancery court’s contempt finding, remanded the case for an entry of an order of recusal, and otherwise ordered further proceedings. View "In the Matter of C. W." on Justia Law

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The 2013 Public Employment Labor Relations Act (PELRA) did not infringe on the First Amendment rights of a group of parents who provide home care services to their disabled children. PELRA applied to persons who provide in-home care to disabled Medicaid recipients, and authorized covered employees to organize and to designate by majority vote an exclusive representative to negotiate employment terms with the state. The parents complained that the Act unconstitutionally compelled them to associate with the exclusive negotiating representative. Determining that the parents had Article III standing, the Eighth Circuit affirmed the district court's judgment and held that, under Minnesota State Board for Community Colleges v. Knight, the current version of PELRA allowed the homecare providers to form their own advocacy groups independent of the exclusive representative, and it did not require any provider to join the union. Therefore, the state did not impinge on the parents' right not to associate by recognizing an exclusive negotiating representative. View "Bierman v. Dayton" on Justia Law

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Hospitals challenged the methodology that the Department used to calculate the "outlier payment" component of their Medicare reimbursements for 2008, 2009, 2010, and 2011. At issue was whether the Department's decision to continue with its methodology after the 2007 fiscal year was arbitrary in light of accumulating data about the methodology's generally sub-par performance. The DC Circuit held in Banner Health v. Price, 867 F.3d 1323 (D.C. Cir. 2017) (per curiam), that the Department's decision to wait a bit longer before reevaluating its complex predictive model was reasonable, because the Department had, at best, only limited additional data for 2008 and 2009 and because the 2009 data suggested that hospitals were paid more than expected. In this appeal, the court held that Banner Health foreclosed the hospitals' challenges to the Department's failure to publish a proposed draft rule during the 2003 rulemaking process and the Department's failure to account for the possibility of reconciliation claw-backs in setting the 2008, 2009, 2010, and 2011 thresholds. Finally, the court held that, while the hospitals' frustration with the Department's frequently off-target calculations was understandable, the methodology had not sunk to the level of arbitrary or capricious agency action. View "Billings Clinic v. Azar" on Justia Law

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This matter stemmed from a lawsuit filed by the State of Mississippi against the defendant pharmacies. The State alleged deceptive trade practices and fraudulent reporting of inflated “usual and customary” prices in the defendant’s reimbursement requests to the Mississippi Department of Medicaid. The State argued that Walgreens, CVS, and Fred’s pharmacies purposefully misrepresented these prices to obtain higher prescription drug reimbursements from the State. Finding that the circuit court was better equipped to preside over this action, the DeSoto County Chancery Court transferred the matter to the DeSoto County Circuit Court in response to the defendants’ request. Aggrieved, the State timely filed an interlocutory appeal disputing the chancellor’s decision to transfer the case. After a thorough review of the parties’ positions, the Mississippi Supreme Court found that though the chancery court properly could have retained the action, the chancellor correctly used his discretion to transfer the case, allowing the issues to proceed in front of a circuit-court jury. As a result, the Supreme Court affirmed the chancellor’s decision. View "Mississippi v. Walgreen Co." on Justia Law

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Harvey Cohoon was diagnosed with a treatable form of cancer and was residing at Victoria Healthcare Center while he underwent treatment and recovered from various injuries he had suffered. For 19 days, Cohoon did well at Victoria Center. On the 20th day, he was observed to have difficulty swallowing thin liquids, and after evaluation, his diet was changed. Plaintiff contended that change was not properly communicated to the kitchen, and that night he was served a dinner that did not comport with his new diet. Less than 20 minutes after being served dinner, a nurse found him in respiratory arrest. The paramedics had to remove large pieces of chicken from his throat before intubating him. More pieces of chicken were removed from his airway at the hospital. He died the following day due to complications from oxygen deprivation to his brain. Donna Cochrum, Cohoon’s niece, filed suit against Victoria Center, asserting causes of action for elder abuse and negligence. As personal representative of Cohoon’s estate, Cochrum asserted a wrongful death cause of action. A jury returned a verdict in favor of Cochrum on all causes of action. Subsequently, the trial court granted a motion for judgment notwithstanding the verdict (JNOV), finding insufficient evidence of recklessness to support the elder abuse cause of action. It also adjusted the remaining damages pursuant to Civil Code section 3333.2. Cochrum appealed the amended judgment, contending the evidence supported the elder abuse cause of action. Two of the defendants cross-appealed, contending the court improperly applied the Medical Injury Compensation Reform Act of 1975 cap. Finding no reversible error, the Court of Appeal affirmed the amended judgment. View "Cochrum v. Costa Victoria Healthcare, LLC" on Justia Law

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The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

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The Court of Appeals affirmed the judgments of the circuit court and Court of Special Appeals that there were no errors of procedure or substantive law on the part of Respondents - the University of Maryland Baltimore Washington Medical Center (Hospital) and the Maryland Department of Health - and the administrative law judge (ALJ) in determining that Petitioner met the requirements for involuntary admission to the psychiatric unit of the Hospital. The Court held (1) the ALJ did not err in finding that Petitioner’s hearing on involuntary admission complied with the ten-day deadline for an involuntary admission hearing set forth in Md. Code Ann. Health-Gen. 10-632(b); and (2) there was substantial support in the record for the ALJ’s finding that Petitioner presented a danger to the life or safety of herself or of others at the time of the hearing. View "In re J.C.N." on Justia Law

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Memorial Hospital at Gulfport and Singing River Health System (“Hospitals”) sought judicial review of a June 24, 2016 administrative decision which found the Division of Medicaid’s (“DOM’s”) 2014 Fiscal Year Methodology “correctly interprets statutes and regulations and is neither arbitrary or capricious.” The chancellor affirmed the decision of DOM. Finding no evidence in the record before it that DOM failed to comply with Sections 43-13-117 and 43-13-145 in allocating and distributing supplemental payments to Mississippi hospitals, the Mississippi Supreme Court affirmed. View "Memorial Hospital at Gulfport v. Dzielak" on Justia Law

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From 1996-2011 Pennsylvania claimed the costs of a training program, the Pennsylvania Restraint Reduction Initiative, “to train long-term care facility staff in the use of alternative measures to physical and chemical restraints,” as administrative costs under its Medicaid program, 42 U.S.C. 1396b(a)(7) . The Centers for Medicare & Medicaid Services (CMS) reimbursed Pennsylvania for about $3 million. After an audit, CMS sought a return of the money on the ground that funds spent on training programs are not reimbursable as administrative costs under Medicaid. CMS relied heavily on a 1994 State Medicaid Director Letter. The Appeals Board, district court, and Third Circuit rejected the state’s arguments that the 1994 Letter was an invalid substantive rule, that the Letter’s text does not exclude the training costs from reimbursement, that the Letter imposed an ambiguous condition on a federal grant, that the Appeals Board abused its discretion in denying discovery, that the HHS Grants Administration Manual limits the disallowance period to three years, and that the district court should have taken judicial notice of the 2015 CMS Question and Answer document concerning training costs. The court noted CMS could have reimbursed Pennsylvania if Pennsylvania factored the amount into its rate-setting scheme instead of claiming it as administrative costs. View "Commonwealth of Pennsylvania Department of Human Services v. United States" on Justia Law