Justia Health Law Opinion Summaries

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The Court of Appeal reversed the district court's grant of summary judgment in favor of Aetna. In plaintiff's first cause of action, plaintiff alleged that Aetna violated Health & Safety Code section 1371.4. In plaintiff's second cause of action, plaintiff alleged that Aetna breached an implied contract based on its prior dealing with Aetna by not paying for the emergency medical services it rendered to a patient covered by Aetna's health care service plan. The court held that there were triable issues of fact as to whether plaintiff provided and billed for emergency services and was entitled to reimbursement from Aetna. Accordingly, the court remanded for further proceedings. View "San Jose Neurospine v. Aetna Health of California, Inc." on Justia Law

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The Supreme Judicial Court vacated the judgment of the superior court vacating a Department of Health and Human Services hearing officer's decision requiring AngleZ Behavioral Health Services to pay $392,603.31 in MaineCare reimbursements because of billing errors, holding that the superior court erred by finding that the Department did not submit proper evidence in support of some of its recoupment claims. After auditing the claims submitted by AngleZ between February 13, 2013 and July 20, 2013 The Department issued a notice of violation applying an error rate to all of AngleZ's claims during that time period. The Department ultimately sought a total recoupment of $392,603.31. A hearing officer concluded that the Department was correct in seeking 392,603.31 in recoupment, and the Department's acting commissioner adopted the recommendation. The superior court vacated the Commissioner's decision, concluding that the hearing officer's decision was not supported by substantial evidence. The Supreme Judicial Court vacated the superior court's judgment, holding that the hearing officer's decision was supported by substantial evidence and was neither arbitrary nor capricious. View "AngleZ Behavioral Health Services v. Department of Health and Human Services" on Justia Law

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The Fifth Circuit affirmed the district court's grant of summary judgment to the Secretary in an action brought by Hendrick challenging Medicare payments it received for the 2015 federal fiscal year. The court held that the district court did not err by dismissing Hendrick's appeal, because the Board's determination that it did not have jurisdiction over Hendrick's appeal for failure to exhaust administrative remedies was correct. In this case, Hendrick received notice via the Federal Register but failed to request correction of its wage data by the published deadline in accordance with the established process under the statute. View "Hendrick Medical Center v. Azar" on Justia Law

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Plaintiffs' challenges to HHS's 2019 Final Rule, implementing Title X of the Public Health Service Act, failed in light of Supreme Court approval of the 1988 regulations and the Ninth Circuit's broad deference to agencies' interpretations of the statutes they are charged with implementing. Section 1008 of Title X prohibits grant funds from being used in programs where abortion is a method of family planning. Specifically, plaintiffs challenged the "gag" rule on abortion counseling, where a counselor providing nondirective pregnancy counseling "may discuss abortion" so long as "the counselor neither refers for, nor encourages, abortion." The Final Rule also requires providers to physically and financially separate any abortion services from all other health care services. The panel held that the Final Rule is a reasonable interpretation of Section 1008; it does not conflict with the 1996 appropriations rider or other aspects of Title X; and its implementation of the limits on what Title X funds can support does not implicate the restrictions found in Section 1554 of the Patient Protection and Affordable Care Act (ACA). The panel also held that the Final Rule is not arbitrary and capricious because HHS properly examined the relevant considerations and gave reasonable explanations; because plaintiffs will not prevail on the merits of their legal claims, they are not entitled to the extraordinary remedy of preliminary injunction; and thus the district courts' preliminary injunction orders are vacated and the cases are remanded for further proceedings. View "California v. Azar" on Justia Law

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Four men from Miami drove to Louisville to set up chiropractic clinics. Lezcano, the mastermind, decided to file false claims with the patients’ insurers and get paid for treatments that never happened. The others, Chavez, Betancourt, and Diaz joined in. The plan worked due to aggressive marketing. The conspirators recruited and paid patients both to come to the clinics and to recruit others. Many of the patients worked at the Jeffboat shipyard. Jeffboat (through its claim administrator, United Healthcare) paid the clinics more than $1 million for fake injections of a muscle relaxant. The government discovered the scheme and brought criminal charges. Chavez went to trial, claiming he had no idea that Lezcano was cooking the books. Convicted of healthcare fraud, conspiracy to commit healthcare fraud, aggravated identity theft, and conspiracy to commit money laundering for purposes of concealment. Chavez was sentenced to 74 months’ imprisonment. The Sixth Circuit affirmed, rejecting his challenges to the sufficiency of the evidence and a related challenge to the prosecutor’s closing argument; two hearsay arguments; three objections to the jury instructions; and a sentencing argument. View "United States v. Chavez" on Justia Law

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The Supreme Court held that the corporation alleging a healthcare liability claim against a hospital in this case fell within the Texas Medical Liability Act's definition of "claimant" under Tex. Civ. Prac. & Rem. Code 74.351(a) and that the allegations stated a health care claim against the hospital, and therefore, the corporation was required to submit an expert report supporting the claim. A bridal shop in Ohio was required to close when health authorities learned that a nurse at the Dallas Presbyterian Hospital who had visited the bridal shop was diagnosed as having the Ebola virus. The shop's owner sued the hospital, alleging that the hospital's negligence in failing to prevent transmission of the Ebola virus to the nurse caused the shop to close permanently due to health concerns and adverse publicity. Invoking the Act, the hospital moved to dismiss the claims because the owner failed to submit an expert report detailing a factual basis for its healthcare liability claim. The trial court denied the motion. The court of appeals reversed. The Supreme Court affirmed, holding that the business's claims that the hospital's departure from accepted safety standards caused its injury stated a healthcare liability claim under the Act and that the business was a claimant under the Act. View "Coming Attractions Bridal v. Texas Health Resources" on Justia Law

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In this healthcare liability action, the Supreme Court reversed the judgment of the court of appeals affirming the judgment of the trial court denying Defendant's motion for directed verdict and motion for judgment notwithstanding the verdict (JNOV), holding that the trial court gave an erroneous charge that instructed the jury on the incorrect law applicable in the case. Plaintiffs filed this action against their obstretician, claiming that Defendant failed to exercise ordinary care when delivering Plaintiffs' baby and that Defendant's negligence proximately caused the baby's brachial plexus injury. At the close of the evidence Defendant moved for a directed verdict, arguing that there was legally insufficient evidence of willful and wanton negligence as required under Tex. Civ. Prac. & Rem. Code 74.153. The trial court denied the motion. The jury returned a verdict in favor of Plaintiffs, finding that Defendant was negligent under an ordinary, and not a willful and wanton, negligence standard. The trial court denied Defendant's motion for JNOV. The Supreme Court reversed, holding that the court erred in charging the jury because the jury should have considered whether section 74.153's standard of willful and wanton negligence applied in this case where it was contested whether Defendant provided emergency medical care to the mother and the baby. View "Glenn v. Leal" on Justia Law

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The Fifth Circuit affirmed the district court's preliminary injunction enjoining Senate Bill 2116, which makes it a crime to perform an abortion, with exceptions only to prevent the death of, or serious risk of "substantial and irreversible" bodily injury to, the patient, after a "fetal heartbeat has been detected." The court previously upheld an injunction enjoining a law prohibiting abortions, with limited exceptions, after 15 weeks' gestational age. The court held that S.B. 2116 bans abortions at a previability stage of pregnancy regardless of the reason the abortion is sought. In this case, the parties agree that cardiac activity can be detected well before the fetus is viable. Therefore, the court held that if a ban on abortion after 15 weeks is unconstitutional, then it follows that a ban on abortion at an earlier stage of pregnancy is also unconstitutional. View "Jackson Women's Health Organization v. Dobbs" on Justia Law

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Sixteen-year old Julisa Matute, along with her sister and father, were involved in a motor-vehicle accident in Harrison County, Mississippi. Julisa was transported to Mobile, Alabama, and was admitted to University of South Alabama Medical Center, a hospital operated by University of South Alabama (USA). Julisa died there intestate. Julisa’s mother and sister executed an authorization for the donation of Julisa’s organs with the Alabama Organ Center (AOC). An estate was opened; Julisa’s mother was appointed administratrix of the Estate. Shortly thereafter notice was served to creditors, USA probated a claim against the Estate for medical expenses. The Estate filed a “complaint to contest illegal probated claim and compulsory counterclaim,” alleging that before Julisa’s death, USA representatives approached Julisa’s family and asked that they donate her organs and, in turn, Julisa’s hospital bill incurred at USA would be “totally wiped out and not be collected.” As a result of this alleged agreement, the Estate contested USA’s probated claim and asserted that the “probated claim [wa]s null and void and uncollectable.” In a counterclaim, the Estate alleged emotional distress, fraud, and punitive damages because, according to the Estate, “[t]he hospital told [Julisa’s family] that the bill would be wiped clean for allowing them to have [Julisa’s] organs . . . .” A wrongful-death lawsuit related to the motor-vehicle accident was filed then by the Estate. A settlement was reached among the parties in September 2018. Months later, a hearing was held on USA’s contested probated claim. The chancellor entered a judgment approving the Estate’s Petition to Receive First and Final Accounting, Discharge Administratrix and Close Estate. USA filed a motion to alter or amend the order granting the Estate’s Petition to Approve Settlement of Claims of Wrongful Death Beneficiaries of Julisa, and asserted that the chancellor’s reference to a “hospital lien claim” was erroneous. The chancellor denied the motion. USA timely appealed. The Mississippi Supreme Court determined that while the chancellor properly denied USA's probated claim as uncollectable, the chancellor erred in finding the probated claim was invalid and erroneously ruled on USA's hospital-lien claim. As a result, the chancery court's judgment was affirmed in part, reversed in part, and remanded for further proceedings. View "In the Matter of the Estate of Julisa Matute" on Justia Law

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Respondent L.N. appealed a circuit court order denying a motion to authorize removal of life support filed by her guardian. In 2018, tests indicated that L.N. had suffered a stroke. L.N. was 69 years old at the time of the orders on appeal, and had “enjoyed a full, active, independent life” prior to her stroke on September 12. Thereafter, L.N. remained in the hospital on a ventilator to assist with breathing and a nasal-gastric tube for nutrition and hydration. L.N.’s attorney informed the court in a motion for expedited hearing that “[a]fter consulting with personnel, it has been indicated that [L.N.] will probably not survive the massive stroke which precipitated this hospitalization, but there is no one with authority to act.” There was no evidence that L.N. had previously executed either a living will or a durable power of attorney for healthcare. M.C., a former co-worker, was ultimately appointed as guardian. Based upon conversations, the guardian’s sense was that L.N. “would want to be allowed to have a natural death.” Notwithstanding testimony by L.N.’s caregivers and guardian, the trial court concluded that, “in cases of doubt, the Court must assume that the patient would choose to defend life” and did “not find that [L.N.] - under the facts in this case - would choose to have life support removed and a natural death process to occur.” On appeal, L.N. argues that the probate court erred in determining that “it had jurisdiction to make a determination as to the appropriateness, or lack thereof, of the removal of life support in the case of a patient who was in a persistent vegetative state” where “no party challeng[ed] the proposed removal.” She further argued that, even if the court had the authority to exercise its discretion in this matter, its findings were unsupported by the testimony. The New Hampshire Supreme Court reversed the order denying authority to remove life support and vacated, in part, the order appointing the guardian: “Because any limitation on the guardian’s RSA 464-A:25, I(d) authority after the October 17 hearing was not supported by the statutorily-required finding that it was “desirable for the best interests of [L.N.],” RSA 464-A:25, II, we vacate that limitation. Without that limitation, the guardianship order’s grant of the ‘right and authority to determine if refusal should be made or consent should be given to any medical or other professional care, counseling, treatment, or service’ constitutes a general grant of authority that includes the authority to withdraw life-sustaining treatment in appropriate circumstances.” View "In re Guardianship of L.N." on Justia Law