Justia Health Law Opinion Summaries

Kentucky and Arkansas residents sued the Secretary of Health and Human Services based on the approval under 42 U.S.C. 1315(a) of an “experimental, pilot, or demonstration projects which, in the judgment of the Secretary, is likely to assist in promoting the objectives” of Medicaid. The district court held that the Secretary failed to analyze whether the projects would promote the primary objective of Medicaid—to furnish medical assistance. Kentucky terminated its project and obtained voluntary dismissal. The D.C. Circuit affirmed with respect to the Arkansas Works program, which required beneficiaries aged 19-49 to “work or engage in specified educational, job training, or job search activities for at least 80 hours per month,” except beneficiaries who show they are medically frail or pregnant, caring for a dependent child under age six, participating in a substance treatment program, or are full-time students. Works proposed to eliminate retroactive coverage, to lower the income eligibility threshold from 133% to 100% of the federal poverty line, and eliminated using Medicaid funds to assist beneficiaries in paying the premiums for employer-provided health care coverage. Instead of analyzing whether the demonstration would promote the objective of providing coverage, the Secretary identified three alternative objectives. Congress has not conditioned the receipt of Medicaid benefits on fulfilling work requirements or taking steps to end receipt of governmental benefits View "Gresham v. Azar" on Justia Law

Central Mississippi Medical Center (CMMC) appealed a Chancery Court decision denying its appeal of a Division of Medicaid (DOM) hearing. The DOM had determined that CMMC owed it $1.226 million due to overpayment. The Mississippi Supreme Court recently decided a reimbursement dispute involving the DOM, Crossgates River Oaks Hosp. v. Miss. Div. of Medicaid, 240 So. 3d 385 (Miss. 2018). In Crossgates, the hospitals prevailed because the DOM had failed to adhere to the Medicare State Plan Agreement. Applying the same legal principles to this case, the Supreme Court ruled the DOM prevailed because the DOM adhered to the Plan. The chancellor found sufficient evidence to support the DOM’s decision, decreed that it was neither arbitrary nor capricious, and decreed that it did not exceed the DOM’s authority or violate any of CMMC’s statutory or constitutional rights. View "Central Mississippi Medical Center v. Mississippi Division of Medicaid" on Justia Law

Baystate filed suit against the Secretary, challenging his promulgation of a final rule calculating the wage index for hospital reimbursements in 2017. Baystate alleged that the Secretary failed to comply with the statutory requirement to calculate a wage index that reflected the actual wage levels in Massachusetts, relied on data that he knew to be false, and entirely failed to consider an important aspect of the problem. The DC Circuit affirmed the district court's grant of summary judgment for the Secretary, holding that the Secretary's interpretation of his authority under the Medicare statute was lawful and his action was not arbitrary and capricious. In this case, the Secretary provided a reasonable explanation for his decision to enforce the deadline and reject Nantucket's revised data; the decision to enforce the deadline against third-party hospitals was not arbitrary or capricious; and the Secretary's interpretation of his authority to enforce a deadline in calculating the wage index fell squarely within them. View "Baystate Franklin Medical Center v. Azar" on Justia Law

Stacey Janssen alleged Lawrence Memorial Hospital ("LMH") engaged in two healthcare schemes to fraudulently receive money from the United States. Janssen first contended LMH falsified patients’ arrival times in order to increase its Medicare reimbursement under certain pay-for-reporting and pay-for-performance programs the Government used to study and improve hospitals’ quality of care. Second, Janssen contended LMH falsely certified compliance with the Deficit Reduction Act in order to receive Medicare reimbursements to which it was otherwise not entitled. LMH moved for summary judgment below, arguing Janssen failed to show her allegations satisfied the Act’s materiality requirement - that the alleged falsehoods influenced the Government’s payment decision as required under the FCA. The district court granted LMH summary judgment on all of Janssen’s claims on this basis, and finding no reversible error, the Tenth Circuit affirmed. View "United States ex rel. Janssen v. Lawrence Memorial Hospital" on Justia Law

Martin, a 67-year-old woman, sought Social Security Disability benefits. Her persistent back pain stems from two car accidents; she also suffers from depression, anxiety, bipolar disorder, panic disorder, and PTSD. These conditions caused Martin to stop working in 2009. Before then she had worked as a home health aide, data entry clerk, and administrative assistant. An ALJ determined that Martin’s severe impairments left her capable of performing only a limited range of sedentary jobs. The district court remanded for a more thorough consideration of Martin’s mental health problems. A new ALJ then found that Martin had no physical limitations whatsoever and declined to award benefits. The Seventh Circuit reversed, finding the second ALJ’s decision not supported by substantial evidence, and took “the rare step of ordering the award of benefits.” The court rejected Martin’s argument that the ALJ’s residual functional capacity determination failed to translate her mental health symptoms into limitations related to concentration, persistence, and pace but the record is clear that Martin’s physical limitations leave her unable to perform any work above the light level. Given her restricted range of motion and symptoms of pain, light exertion would likely be a challenge for Martin because it requires “a good deal of walking or standing.” View "Martin v. Saul" on Justia Law

Shane and Rebecca Ackerschott sued Mountain View Hospital, LLC, doing business as Redicare (“Redicare”), after Shane sustained an injury leading to paraplegia. A jury found Redicare’s treatment of Shane breached the standard of care and awarded the Ackerschotts $7,958,113.67 in total damages. After judgment was entered, Redicare filed a motion for judgment notwithstanding the verdict, or in the alternative, a new trial. The Ackerschotts also moved to alter or amend the judgment. All post-trial motions were denied. Redicare appealed, arguing the district court erred by not submitting an instruction on comparative negligence to the jury and by allowing testimony of the Ackerschotts’ expert witness. The Ackerschotts cross-appealed, arguing the cap on noneconomic damages imposed by Idaho Code section 6-1603 was unconstitutional. After review, the Idaho Supreme Court affirmed as to Redicare’s direct appeal, and declined to reach the merits of the Ackerschotts’ constitutional claim on cross-appeal. View "Ackerschott v. Mtn View Hospital; Redicare" on Justia Law

In this review of the court of appeals' decision affirming the circuit court's orders for involuntary commitment and involuntary medication and treatment of D.K. the Supreme Court held that there was clear and convincing evidence at a final hearing that D.K. was dangerous as defined under Wis. Stat. 51.20(1)(a)2.b. D.K. argued that he should not have been committed because Winnebago County failed to prove by clear and convincing evidence that he was dangerous. The circuit court concluded that the County met its burden to prove by clear and convincing evidence that D.K. was mentally ill and dangerous. The court of appeals affirmed, holding that the circuit court's dangerousness determination was supported by the evidence. The Supreme Court affirmed, holding (1) D.K.'s commitment was not a moot issue because it still subjected him to a firearms ban; and (2) there was clear and convincing evidence that D.K. was dangerous as defined under section 51.20(1)(a)2.b. View "Marathon County v. D. K." on Justia Law

The Supreme Judicial Court vacated the judgment of the probate court denying L.'s petition for termination of his adult guardianship, holding that the court applied an incorrect standard of proof in contravention of Me. Rev. Stat. 18-A, 5-307(d). In denying L.'s petition the probate court determined that L. "failed to prove by clear and convincing evidence that his adult guardianship was no longer necessary for his safety and well-being." The Supreme Court vacated the judgment, holding (1) Me. Rev. Stat. 18-A, 5-307(d) sets forth the burden of proof applicable to L.'s petition for termination of guardianship; and (2) the probate court in this case failed to apply the proper statutory standard of proof in denying L.'s petition. View "In re Adult Guardianship of L." on Justia Law

The Court of Appeals held that Md. Code Crim. Proc. (CP) 3-121(e), which sets forth the process for issuing a hospital warrant and recommitment pending a hearing on a petition for revocation or modification, does not violate due process under either the United States Constitution or the Maryland Declaration of Rights. Upon pleading guilty to involuntary manslaughter, Appellant was found not criminally responsible and committed to the Health Department. After Appellant was conditionally released pursuant to court order the State filed a petition for revocation or modification of her conditional release on the basis that she had violated a condition of her release. The circuit court issued a hospital warrant, acting pursuant to CP 3-121. Appellant was subsequently recommitted to a mental health facility in anticipation of a required hearing. Appellant filed a petition for habeas corpus arguing that recommitment of a person alleged to have violated conditional release must include a finding that the committed person was currently danger to self or to the person or property of others. The habeas court denied the petition. The court of special appeals affirmed. The Court of Appeals affirmed, holding that CP 3-121 appropriately balances the interests of society against a committed individual's conditional liberty interest. View "Simms v. Maryland Department of Health" on Justia Law

The Louisiana Supreme Court granted writs in consolidated matters to consider whether allegations of negligent credentialing against two healthcare providers were claims that fell within the purview of Louisiana’s Medical Malpractice Act or, alternatively, sounded in general negligence. Mariah Charles was born prematurely in October 2014 at Lafayette General Medical Center (LGMC) and hospitalized there until March 2015, when she was transferred to Women’s and Children’s Hospital of Lafayette (W&C) until her release a month later. Dr. Geeta Dalal, a pediatric cardiologist with clinical privileges at both hospitals, contributed to Mariah’s care during and after Mariah’s hospitalization. While Mariah remained at LGMC, Dr. Dalal ordered and interpreted eight echocardiograms that, according to the petition, revealed abnormal findings that could cause pulmonary artery hypertension, yet, the petition alleged Dr. Dalal took no action other than ordering additional echocardiograms. After Mariah’s transfer to W&C, Dr. Dalal interpreted more echocardiograms, again noted abnormalities, and allegedly failed to properly diagnose or treat Mariah. Mariah’s mother initiated Medical Review Panel proceedings with the Patient’s Compensation Fund against Dr. Dalal and the hospital defendants alleging medical malpractice and seeking damages for their alleged failure to properly diagnose and treat Mariah. In addition to the Medical Review Panel proceedings, Mariah's mother filed suit against the hospitals, The Regional Health System of Acadiana, LLC, Women’s & Children’s Hospital, Inc., HCA Holdings, Inc., and Health Care Indemnity, Inc. (W&C), as well as Lafayette General Medical Center, Inc. and/or Lafayette General Health System, Inc. (LGMC), for damages related to Mariah’s care. The petition for damages asserted a single cause of action that LGMC and W&C were liable under general tort law because they “negligently credentialed Dr. Dalal and negligently provided her with privileges to practice” in their facilities “even though [they] knew or should have known she was not board certified in the field of pediatric cardiology.” LGMC and W&C filed dilatory exceptions of prematurity to this suit, asserting that they were qualified healthcare providers under the MMA and were entitled to have Thomas’s negligent credentialing claims presented first to a medical review panel pursuant to R.S. 40:1231.8(B)(1)(a)(i). Based on the allegations presented by the petition, the provisions of the LMMA, and application of the "Coleman" factors, the Supreme Court found the trial court correctly sustained the exceptions of prematurity raised by LGMC and W&C, therefore reversing the court of appeal's judgment and reinstated the trial court’s judgment. View "Thomas v. Regional Health System of Acadiana, LLC" on Justia Law