Justia Health Law Opinion Summaries

The case involves a coalition of states led by Washington suing the FDA over its 2023 REMS, which eliminated in-person dispensing requirements for the abortion drug mifepristone. Washington argues that the FDA should have further reduced restrictions on the drug, claiming that the remaining requirements impose unnecessary hurdles. Idaho, leading another coalition of states, sought to intervene, arguing that the elimination of the in-person dispensing requirement would harm its interests by making the drug easier to obtain and harder to police, potentially increasing Medicaid costs and endangering maternal health and fetal life.The United States District Court for the Eastern District of Washington denied Idaho's motion to intervene. The court found that Idaho did not have a significantly protectable interest that would be impaired by the litigation, as its complaint concerned different aspects of the 2023 REMS. The court also denied permissive intervention, concluding that Idaho's claims did not share common questions of law or fact with Washington's claims.The United States Court of Appeals for the Ninth Circuit reviewed the case and affirmed the district court's denial of Idaho's motion to intervene as of right. The Ninth Circuit held that Idaho must independently satisfy the requirements of Article III standing because it sought different relief from Washington. The court concluded that Idaho's complaint did not establish a cognizable injury-in-fact that was fairly traceable to the FDA's revised safe-use restrictions. Idaho's alleged economic injuries, law enforcement burdens, and quasi-sovereign interests were deemed too speculative or indirect to confer standing. The court dismissed for lack of jurisdiction the portion of the appeal concerning the denial of permissive intervention. View "STATE OF WASHINGTON V. FDA" on Justia Law

Farzam Salami received emergency services at Los Robles Regional Medical Center on three occasions in 2020. He signed a conditions of admission contract agreeing to pay for services rendered, as listed in the hospital's chargemaster. Los Robles billed him for these services, including a significant emergency services fee (EMS fee). Salami paid part of the discounted bill but disputed the EMS fee, claiming it covered general operating costs rather than services actually rendered. He argued that had he known about the EMS fee, he would have sought treatment elsewhere.Salami sued Los Robles in December 2021 for breach of contract and declaratory relief. The trial court sustained Los Robles's demurrer to the first amended complaint (FAC), finding that Salami did not allege he performed his duties under the contract or that Los Robles failed to perform its duties. The court also found that the breach of contract claim could not be cured by amendment. Salami was granted leave to amend to assert claims under the Unfair Competition Law (UCL) and Consumers Legal Remedies Act (CLRA). In his third amended complaint (TAC), Salami alleged that Los Robles failed to disclose the EMS fee adequately.The Court of Appeal of the State of California, Second Appellate District, Division Six, reviewed the case. The court affirmed the trial court's decision, holding that Los Robles had no duty to disclose the EMS fee beyond including it in the chargemaster. The court referenced recent cases, including Moran v. Prime Healthcare Management, Inc., which held that hospitals are not required to provide additional signage or warnings about EMS fees. The court concluded that Los Robles complied with its statutory and regulatory obligations, and Salami's claims under the UCL and CLRA failed as a result. The judgment in favor of Los Robles was affirmed. View "Salami v. Los Robles Regional Medical Center" on Justia Law

A group of hospitals challenged a rule by the Department of Health and Human Services (HHS) that adjusted Medicare reimbursement rates. HHS had increased reimbursements for hospitals in the lowest wage quartile and decreased them for others to maintain budget neutrality. The hospitals argued that this adjustment exceeded HHS's statutory authority under the Medicare Act.The United States District Court for the District of Columbia ruled in favor of the hospitals, finding that HHS lacked the authority to make such adjustments. However, the court did not vacate the rule but remanded it to HHS with instructions to recalculate the reimbursements.The United States Court of Appeals for the District of Columbia Circuit reviewed the case and agreed with the lower court that HHS exceeded its authority. The court held that the Medicare Act's wage-index provision did not allow HHS to deviate from the congressionally prescribed formula. The adjustments provision also did not grant HHS the power to override the specific statutory formula. The court concluded that HHS's action must be vacated, not just remanded. Additionally, the court directed that the hospitals should receive an award of interest on the recalculated reimbursements as required by the Medicare statute.The court affirmed in part, reversed in part, and remanded the case to the district court for further proceedings consistent with its opinion. View "Bridgeport Hospital v. Becerra" on Justia Law

Elizabeth Peters Young was convicted of conspiring to pay and receive kickbacks from federal reimbursements for medical creams and lotions dispensed by pharmacies she worked with. The district court sentenced her to 57 months in prison and ordered her to pay $1.5 million in restitution and forfeiture, representing the gross proceeds she controlled during the conspiracy.The United States District Court for the Southern District of Florida initially reviewed the case. Young challenged her conviction, restitution order, and forfeiture judgment, arguing insufficient evidence for her conspiracy conviction, improper calculation of restitution, and errors in the forfeiture amount. The district court denied her motion to set aside the verdict and sentenced her, including the contested financial penalties.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court affirmed Young’s conspiracy conviction, finding sufficient evidence that she conspired with others, including a pharmacy, to receive kickbacks. The court also upheld the forfeiture judgment, ruling that Young was liable for the gross proceeds she controlled, even if she distributed some to co-conspirators. However, the court vacated the restitution order, agreeing with Young that the government did not prove the amount of loss it experienced due to her conduct. The court remanded the case for further proceedings to determine the correct restitution amount. View "USA v. Young" on Justia Law

A group of retired firefighters from the City of Columbia claimed that the City had promised them free lifetime health insurance. This promise was allegedly made through verbal statements, newsletters, and retirement letters. The dispute arose when the City Council required all active and retired employees under 65 to contribute to their health insurance premiums, and later extended this requirement to Medicare supplemental coverage for retirees over 65. The firefighters argued that the City should be held to its promise under the doctrine of promissory estoppel.Initially, the Circuit Court granted summary judgment in favor of the City, but the Court of Appeals reversed this decision, allowing the promissory estoppel claim to proceed. After a nonjury trial, Judge Sprouse ruled in favor of the City, and the Court of Appeals affirmed this decision, stating that the firefighters had not proven an unambiguous promise or reasonable reliance on such a promise.The Supreme Court of South Carolina reviewed the case and affirmed the Court of Appeals' decision but modified the reasoning. The Supreme Court found that the firefighters did not prove the City made a clear promise of free lifetime health insurance. Additionally, the Court emphasized that the City Council, not individual employees, had the authority to make such promises. The Court also clarified that promissory estoppel claims need only be proven by the greater weight of the evidence, not by clear and convincing evidence, except in cases involving specific performance of land transfers. The Court concluded that the firefighters had no right to rely on statements made by City employees who lacked the authority to bind the City. View "Cruz v. City of Columbia" on Justia Law

Caris MPI, Inc. (Caris) provided cancer diagnostic services to UnitedHealthcare, Inc. (United) for over ten years without a written contract. United audited Caris’s past claims and determined that Caris had used incorrect billing codes, resulting in overpayments. United began recouping these overpayments by offsetting them against new payment claims from Caris. Caris challenged United’s recoupment through United’s internal process, but after United rejected Caris’s appeals, Caris filed suit in Texas state court alleging various state law claims.United removed the case to the United States District Court for the Northern District of Texas, asserting federal officer jurisdiction under 28 U.S.C. § 1442(a)(1). The district court denied Caris’s motion to remand and dismissed Caris’s claims without prejudice, finding that Caris failed to exhaust administrative remedies under the Medicare Act.The United States Court of Appeals for the Fifth Circuit reviewed the case and agreed that federal officer jurisdiction existed. However, the court found that the district court erred in dismissing Caris’s claims for failure to exhaust administrative remedies. The Fifth Circuit held that the administrative review process under Medicare Part C does not extend to claims where an enrollee has no interest, and there were no administrative remedies for Caris to exhaust. The court distinguished this case from others by noting that no enrollee had requested an organization determination or appeal, and all enrollees had already received the services for which United sought recoupment. Consequently, the court affirmed the denial of the remand motion, reversed the dismissal of Caris’s claims, and remanded the case for further proceedings. View "Caris MPI v. UnitedHealthcare, Incorporated" on Justia Law

Hector Rodriguez-Pena was convicted in 1993 for his involvement in a drug trafficking conspiracy, firearms possession, and the attempted murder of federal law enforcement officers. He was sentenced to a total of 622 months' imprisonment, which was later reduced to 570 months. Over the years, Rodriguez-Pena has repeatedly challenged his sentence and conviction through various legal avenues, including direct appeals and motions for sentence modifications, all of which were denied.Rodriguez-Pena filed a motion for compassionate release in the U.S. District Court for the District of Puerto Rico, citing his vulnerability to COVID-19 due to his health conditions and the prevalence of the virus in his prison facility, FCI Coleman Low. He argued that his medical conditions, including high blood pressure and hyperlipidemia, increased his risk of severe complications from COVID-19. The district court denied his motion, concluding that he did not demonstrate extraordinary and compelling reasons for a sentence reduction, particularly noting his vaccination status and the low COVID-19 infection rates in his facility.The United States Court of Appeals for the First Circuit reviewed the case and affirmed the district court's decision. The appellate court found that the district court did not abuse its discretion in concluding that Rodriguez-Pena's risk from COVID-19, given his vaccination status and the conditions at FCI Coleman Low, did not constitute an extraordinary and compelling reason for compassionate release. The court also noted that the district court properly considered the evidence and arguments presented, including the effectiveness of COVID-19 vaccines and the current state of the pandemic within the prison. View "US v. Rodriguez-Pena" on Justia Law

The case involves a congressional program that awards grants for family-planning projects, with the Department of Health and Human Services (HHS) setting eligibility requirements. Oklahoma, a grant recipient, expressed concerns about these requirements, citing state laws prohibiting counseling and referrals for abortions. HHS proposed that Oklahoma provide neutral information about family-planning options, including abortion, through a national call-in number. Oklahoma rejected this proposal, leading HHS to terminate the grant. Oklahoma challenged the termination and sought a preliminary injunction.The United States District Court for the Western District of Oklahoma denied Oklahoma's motion for a preliminary injunction, determining that Oklahoma was unlikely to succeed on the merits of its claims. Oklahoma then appealed the decision.The United States Court of Appeals for the Tenth Circuit reviewed the case. Oklahoma argued that it would likely succeed on the merits for three reasons: (1) Congress's spending power did not allow it to delegate eligibility requirements to HHS, (2) HHS's requirements violated the Weldon Amendment, and (3) HHS acted arbitrarily and capriciously. The Tenth Circuit rejected these arguments, holding that:1. The spending power allowed Congress to delegate eligibility requirements to HHS, and Title X was unambiguous in conditioning eligibility on satisfaction of HHS's requirements. 2. The Weldon Amendment, which prohibits discrimination against health-care entities for declining to provide referrals for abortions, was not violated because HHS's proposal to use a national call-in number did not constitute a referral for the purpose of an abortion. 3. HHS did not act arbitrarily and capriciously in terminating Oklahoma's grant, as the eligibility requirements fell within HHS's statutory authority, and Oklahoma did not demonstrate a likely violation of HHS's regulations.The Tenth Circuit affirmed the district court's denial of the preliminary injunction, concluding that Oklahoma had not shown a likelihood of success on the merits of its claims. View "State of Oklahoma v. HHS" on Justia Law

K.B., a patient at the Alaska Psychiatric Institute (API), has been under successive involuntary commitment orders since 2019 due to his diagnoses of schizoaffective disorder, antisocial personality disorder, and traumatic brain injury. His condition has led to violent outbursts and delusional behavior, resulting in his banishment from local shelters and hotels. In September 2022, Dr. Anthony Blanford, K.B.'s attending psychiatrist, filed another 180-day commitment petition. During the proceedings, K.B. expressed dissatisfaction with his appointed attorney, particularly over whether his trial would be by jury or bench.The Superior Court of the State of Alaska, Third Judicial District, Anchorage, initially set the trial for late September. K.B.'s attorney informed the court that K.B. had requested a jury trial. However, on the first day of jury selection, K.B. indicated he preferred a bench trial. The court allowed defense counsel to consult with K.B., who confirmed his preference for a bench trial. The next day, K.B.'s attorney reported that K.B. had fired him for not listening and reiterated his preference for a bench trial. After further consultation, the attorney confirmed K.B.'s preference for a bench trial, and the court proceeded accordingly, ultimately granting the 180-day commitment petition.The Supreme Court of the State of Alaska reviewed the case. K.B. argued that the superior court erred by not conducting a representation hearing or inquiring further into his dissatisfaction with his attorney. The Supreme Court held that the superior court was not required to delve further into the attorney-client relationship. The court found that the circumstances, viewed objectively, did not indicate a breakdown in communication or decision-making capability between K.B. and his attorney. Therefore, the superior court's order granting the 180-day commitment was affirmed. View "In re Hospitalization of K.B." on Justia Law

Law enforcement executed a search warrant at Ryan Dewayne Myrick’s apartment, discovering 69.01 grams of methamphetamine, drug packaging, a digital scale, and other paraphernalia. In his vehicle, they found additional drug packaging. Myrick was charged with conspiracy to distribute methamphetamine and possession with intent to distribute. He pleaded guilty to the latter charge, admitting to possessing 69.01 grams of methamphetamine, with the intent to distribute at least 50 grams. The government agreed to dismiss the conspiracy charge and recommend a reduction for acceptance of responsibility, contingent on Myrick’s continued demonstration of acceptance.The United States District Court for the Southern District of Iowa reviewed the case. The Presentence Investigation Report (PSR) recommended holding Myrick responsible for 4.5 kilograms or more of methamphetamine, resulting in a base offense level of 38. It also suggested a two-level enhancement for maintaining a premises for drug distribution and a three-level reduction for acceptance of responsibility. Myrick objected to the drug quantity and the premises enhancement, while the government objected to the reduction for acceptance of responsibility. The district court overruled Myrick’s objections and sustained the government’s, resulting in a total offense level of 40 and an advisory Guidelines range of 360 months to life. Myrick was sentenced to 300 months of imprisonment and 5 years of supervised release.The United States Court of Appeals for the Eighth Circuit reviewed the case. Myrick challenged the district court’s drug quantity determination, the premises enhancement, and the denial of a reduction for acceptance of responsibility. The appellate court found no clear error in the district court’s findings, including the credibility of witness testimony and the application of relevant conduct principles. The court affirmed the district court’s judgment, upholding Myrick’s sentence. View "United States v. Myrick" on Justia Law