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The Eighth Circuit affirmed the district court's grant of judgment on the pleadings to the Med and Avectus in a class action suit alleging that both federal and Arkansas Medicaid laws prohibited the Med from directly billing Medicaid beneficiaries. The court held that federal law did not bar the Med from attempting recovery from plaintiff or a liable third party because the Med had opted not to bill and to accept payment from Arkansas Medicaid. The court also held that, like the federal provisions, the Arkansas Medicaid statutes do not prohibit a medical provider from foregoing Medicaid’s guaranteed payment for covered services and opting instead to bill the patient or liable third parties directly. View "Robinett v. Shelby County Healthcare Corp." on Justia Law

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The process of involuntary admission of an individual begins with the initiation application for involuntary admission and ends upon a hearing officer’s decision whether to admit or release that individual. If, during the process, a physician applies the statutory criteria for involuntary admission and concludes, in good faith, that the individual no longer meets those criteria, the facility must release the individual. The physician’s decision is immune from civil liability and cannot be the basis of a jury verdict for medical malpractice. Brandon Mackey was taken to Bon Secours Hospital pursuant to an application for involuntary admission after he attempted to commit suicide. Dr. Leroy Bell treated Mackey. Two days before a scheduled hearing to determine whether Mackey should be admitted involuntarily or released, Dr. Bell authorized Mackey’s release. Thereafter, Mackey committed suicide. Plaintiff brought suit contending that Dr. Bell, and Bon Secours vicariously as his employer, were negligent in releasing Mackey. The jury returned a verdict in favor of Chance. The circuit court vacated the judgment based in part on its understanding of the immunity statute. The court of special appeals reversed. The Court of Appeals reversed, holding that Dr. Bell’s decision to discharge Mackey, made in good faith and with reasonable grounds, was immune from liability. View "Bell v. Chance" on Justia Law

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This case was a qui tam action alleging violations of the False Claims Act (“FCA”) involving fraudulent reimbursements under the Medicare Act. Plaintiff Gerald Polukoff, M.D., was a doctor who worked with Defendant Sherman Sorensen, M.D. After observing some of Sorensen’s medical practices, Polukoff brought this FCA action, on behalf of the United States, against Sorensen and the two hospitals where Sorensen worked (collectively, “Defendants”). Polukoff alleged Sorensen performed thousands of unnecessary heart surgeries and received reimbursement through the Medicare Act by fraudulently certifying that the surgeries were medically necessary. Polukoff further alleged the hospitals where Sorensen worked were complicit in and profited from Sorensen’s fraud. The district court granted Defendants’ motions to dismiss, reasoning that a medical judgment could not be false under the FCA. The Tenth Circuit reversed and remanded, holding that a doctor’s certification to the government that a procedure is “reasonable and necessary” is “false” under the FCA if the procedure was not reasonable and necessary under the government’s definition of the phrase. View "Polukoff v. St. Mark's Hospital" on Justia Law

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In this case involving a therapist who caused a child to falsely accuse a parent of sexual abuse, the Supreme Court held (1) a treating therapist working with a minor child owes a duty of reasonable care to a nonpatient parent to refrain from the affirmative act of recklessly giving rise to false memories or false allegations of childhood sexual abuse by that parent; and (2) a treating therapist owes a duty to refrain from affirmatively causing the nonpatient parent severe emotional distress by recklessly giving rise to false memories or false allegations of childhood sexual abuse by that parent. As a result of Nancy Baird’s treatment of Thomas Mower’s four-year-old daughter, T.M., false allegations of sexual abuse were levied against Mower. Mower sued Baird and The Children’s Center (collectively, Defendants) for the harm he suffered as a result of T.M.’s treatment. The district court dismissed the claims under Utah R. Civ. P. 12(b)(6) on the grounds that therapists do not have “a duty of care to potential sexual abusers when treating the alleged victim.” The Supreme Court reversed, holding that a treating therapists do not have “the unfettered right" to treat patients "using techniques that might cause the patient to develop a false memory [or allegations] of sexual abuse.” View "Mower v. Children’s Center" on Justia Law

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The Court of Appeal affirmed the trial court's order dismissing plaintiffs' challenge to an amendment to California law that eliminated the previously existing "personal beliefs" exemption from mandatory immunization requirements for school children. Senate Bill No. 277 eliminated the personal beliefs exemption from the requirement that children receive vaccines for specified infectious diseases before being admitted to any public or private elementary or secondary school, day care center or the like. The court held that plaintiffs failed to cite any authority for their assertion that SB 277 violated freedom of religion and plaintiffs' free exercise claim was meritless; SB 277 did not violate plaintiffs' constitutional right to attend school; SB 277 did not violate the equal protection clause where the statutory classifications and exemptions plaintiffs disputed did not involve similarly situated children, or were otherwise entirely rational classifications; SB 277 was not void for vagueness where it was sufficiently clear to give fair warning of the required conduct; and SB 277 did not violate Health and Safety Code 24175 subdivision (a). View "Brown v. Smith" on Justia Law

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When Charlotte Fischer moved into a nursing home, she received an admissions packet full of forms. Among them was an agreement that compelled arbitration of certain legal disputes. The Health Care Availability Act (“HCAA” or “Act”) required such agreements contain a four-paragraph notice in a certain font size and in bold-faced type. Charlotte’s agreement included the required language in a statutorily permissible font size, but it was not printed in bold. Charlotte’s daughter signed the agreement on Charlotte’s behalf. After Charlotte died, her family initiated a wrongful death action against the health care facility in court. Citing the agreement, the health care facility moved to compel arbitration out of court. The trial court denied the motion, and the court of appeals affirmed, determining the arbitration agreement was void because it did not strictly comply with the HCAA. At issue was whether the Act required strict or substantial compliance. The Colorado Supreme Court held "substantial:" the agreement at issue her substantially complied with the formatting requirements of the law, notwithstanding the lack of bold type. View "Colorow Health Care, LLC v. Fischer" on Justia Law

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The DC Circuit held that 42 C.F.R. 405.1885 does not apply to appeals from a fiscal intermediary to the Provider Reimbursement Review Board. Therefore, the court had no occasion to address whether the 2013 amendments to the reopening regulation were arbitrary and capricious or whether applying the amendments to proceedings pending on their effective date would be impermissibly retroactive. Accordingly, the court reversed and remanded for further proceedings. View "Saint Francis Medical Center v. Azar" on Justia Law

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The Justice Center for the Protection of People with Special Needs acted within its authority under N.Y. Social Services Law 493 when it required Petitioner to undertake certain remedial measures to correct the systemic problems that led to three sexual assaults at Petitioner’s residential health care facility. The sexual assaults at Petitioner’s facility were committed by the same resident and occurred within a six-month period. After an investigation, the Justice Center substantiated allegations of neglect against Petitioner and required it to undertake certain remedial measures to correct its “systemic problems.” Petitioner brought this N.Y. C.P.L.R. 78 proceeding seeking to annul the Justice Center’s determination, contending that section 493 did not authorize the Justice Center to substantiate a finding of neglect against Petitioner and that the Justice Center’s determination was not supported by substantial evidence. The Appellate Division granted the petition and annulled the Justice Center’s determination. The Court of Appeals reversed, holding that section 493 enables the Justice Center to address systemic issues at a facility regardless of whether allegations against a particular employee are also substantiated. View "Anonymous v. Molik" on Justia Law

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The New York City Board of Health’s promulgation of the flu vaccine falls within the powers specifically delegated to the New York City Department of Health and Mental Hygiene in New York City Administrative Code 17-109. At issue was the Board’s amendments to the New York City Health Code mandating that children between the ages of six months and fifty-nine months who attend city-regulated child care or school-based programs receive annual influenza vaccinations. Petitioners - parents of children enrolled in child care programs subject to the flu vaccine rules who objected to their children receiving the vaccination - commenced this hybrid N.Y. C.P.L.R. 78 proceeding and declaratory judgment action to enjoin Respondents from enforcing the flu vaccine rules. Supreme Court granted Petitioners’ motion and permanently enjoined Respondents from enforcing the flu vaccine rules. The Appellate Division affirmed. The Court of Appeals reversed, holding (1) the Board permissibly adopted the flu vaccine rules pursuant to its authority to regulate vaccinations; (2) the Board’s actions did not violate the separation of powers doctrine; and (3) the flu vaccine rules are not preempted by state law. View "Garcia v. New York City Department of Health & Mental Hygiene" on Justia Law

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The Court of Appeals held that whether an absolute privilege applies to a communication made in the course of a quasi-judicial proceeding depends on the status of the subject of the communication. New York Downtown Hospital terminated the employment of Plaintiff, a medical scientist, and removed her as chairperson of the hospital’s Institutional Review Board. Dr. Steven Friedman’s statements to the FDA during an investigation of Downtown Hospital’s IRBs about Plaintiff, which discussed the reasons for the removal of Plaintiff from her positions, were published in an Establishment Inspection Report (EIR) released by the FDA. Plaintiff commenced this defamation action against Downtown Hospital, Friedman, and others, asserting that her professional reputation was damaged by the publication of defamatory statements about her made by Friedman to the FDA inspectors. Defendants filed a motion to dismiss. Supreme Court allowed Plaintiff’s defamation claim against Downtown Hospital and Friedman to survive, concluding that the statements were not shielded by an absolute privilege because the FDA’s investigation had none of the indicia of a quasi-judicial proceeding. The Appellate Division reversed, concluding that the complained-of statements were made in a quasi-judicial context in which an absolute privilege protected them. The Court of Appeals reversed, holding that Friedman’s statements, as published in the EIR, were not protected by absolute privilege. View "Stega v. New York Downtown Hospital" on Justia Law