This interlocutory appeal arose from a circuit court’s denial of a motion to transfer venue. Under Mississippi law, venue is determined at the time the lawsuit originally is filed. The resolution of this appeal hinged on the application of this principle to an issue of first impression for the Mississippi Supreme Court: does an amended complaint, which names a new party to the suit, relate back to the time of filing of the original complaint for the purposes of determining venue? The Court found it did not. The suit here was filed in Hinds County, naming only Forrest County defendants, and the amended complaint did not relate back to the time of filing for the purposes of determining venue. The circuit court abused its discretion in denying the motion to transfer venue. The Supreme Court reversed the judgment of the circuit court and remanded the case to be transferred to the Circuit Court Forrest County. View "Forrest General Hospital v. Upton" on Justia Law

For several weeks, Redman posed as a psychiatrist at a Chicago medical clinic using the name and license number of Dr. Garcia. He “treated” patients for mental illnesses, and “prescribed” controlled substances. Redman actually did not attend school past the tenth grade. Before commencing employment, Redman provided falsified documentation: an employment application, payroll application, I‐9 Employment Eligibility Verification form, W‐9 form, photograph of an Indiana driver’s license with Redman’s picture, photocopy of an Illinois medical license, photocopy of a medical school diploma, a residency certificate for training in psychiatry, and a photocopy of a social security card. He used online counterfeiting services; he submitted an online Drug Enforcement Administration application and obtained malpractice insurance using false information. He was discovered when the real Dr. Garcia learned that someone had used his medical license number to obtain a DEA registration. A jury found Redman guilty of wire fraud, aggravated identity theft, furnishing false and fraudulent material information in documents required under the federal drug laws, and distributing controlled substances. The Seventh Circuit affirmed his 157-month sentence, upholding the application of two-level enhancements for use of sophisticated means and for conduct that involved a conscious or reckless disregard of a risk of death or serious bodily injury. View "United States v. Redman" on Justia Law

The Board of Directors (the Board) of Bear Valley Community Hospital (Bear Valley) refused to promote Dr. Robert O. Powell from provisional to active staff membership and reappointment to Bear Valley's medical staff. Dr. Powell appealed the superior court judgment denying his petition for writ of mandate to void the Board's decision and for reinstatement of his medical staff privileges. Dr. Powell practiced medicine in both Texas and California as a general surgeon. In 2000, the medical executive committee of Brownwood Regional Medical Center (Brownwood), in Texas, found that Dr. Powell failed to advise a young boy's parents that he severed the boy's vas deferens during a hernia procedure or of the ensuing implications. Further, the committee found that Dr. Powell falsely represented to Brownwood's medical staff, on at least two occasions, that he fully disclosed the circumstances to the parents, behavior which the committee considered to be dishonest, obstructive, and which prevented appropriate follow-up care. Based on the committee's findings, Brownwood terminated Dr. Powell's staff membership and clinical privileges. In subsequent years, Dr. Powell obtained staff privileges at other medical facilities. In October 2011, Dr. Powell applied for appointment to the medical staff at Bear Valley. On his initial application form, Dr. Powell was given an opportunity to disclose whether his clinical privileges had ever been revoked by any medical facility. In administrative hearings generated by the Bear Valley Board’s decision, there was a revelation that Dr. Powell had not been completely forthcoming about the Brownwood termination, and alleged the doctor mislead the judicial review committee (“JRC”) about the circumstances leading to that termination. Under Bear Valley's bylaws, Dr. Powell had the right to an administrative appeal of the JRC's decision; he chose, however, to bypass an administrative appeal and directly petition the superior court for a writ of mandamus. In superior court, Dr. Powell filed a petition for writ of mandate under Code of Civil Procedure sections 1094.5 and 1094.6, seeking to void the JRC's/Board's decision and to have his medical privileges reinstated. The trial court denied the petition, and this appeal followed. On appeal of the superior court’s denial, Dr. Powell argued he was entitled to a hearing before the lapse of his provisional staff privileges: that the Board surreptitiously terminated his staff privileges, presumably for a medical disciplinary cause, by allowing his privileges to lapse and failing to act. The Court of Appeal determined the Bear Valley Board had little to no insight into the true circumstances of Dr. Powell’s termination at Brownwood or the extent of his misrepresentations, thus the Board properly exercised independent judgment based on the information presented. In summary, the Court of Appeal concluded Bear Valley provided Dr. Powell a fair procedure in denying his request for active staff privileges and reappointment to the medical staff. View "Powell v. Bear Valley Community Hospital" on Justia Law

In 2017, Maryland enacted “An Act concerning Public Health – Essential Off-Patent or Generic Drugs – Price Gouging – Prohibition.” The Act, Md. Code, Health–General 2-802(a), prohibits manufacturers or wholesale distributors from “engag[ing] in price gouging in the sale of an essential off-patent or generic drug,” defines “price gouging” as “an unconscionable increase in the price of a prescription drug,” and “unconscionable increase” as “excessive and not justified by the cost of producing the drug or the cost of appropriate expansion of access to the drug to promote public health” that results in consumers having no meaningful choice about whether to purchase the drug at an excessive price due to the drug’s importance to their health and insufficient competition. The “essential” medications are “made available for sale in [Maryland]” and either appear on the Model List of Essential Medicines most recently adopted by the World Health Organization or are “designated . . . as an essential medicine due to [their] efficacy in treating a life-threatening health condition or a chronic health condition that substantially impairs an individual’s ability to engage in activities of daily living.” The Fourth Circuit reversed the dismissal of a “dormant commerce clause” challenge to the Act, finding that it directly regulates the price of transactions that occur outside Maryland. View "Association for Accessible Medicine v. Frosh" on Justia Law

Twelve Medicaid-participating hospitals (“Hospitals”) challenged the Department of Medicaid’s (“DOM’s”) recalculation of their Medicaid outpatient rates for fiscal year 2001. The chancery court affirmed the opinion of the DOM, finding that “DOM interpreted its own regulation – the State Plan, which is its contract with the federal government and which it is required to follow to receive federal funds to require Medicaid to calculate the cost to charge ratio by using Medicare Methodology, which at that time was using a blended rate.” The Mississippi Supreme Court found the plain language of Attachment 4.19-B of the State Plan provided a cost-to-charge-ratio formula for calculating outpatient rates. Laboratory and radiology charges were to be excluded from this formula, because they were reimbursed on a fee-for-service basis. DOM’s inclusion of radiology and laboratory services in the charges and substitution of costs with Medicare blended payment amounts was a clear violation of the State Plan. Therefore, the Court reversed the judgments of DOM and the chancery court. Consistent with its opinion, the Court remanded and ordered the Executive Director of DOM to recalculate the Hospitals’ cost-to-charge ratio using the Hospital’s submitted costs in their cost reports, excluding laboratory and radiology services, and reimbursing the Hospitals the appropriate amounts determined by using the State Plan. View "Crossgates River Oaks Hospital v. Mississippi Division of Medicaid" on Justia Law

The Ninth Circuit reversed the district court's partial grant of summary judgment for the Department and held that the Department did not violate the dormant Commerce Clause in adopting Medi-Cal policies related to reimbursement to out-of-state hospitals. The panel held that when a state was acting as a market participant, rather than a market regulator, its decisions were exempted from the dormant Commerce Clause. In this case, the Department sets rates of reimbursement to hospitals for those who were essentially insured as beneficiaries under Medi-Cal in a manner much like that of a private insurer participating in the market. Therefore, the Department was acting as a market participant, rather than a regulator and was exempt from dormant Commerce Clause requirements. View "Asante v. California Department of Healthcare Services" on Justia Law

The Court of Appeal affirmed the trial court's order appointing the Public Guardian of the County of Ventura as the conservator of objector's person and estate after the jury found beyond a reasonable doubt that he was gravely disabled as a result of mental disorder. The court held that the trial court committed harmless error by giving instructions concerning possible consequences should a party prevail. In this case, the trial court's instruction informed the jury about the duration and types of treatment that may be ordered if a conservatorship was established. View "Conservatorship of P.D." on Justia Law

At issue was Nev. Rev. Stat. 453A.322(3)(a)(5)’s requirement that an applicant seeking to obtain a medical marijuana establishment registration certificate must obtain approval from the local government where the establishment is to be located verifying that the applicant is in compliance with applicable zoning restrictions and building requirements. Specifically at issue was whether this requirement must be satisfied before an applicant can receive a registration certificate. The Supreme Court held that it need not be satisfied and that the registration certificate is deemed provisional until the applicant is able to satisfy section 453A.322(3)(a)(5). View "Nuleaf CLV Dispensary, LLC v. State Department of Health & Human Services, Division of Public & Behavioral Health" on Justia Law

After Family Rehabilitation was assessed about $7.6 million for Medicare overpayments, it filed suit for an injunction against recoupment until it received an ALJ hearing. The Fifth Circuit reversed the district court's dismissal for lack of subject matter jurisdiction and remanded in regard to Family Rehabilitation's procedural due process and ultra vires claims. The court held that exhaustion of administrative review was waived because Family Rehabilitation asserted a collateral challenge that could not be remedied after the exhaustion of administrative review. In this case, Family Rehabilitation sought only the suspension of recoupment before a hearing, which was plainly collateral to the result of that hearing, and the combined threats of going out of business and disruption to Medicare patients were sufficient to show that it would suffer irreparable injury. The court affirmed in all other respects. View "Family Rehabilitation, Inc. v. Azar" on Justia Law

Al-Shaikh, an orthopedic surgeon, moved his Fremont practice and sought approval by the Department of Health Care Services (DHCS), under Medi-Cal regulations. He had been an approved Medi-Cal provider in Fremont for six years. DHCS denied his application, claiming that Al-Shaikh’s fee arrangement with his billing service was unlawful. Al-Shaikh appealed. DHCS agreed the provisions it had cited were inapplicable but cited another state law, incorporating a federal Medicaid regulation. Al-Shaikh filed suit, then relocated his Auburn practice, for which he used the same billing service; the relocation was approved by a different DHCS regional office. Al-Shaikh cited an Office of the Inspector General publication that expressly states his fee arrangement does not violate federal law. DHCS approved the Fremont office after three years. The court dismissed the case as moot. Al-Shaikh moved for fees under Code of Civil Procedure 1028.5, which allows a small business or a licensee that prevails in an action against a state regulatory agency to recover a maximum of $7,500 in fees if the agency acted without substantial justification. The court of appeal directed the superior court to award Al-Shaikh the full amount recoverable under section 1028.5. DHCS has an obligation to be knowledgeable about the law it is charged with implementing and was unable to cite a case or regulatory decision supporting its position; it acted without substantial justification. View "Al-Shaikh v. State Department of Health Care Services" on Justia Law