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The Supreme Court held that, in dismissing the Commonwealth’s petition to have Troy Lamar Giddens, Sr. civilly committed as a sexually violent predator, the trial court misapplied the relevant statute, Va. Code 37.2-905.1. Moreover, the evidence did not support dismissal. The trial court dismissed the Commonwealth’s petition, concluding that the burden was on the Commonwealth to prove that Giddens was eligible for the sexually violent predator program and that the Commonwealth failed to show that Giddens' score on Static-99, the test designed to assess the recidivism risk of adult male sexual offenders, was scored correctly. The Supreme Court reversed, holding that Giddens did not show gross negligence or willful misconduct, which was required for him to prevail under section 37.2-905.1. View "Commonwealth v. Giddens" on Justia Law

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The DEA bars hospitals from hiring, as an employee with “access to controlled substances,” any doctor who “for cause” has surrendered his registration to handle those substances. The DEA enforced this regulation against Doctors McDonald and Woods, who had voluntarily surrendered their registrations while in addiction treatment. They later regained full registrations. The doctors sued to enjoin the DEA from enforcing the regulation against them in the future, arguing that it no longer applied to them once their registrations were restored. The parties settled. Their agreement provides that “[t]he DEA no longer interprets 21 C.F.R. 1301.76(a) as requiring . . . potential employers of doctors with unrestricted DEA registrations to seek waivers.” The Sixth Circuit denied the government’s motion to keep the agreement under seal, noting “a strong presumption in favor of openness as to court records.” The government did not identify information too sensitive to remain public. Public interest is particularly strong where the information pertains to an agency’s interpretation of a regulation. Other doctors would no doubt be interested. View "Woods v. United States Drug Enforcement Administration" on Justia Law

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This case was one in a longstanding dispute between major health services providers operating in Western Pennsylvania: UPE, a/k/a Highmark Health and Highmark, Inc. (collectively, Highmark) and UPMC (University of Pittsburgh Medical Center). Highmark and UPMC separately entered into Consent Decrees with the Commonwealth's Office of Attorney General (OAG). In this case, an issue arose concerning the obligations imposed by the Consent Decrees relative to UMPC's attempt to terminate ten hospital Medicare Acute Care Provider Agreements it had with Highmark. Pertinent here, UPMC's Consent Decree required it to treat Highmark's Medicare Advantage Plan consumers as in-network through the end date of the Consent Decree. UPMC allowed Provider Agreements with Highmark to renew annually in satisfaction of its in-network obligation. UPMC informed Highmark in accordance with the notice provisions, it would terminate the Provider Agreements on December 31, 2018, but would nonetheless continue to comply with all terms and obligations of those agreements through June 30, 2019, pursuant to the Decree runout provision. Highmark filed for an injunction and to hold UPMC in contempt. The Commonwealth granted OAG's petition to enforce, rejecting UPMC's contention that the six-month runout provision of the Provider Agreements satisfied its obligation to remain in "contract" with Highmark. The Pennsylvania Supreme Court reversed, finding the runout provision of the Provider Agreement satisfied UPMC's obligation to contract for in-network access to its facilities for Highmark's MA Plan subscribers through June 30, 2019. View "Pennsylvania v. UPMC, et al" on Justia Law

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The Supreme Court affirmed the order of the district court approving S.D.’s waiver of her rights and ordering S.D.’s involuntary commitment, holding that the district court did not violate S.D.’s statutory and due process rights when it committed her without holding a hearing. The State filed a petition against S.D., alleging that she suffered from a mental disorder and required involuntary commitment. S.D. and her attorney signed a “waiver of hearing on petition,” and S.D. expressly waived all her procedural rights listed in Mont. Code Ann. 53-21-115 to -118 except the right to receive treatment. The district court issued an order committing S.D. to the Montana State Hospital. S.D. appealed, arguing that the district court erred when it committed her upon her signed waiver without a hearing or trial. The Supreme Court affirmed, holding that both S.D.’s waiver and the district court’s order committing her were sufficient to find an intentional and knowing waiver pursuant to section 53-21-119(1), and it was not necessary for the court to set a hearing to inquire further into S.D.’s waiver of rights. View "In re S.D." on Justia Law

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This case involved the "340B Program," which allowed certain hospitals to purchase outpatient drugs from manufacturers at or below specified prices. Plaintiffs filed suit challenging a regulation that sets the Outpatient Prospective Payment System (OPPS) reimbursement drugs purchased through the 340B Progam for 2018. The district court held that plaintiffs failed to present claims for reimbursement to the Secretary, as required to obtain judicial review of claims under Medicare, and thus dismissed the complaint for lack of subject matter jurisdiction. The DC Circuit held that plaintiffs neither presented their claim nor obtained any administrative decision at all, much less the "final decision" required under 42 U.S.C. 405(g). In this case, when plaintiffs filed this action, neither the hospital plaintiffs, nor any members of the hospital-association plaintiffs, had challenged the new reimbursement regulation in the context of a specific administrative claim for payment. They could not have done so because the new regulation had not yet even become effective. Therefore, plaintiffs failed to satisfy the presentment requirement of section 405(g), and the district court properly dismissed this case for lack of subject matter jurisdiction. View "American Hospital Ass'n v. Azar" on Justia Law

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Petitioners sought a writ of mandate directing the superior court to vacate its order denying their motion for summary judgment and issue an order granting the motion. The Court of Appeal issued a stay pending this court's resolution of the petition and an order to show cause why a writ of mandate should not issue. In this case, real party in interest's complaint alleged that petitioners' breakfast cereals were required by California's Proposition 65 to display cancer and reproductive harm warnings because they contain acrylamide. The court held that the Proposition 65 claim was preempted by federal law and granted the petition. The court directed the superior court to vacate its order denying petitioners' motion and enter a new and different order granting the motion. View "Post Foods, LLC v. Superior Court" on Justia Law

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The Eighth Circuit granted Bussen's petition for review of the MSHA's issuance of a citation to Bussen. In this case, the Secretary claimed that Bussen violated federal regulation 30 C.F.R. 56.15005, which requires the use of certain fall-protection equipment at surface metal and nonmetal mines when working where there is a danger of falling. The court held that there was no evidence to support a conclusion that any miner approached the highwall edge when moving the pump cart or were otherwise working without safety belts and lines where there was a danger of falling. Therefore, substantial evidence did not support the ALJ's finding that Bussen violated section 56.15005. View "Bussen Quarries, Inc. v. Acosta" on Justia Law

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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