Justia Health Law Opinion Summaries

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The Fifth Circuit affirmed the district court's grant of HHS's motion for summary judgment in an action where HHS concluded that Dominion must return approximately $1.3 million in Medicare payments. The Secretary argues that a physician certification statement is necessary but not sufficient to establish that nonemergency, scheduled, repetitive ambulance transportation is covered by Medicare, as the contrary interpretation would render the phrase "medically necessary" in 42 C.F.R. 410.40(d)(2) superfluous. The court held that the Secretary's interpretation is neither plainly erroneous nor inconsistent with the regulation, and Dominion's arguments to the contrary are unavailing. Furthermore, HHS's statement in 2012 when it amended the regulation supports its position that HHS did not consider a physician certification statement conclusive. Therefore, the district court properly deferred to the agency's reasonable interpretation. Finally, the court assumed, without deciding, that the district court had jurisdiction to review the timeliness of the decision to reopen the initial determination, and held that the decision to reopen was timely. View "Dominion Ambulance, LLC v. Azar" on Justia Law

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Mitze unsuccessfully appealed the denial of her application for social security benefits. Several years later, Mitze moved to seal her medical information and all other information pertaining to her case, citing “harassing phone calls from solicitors” who knew her personal medical information because the courts had “publicized” it by issuing opinions. She claims that she and her children have experienced social stigma and that thieves broke into her home to steal pain medication, which publicly available documents revealed that she had been prescribed. The Seventh Circuit affirmed the denial of Mitze’s motion. A strong presumption exists in favor of publishing dispositional orders, even in cases involving substantial privacy interests such as state secrets, trade secrets, and attorney-client privilege. The court acknowledged that the existing remedies of proceeding anonymously, requesting redactions, or sealing records may be inadequate in the social security context. News outlets have the right to publish information obtained from public court records and cannot be ordered to remove articles reporting on the decisions in her case. The court rejected an argument under the Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-6, which regulates the disclosure of information by only healthcare providers and their affiliates. View "Mitze v. Saul" on Justia Law

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The States filed suit raising constitutional challenges to Section 9010 of the Affordable Care Act (ACA) and statutory and constitutional challenges to the Certification Rule. The Fifth Circuit affirmed the district court's ruling that the States had standing to raise their Certification Rule claims; reversed the district court's ruling that the States' Administrative Procedure Act (APA) claims were not time-barred; and dismissed those claims for lack of jurisdiction. On the merits, the court affirmed the district court's judgment on the Section 9010 claims, holding that the Provider Fee is a constitutional tax that does not violate the Spending Clause and that Section 9010 satisfies both the requirements under the Tenth Amendment doctrine of intergovernmental tax immunity. In this case, the Provider Fee does not discriminate against states or those with whom they deal because it is imposed on any entity that provides health insurance (with certain exclusions). Furthermore, the legal incidence of the Provider Fee does not fall on the states because Congress expressly excluded states from paying the fee. However, the court reversed the district court's judgment that the Certification Rule violated the nondelegation doctrine, holding that HHS did not unlawfully delegate to a third party its authority to approve state managed-care organization (MCO) contracts. Accordingly, the court rendered judgment in favor of the United States. Because neither the Certification Rule nor Section 9010 are unlawful, the court vacated the district court's grant of equitable disgorgement to the States. View "Texas v. Rettig" on Justia Law

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A man appealed superior court orders authorizing his hospitalization for evaluation, his 30-day commitment, and the involuntary administration of psychotropic medication. He argued the superior court’s failure to conduct a screening investigation was an error that required vacation of the evaluation order and the commitment and medication orders that followed it. He also specifically challenged the commitment order, claiming that the court erred by relying on facts not in evidence and by finding clear and convincing evidence that he was gravely disabled and that commitment was the least restrictive alternative. The Alaska Supreme Court concluded: (1) that failing to perform a screening investigation was error, but the error was harmless because the court made findings supported by clear and convincing evidence when ordering a 30-day commitment; (2) it was also harmless error to rely to any extent on facts not in evidence because there was sufficient evidence in the record to support a finding that the respondent was gravely disabled; (3) the superior court did not err when it found by clear and convincing evidence that the respondent was gravely disabled and that commitment was the least restrictive alternative, or when it granted the petition for involuntary hospitalization; and (4) the superior court did not err by finding that medication was in the respondent’s best interests and that there was no less intrusive alternative, or by granting the petition for its involuntary administration. View "In the Matter of the Necessity for the Hospitalization of Rabi R." on Justia Law

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Hospitals and hospital associations filed suit challenging HHS's decision to reduce the reimbursement rates for 340B hospitals. The district court held that the rate cute exceeded HHS's statutory authority to adjust specified covered outpatient drugs (SCOD) rates. After determining that it had jurisdiction, the DC Circuit proceeded to the merits and held that HHS had statutory authority to impose its 28.5 percent cut to SCOD reimbursement rates for 340B hospitals. The court held that HHS reasonably interpreted 42 U.S.C. 1395l(t)(14)(A)(iii)(II)'s adjustment authority to enable reducing SCOD payments to 340B hospitals, so as to avoid reimbursing those hospitals at much higher levels than their actual costs to acquire the drugs. Applying Chevron deference, the court held that, at a minimum, the statute does not clearly preclude HHS from adjusting the SCOD rate in a focused manner to address problems with reimbursement rates applicable only to certain types of hospitals. View "American Hospital Ass'n v. Azar" on Justia Law

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Federal regulations require commercial truck drivers to undergo annual physicals to be “medically certified as physically qualified." A driver is not physically qualified if he has a clinical diagnosis of a respiratory dysfunction likely to interfere with his ability to drive a commercial motor vehicle safely. Respiratory dysfunction includes sleep apnea. Allman was diagnosed with apnea after a sleep study and was instructed to wear a CPAP machine when sleeping in his truck. Allman complained about the device, which was remotely monitored. Allman was suspended twice for noncompliance. Allman independently completed a second sleep study, which showed that Allman did not have sleep apnea. Allman stopped wearing the CPAP and obtained a new DOT certification card without another examination. Walmart instructed Allman to participate in another sleep study because the doctor who performed Allman’s independent study was not board certified. A third study resulted in a second diagnosis of sleep apnea. Allman refused to wear the CPAP machine. Rather than taking the conflicting sleep studies to a DOT medical examiner, Allman resigned and filed suit, asserting discrimination based on perceived disability and retaliation under Ohio law. The Sixth Circuit affirmed the rejection of both claims. Walmart offered a legitimate, nondiscriminatory reason for its CPAP requirement; Allman failed to rebut that reason as pretextual. Walmart’s CPAP requirement was not an unsafe working condition but was a disability accommodation meant to promote public safety and to ensure compliance with federal law. View "Allman v. Walmart, Inc." on Justia Law

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After the Medical Center suspended plaintiff's medical privileges, plaintiff filed suit against the Medical Center, an injunction against the suspension, and a declaration that the Health Care Quality Improvement Act provided no immunity from damages to the Medical Center. The Eleventh Circuit vacated the district court's judgment and remanded with instructions to dismiss plaintiff's complaint for lack of subject matter jurisdiction. Plaintiff contends only that federal question jurisdiction exists over his suit, but a request for declaratory relief that a federal law does not entitle the opposing party to a defense ordinarily does not raise a federal question under 28 U.S.C.1331. The court explained that, because the Declaratory Judgment Act does not enlarge the court's jurisdiction, plaintiff must still assert an underlying ground for federal court jurisdiction. In this case, plaintiff's complaint does not establish that the Medical Center could file a coercive action under federal law. Furthermore, a plaintiff cannot create federal question jurisdiction by seeking a declaration that a federal defense does not protect the defendant. Therefore, plaintiff's request for declaratory judgment does not establish federal question jurisdiction. View "Patel v. Hamilton Medical Center, Inc." on Justia Law

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An employee of a federally supported health center failed to properly administer a drug to Alexis Stokes while she gave birth to Baby Stokes. As a result, Baby Stokes suffered from “cerebral palsy and spastic quadriplegia,” along with other disabilities, and his life expectancy was 22 years. The district court awarded damages to Baby Boy D.S. (Baby Stokes) and his parents, Alexis Stokes and Taylor Stokes, (collectively, the Stokes) in this Federal Tort Claims Act (FTCA) action. The government appealed, arguing that the district court erred in structuring damage payments. The Stokes cross appealed, arguing that the district court erred both by miscalculating the present value of a portion of the award and by awarding too little in noneconomic damages. After review, the Tenth Circuit: (1) vacated and remanded the portion of the district court’s order structuring a trust with respect to Baby Stokes’s future-care award, with instructions to fully approximate section 9.3 of the FTCA; (2) vacated and remanded the portion of the district court’s order calculating the present value of Baby Stokes’s future-care award, with instructions to apply Jones & Laughlin Steel Corp. v. Pfeifer, 462 U.S. 523 (1983); and (3) affirmed the portion of the district court’s order regarding noneconomic damages. The matter was remanded for further proceedings. View "Stokes v. United States" on Justia Law

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The Supreme Court held that when reviewing a finding that a fact has been proved by clear and convincing evidence, the appellate court must view the record in light most favorable to the prevailing party below and give due deference to how the trier of fact may have evaluated the credibility of witnesses, resolved conflicts in the evidence, and drawn reasonable inferences from the evidence. A probate court appointed limited coconservators for O.B., a young woman with autism. O.B. challenged the order, arguing that the proof did not clearly and convincingly establish that a limited conservatorship was warranted. The court of appeal rejected O.B.'s challenge to the sufficiency of the evidence, concluding that the clear and convincing standard of proof "disappears" on appeal. The Supreme Court reversed, holding that when reviewing a finding of fact that has been proved by clear and convincing evidence, the appellate court must determine whether the record as a whole contains substantial evidence from which a reasonable fact-finder could have found it highly probable that the fact was true. View "In re Conservatorship of O.B." on Justia Law

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The parents of a teenage girl (L.M.) sued Premera Blue Cross under the Employee Retirement Income Security Act (ERISA), claiming improper denial of medical benefits. L.M. experienced mental illness since she was a young girl. L.M. was eventually placed in Eva Carlston Academy, where she obtained long-term psychiatric residential treatment. For this treatment, the parents submitted a claim to Premera under the ERISA plan’s coverage for psychiatric residential treatment. Premera denied the claim ten days into L.M.’s stay. But Premera agreed to cover the first eleven days of L.M.’s treatment, explaining the temporary coverage as a "courtesy." The parents appealed the denial of subsequent coverage, and Premera affirmed the denial based on a physician's medical opinion. The parents filed a claim for reimbursement of over $80,000 in out-of-pocket expenses for L.M.’s residential treatment at the Academy. Both parties moved for summary judgment, and the district court granted summary judgment to Premera based on two conclusions: (1) Premera’s decision was subject to the arbitrary-and- capricious standard of review; and (2) Premera had not acted arbitrarily or capriciously in determining that L.M.’s residential treatment was medically unnecessary. The district court granted summary judgment to Premera, and the parents appealed. After review, the Tenth Circuit concluded the district court erred by applying the arbitrary-and-capricious standard and in concluding Premera had properly applied its criteria for medical necessity. Given these conclusions, the Court reversed and remanded the matter back to the district court for de novo reevaluation of the parents’ claim. View "M. v. Premera Blue Cross" on Justia Law