Justia Health Law Opinion Summaries

The Supreme Court reversed the judgment of the district court denying Appellants' petitions to change their legal sex designations because the designations did not reflect their identities, holding that Appellants met the requirements for their sex-change petitions to be approved.Under Utah Code 26-2-11(1), a person who has a name change or sex change approved by an order of a Utah district court can file the order with the state registrar with an application to change their birth certificate, and if the registrar determines that the application is complete, the registrar must change the sex on the person's birth certificate. In denying Appellants' sex-change petitions the district court concluded that a sex-change matter is a nonjusticiable political question due to lack of legislative guidance. The Supreme Court reversed after providing a plain meaning interpretation of the law allowing individuals to change their sex designations, holding that Appellants met the requirements articulated by this Court - based in common law and applied by district courts - for their sex-change petitions to be approved. View "In re Sex Change of Childers-Gray" on Justia Law

Wichita pharmacist Ebube Otuonye (defendant) filled prescriptions written by Dr. Steven Henson for opioids and other controlled substances. The Drug Enforcement Administration (“DEA”) became suspicious of Dr. Henson’s prescriptions and investigated him, which led them to Defendant Otuonye. Based on the results of the DEA’s investigation, Otuonye was indicted for conspiring to unlawfully distribute controlled substances; unlawfully distributing controlled substances; and Medicare and Medicaid fraud. A jury convicted Otuonye on all four counts. The district court imposed a 150-month concurrent prison sentence. Otuonye raised seven issues on appeal: five challenged the admission of evidence; the sixth challenged the sufficiency of the evidence for all four convictions; and in the last, Otuonye argued the district court committed procedural error by miscalculating his sentencing guidelines range. Finding none of these challenges availing, the Tenth Circuit affirmed his conviction and sentence. View "United States v. Otuonye" on Justia Law

The issue presented for the New Mexico Supreme Court’s review centered on the executive branch’s authority to impose business restrictions during a pandemic. Specifically, the Court was asked to address: (1) whether Petitioners were authorized to restrict or close businesses when necessary for the protection of public health; and (2) whether the renewed temporary closure of indoor dining at restaurants and breweries, mandated by a July 13, 2020, emergency public health order (July Order), was arbitrary and capricious. With respect to the first question the Supreme Court held, consistent with its opinion in Grisham v. Reeb, 2020-NMSC-___, (S-1-SC-38336, Nov. 5, 2020), that Petitioners were so authorized. With respect to the second question, the Court held that the July Order’s temporary closure of indoor dining was not arbitrary and capricious. View "Lujan Grisham v. Romero" on Justia Law

The Ninth Circuit affirmed the district court's grant of summary judgment for HHS in an action brought by plaintiff, challenging HHS's denial of his claim for reimbursement from the Medicare program for services that he provided covered patients. The Supreme Court recently reaffirmed that a reviewing court should defer to an agency's reasonable interpretation of ambiguous regulations in Kisor v. Wilkie, 139 S. Ct. 2400 (2019).The panel agreed with the district court that the governing regulation, 42 C.F.R. 424.520(d), is genuinely ambiguous and that the agency's interpretation is reasonable. In this case, section 424.520(d) does not specify whether a certification submitted to reactivate billing privileges constitutes a "Medicare enrollment application" that triggers a new effective date. The panel concluded that the Board's interpretation of section 424.520(d) merits Auer deference and controls this case. Therefore, plaintiff's reactivation request was "a Medicare enrollment application," and its filing date of August 31, 2015 is the effective date of his billing privileges. The panel also agreed with the district court that its review was appropriately confined to the administrative record the agency produced and that the agency was not required to supplement the record. View "Goffney v. Becerra" on Justia Law

In this special action challenging the trial court's ruling that Defendant's due process rights required disclosure of the victim's privileged records for in-camera review, the Supreme Court held that the trial court did not err in ordering in-camera review.Defendant was charged with second-degree murder for killing M.S., his girlfriend. Before trial, Defendant moved to compel Magellan Hospital to disclose for in-camera review M.S.'s privileged mental health records. The trial court ruled that Defendant's due process rights required dislosure of the privileged records for in-camera review. M.S.'s siblings filed a special action under Arizona's Victims' Bill of Rights challenging the ruling. The court of appeals granted relief, concluding that there was not a substantial probability that the records contained information critical to Defendant's justification defense. The Supreme Court vacated the court of appeals' opinion and affirmed the trial court's judgment, holding that a record of M.S.'s purported mental illness would be material to Defendant's justification defense. View "R.S. v. Honorable Peter A. Thompson" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the circuit court compelling Plaintiff to arbitrate his claims of wrongful death and negligence against Signature HealthCARE of East Louisville, holding that arbitration was required on all claims.To secure his father's admittance into Signature, a long-term care facility, Plaintiff signed an arbitration agreement as his father's authorized representative. After his father died, Plaintiff brought a negligence and wrongful death claim against Signature. Signature filed a motion to compel arbitration. The trial court denied the motion. The court of appeals reversed in part, holding that Plaintiff's wrongful death claim was arbitrable because he signed the arbitration agreement in his individual capacity. The Supreme Court affirmed in part and reversed in part, holding that both Plaintiff's individual claims and that claims he brought as the representative of his father's estate were subject to arbitration. View "LP Louisville East, LLC v. Patton" on Justia Law

CMA and others filed suit against Aetna, seeking among other claims, an injunction for alleged violations of the Unfair Competition Law (UCL; Bus. & Prof. Code, section 17200). The trial court found that CMA lacked standing under the UCL because it was not directly injured by Aetna's policy.The Court of Appeal affirmed the trial court's grant of Aetna's motion for summary judgment, concluding that the body of law permitting an association to bring a nonclass representative action does not bestow standing upon CMA to seek an injunction against Aetna under the UCL, whether or not CMA individually suffered injury in fact and lost money or property. The court also concluded that CMA's evidence that it diverted substantial resources to assist its physician members who were injured by Aetna's policy did not create a material disputed fact as to whether CMA itself suffered injury in fact and lost money or property. The court explained that an association must sustain direct economic injury to itself and not just its members to bring a UCL claim. Furthermore, evidence that an association diverted resources to investigate its members' claims of injury and advocate for their interests is not enough to show standing under the UCL. In this case, the federal authorities CMA cites are neither binding on this court nor instructive. View "California Medical Ass'n v. Aetna Health of California, Inc." on Justia Law

Plaintiff, a Nevada physician who treats patients covered by Medicare, filed suit seeking an injunction compelling the contractor that administers Medicare in his region to change the method of evaluating his claims. The district court granted the injunction.The Ninth Circuit vacated the preliminary injunction, concluding that the Medicare statute permits a court to review only claims that have been presented to the agency. The panel explained that, because this case does not involve a claim that was presented to the agency, the district court lacked subject matter jurisdiction. Accordingly, the panel remanded to the district court with instructions to dismiss the complaint for lack of jurisdiction. View "Odell v. U.S. Department of Health & Human Services" on Justia Law

Plaintiffs, a group of nursing homes that participate in both the Medicare and Medicaid programs, challenge the legality of DHS's Final Rule permitting survey teams conducting certain inspections of nursing homes not to include a registered nurse. The district court dismissed plaintiffs' claims, brought under the Medicare and Medicaid Acts, for lack of subject-matter jurisdiction based on claim-channeling and jurisdiction-stripping provisions governing claims arising under the Medicare Act.The Second Circuit reversed, concluding that the district court has jurisdiction under 28 U.S.C. 1331 over plaintiffs' claim arising under the Medicaid Act, which does not incorporate the same claim-channeling and jurisdiction-stripping provisions as the Medicare Act. The court explained that the Medicare Act's review provisions do not preclude plaintiffs from challenging the Final Rule in federal court because their challenge is independently rooted in the Medicaid Act. Furthermore, plaintiffs' Medicaid Act claim is not inextricably intertwined with a Medicare Act claim for benefits or compliance determination, and the government's policy rationale does not support claim channeling and jurisdiction stripping in this case. Accordingly, the court remanded for further proceedings. View "Avon Nursing & Rehabilitation v. Becerra" on Justia Law

The Supreme Court affirmed the order of the circuit court vacating the finding of the West Virginia Department of Health and Human Resources of maltreatment by Respondent as to her son, holding that the circuit court correctly determined that the conduct engaged in by the lay representative of the West Virginia Department of Health and Human Resources (DHHR) constituted the unauthorized practice of law.The circuit court concluded (1) the decision of the administrative law judgment upholding the DHHR's finding of maltreatment was erroneous because it was not supported by a witness with personal knowledge and was based upon inadmissible DHHR records; and (2) the administrative hearing before DHHR's board of review was conducted in an unlawful manner because DHHR's non-lawyer representative engaged in the unauthorized practice of law. The Supreme Court affirmed, holding that the circuit court did not err in concluding that the administrative proceedings were based upon unlawful procedure brought about by DHHR's lay representative engaging in the unauthorized practice of law. View "W. Va. Department of Health and Human Resources v. C.P." on Justia Law