Genesis Hospice LLC provided outpatient hospice care to Medicaid beneficiaries in the Mississippi Delta. Claims Genesis submitted outside the norm, prompting a Mississippi Division of Medicaid audit. A statistical sample of 75 of the 808 billed claims were reviewed, and of that 75, 68 claims were not substantiated by the patients’ records and thus not eligible for payment. The auditing physicians specifically found that the patient records for the 68 rejected claims lacked sufficient documentation to support the given terminal-illness diagnosis and/or lacked documentation of disease progression. Medicaid’s statistician extrapolated that 68 of 75 unsupported claims represented a total overpayment of $1,941,285 for the 808 claims Genesis billed during the relevant time period. And Medicaid demanded Genesis repay this amount. Medicaid’s decision has been affirmed in an administrative appeal before Medicaid and by the Hinds County Chancery Court, sitting as an appellate court. On further appeal to the Mississippi Supreme Court, Genesis essentially argued Medicaid unfairly imposed documentation requirements not found in the federal or state Medicaid regulations. Genesis insisted the only requirement was a physician’s certification that in his or her subjective clinical judgment the patient was terminally ill, which Genesis provided. The Supreme Court found the regulations were clear: a physician’s certification of terminal illness is indeed required, but so is documentation that substantiates the physician’s certification. Because Genesis’ records failed to support 90 percent of its hospice claims, Medicaid had the administrative discretion to demand these unsupported claims be repaid. Therefore, the Supreme Court affirmed. View "Genesis Hospice Care, LLC v. Mississippi Division of Medicaid" on Justia Law

The Supreme Court affirmed a circuit court judgment denying validation of revenue bonds, holding that Halifax Hospital Medical Center, a special tax district, was not authorized to carry out the project for which it sought to issue the bonds. Halifax sought validation of bonds that it intended to issue for the purpose of financing the construction of a hospital outside the geographic boundaries established in the special act creating Halifax. The circuit court denied the complaint for bond validation on the grounds that Halifax lacked the authority operate a facility outside its geographical boundaries. The Supreme Court affirmed, holding that the circuit court properly denied the bond validation because neither Halifax's enabling act nor the Interlocal Act gave Halifax the authority to operate outside its geographic boundaries. View "Halifax Hospital Medical Center v. State" on Justia Law

Over seven years, Dr. Greenspan referred more than 100,000 blood tests to Biodiagnostic Laboratory, which made more than $3 million off these tests. In exchange, the Lab gave Greenspan and his associates more than $200,000 in cash, gifts, and other benefits. A jury convicted Greenspan of accepting kickbacks, 42 U.S.C. 1320a-7(b)(1)(A); using interstate facilities with the intent to commit commercial bribery, 18 U.S.C. 1952(a)(1), (3); honest-services wire fraud, 18 U.S.C. 1343, 1346; and conspiracy to do all of those things. The Third Circuit affirmed, characterizing the evidence of his guilt as overwhelming. The district court erred in instructing the jury that Greenspan had to “demonstrate” the prerequisites for an advice-of-counsel defense; in excluding as hearsay some of his testimony about that legal advice; in asking only Greenspan’s counsel, not Greenspan personally, whether he wished to speak at sentencing; and in limiting the scope of the defense to five particular agreements rather than all eight, but all of those errors were harmless. The court properly excluded evidence that the blood tests were medically necessary. That evidence was only marginally relevant and risked misleading the jury. View "United States v. Greenspan" on Justia Law

The Fifth Circuit affirmed the district court's decision to affirm the revocation of two physicians' Medicare privileges. The court held that the physicians billed for services using their own Medicare National Provider Identifiers without providing direct supervision while traveling outside of the country; the ALJ's summary judgment dismissal of the physicians' claims was supported by substantial evidence; the physicians' constitutional claims were rejected; the court agreed with its sister circuits that have determined that participation in the federal Medicare reimbursement program is not a property interest; and the court deferred to CMS's decision to bar the physicians from re-enrolling in the Medicare program for three years. View "Shah v. Azar" on Justia Law

Ace, a licensed physician, and Lesa Chaney owned and operated Ace Clinique in Hazard, Kentucky. An anonymous caller told the Kentucky Cabinet for Health and Family Services that Ace pre-signed prescriptions. An investigation revealed that Ace was absent on the day that several prescriptions signed by Ace and dated that day were filled. Clinique employees admitted to using and showed agents pre-signed prescription blanks. Agents obtained warrants to search Clinique and the Chaneys’ home and airplane hangar for evidence of violations of 21 U.S.C. 841(a)(1), knowing or intentional distribution of controlled substances, and 18 U.S.C. 1956(h), conspiracies to commit money laundering. Evidence seized from the hangar and evidence seized from Clinique that dated to before March 2006 were suppressed. The court rejected arguments that the warrants’ enumeration of “patient files” was overly broad and insufficiently particular. During trial, an alternate juror reported some “concerns about how serious[ly] the jury was taking their duty.” The court did not tell counsel about those concerns. After the verdict, the same alternate juror—who did not participate in deliberations—contacted defense counsel; the court conducted an in camera interview, then denied a motion for a new trial. To calculate the sentencing guidelines range, the PSR recommended that every drug Ace prescribed during the relevant time period and every Medicaid billing should be used to calculate drug quantity and loss amount. The court found that 60 percent of the drugs and billings were fraudulent, varied downward from the guidelines-recommended life sentences, and sentenced Ace to 180 months and Lesa to 80 months in custody. The Sixth Circuit affirmed, rejecting challenges to the constitutionality of the warrant that allowed the search of the clinic; the sufficiency of the evidence; and the calculation of the guidelines range and a claim of jury misconduct. View "United States v. Chaney" on Justia Law

The Supreme Court reversed the judgment of the circuit court entered on the jury's verdict finding that Davis Life Care Center (DLCC), a long-term care facility, was not entitled to charitable immunity and denying DLCC's motion for new trial, holding that the circuit court erred in submitting the charitable-immunity question to the jury. Plaintiff sued DLCC alleging negligence, medical malpractice, breach of an admission agreement, and other causes of action. DLCC filed a motion for summary judgment claiming entitlement to charitable immunity. The circuit court granted the motion. The court of appeals reversed and remanded for further proceedings, concluding that reasonable persons could reach different conclusions based on the undisputed facts presented. The circuit court submitted the question of charitable immunity to the jury, which returned a verdict against DLCC. The Supreme Court reversed, holding that the issue of charitable immunity is a question of law for the court, rather than the jury, to decide. View "Davis Nursing Ass'n v. Neal" on Justia Law

Kentucky’s “Ultrasound Informed Consent Act,” KRS 311.727, directs a doctor, before performing an abortion, to perform an ultrasound; display the ultrasound images for the patient; and explain, in the doctor’s own words, what is being depicted. There is no requirement that the patient view the images or listen to the description. The doctor also must auscultate the fetal heartbeat but may turn off the volume if the patient requests. The Act does not penalize a doctor if the patient requested that the heartbeat sound be turned off or chose not to look at the ultrasound images or if the doctor makes any other statement, including advising a patient that she need not listen to or view the disclosures, or that the patient should have an abortion. A doctor need not make any disclosures if an abortion is medically necessary or in a medical emergency. Doctors brought a First Amendment challenge. The district court permanently enjoined enforcement of the Act. The Sixth Circuit reversed, citing the Supreme Court’s 2018 decision, National Institute of Family & Life Advocates, clarifying that no heightened First Amendment scrutiny should apply to abortion-informed-consent statutes. Even though an abortion-informed-consent law compels a doctor’s disclosure of certain information, it should be upheld so long as the disclosure is truthful, non-misleading, and relevant to abortion. View "EMW Women's Surgical Center P.S.C. v. Beshear" on Justia Law

Acting as the personal representative of his father’s estate, plaintiff Dennis Sloan brought a medical negligence action against defendants Providence Health System-Oregon and Apogee Medical Group, P.C. Plaintiff claimed defendants were negligent in their care of plaintiff’s father because they failed to diagnose and treat the father's rib fractures and internal bleeding. On November 3, the father, then 85 years old, came to Providence’s hospital after falling at home and was initially treated at the emergency room. He was later admitted to the hospital, where he was treated by Apogee’s doctors. On November 7, Apogee’s doctors discharged Sloan to a skilled nursing facility, Three Fountains. On November 17, Sloan’s condition worsened significantly. Two days later, Three Fountains returned Sloan to the hospital. At the hospital, Sloan was found to have multiple displaced rib fractures and bleeding in his right chest cavity, which had caused his right lung to collapse. Later that same day, Sloan died of respiratory failure due to the bleeding in his chest cavity and the collapse of his lung. Plaintiff claimed the trial court erred in refusing to give his requested jury instruction concerning a tortfeasor’s liability for the subsequent conduct of another. The Court of Appeals agreed and reversed the trial court’s judgment in part and remanded the case to the trial court for a new trial. On defendant’s petition, the Oregon Supreme Court granted review of the appellate court's judgment, and finding no reversible error, affirmed the Court of Appeals decision, which reversed the trial court’s judgment in part. The case was remanded for a new trial. View "Sloan v. Providence Health System-Oregon" on Justia Law

The Alaska Department of Health and Social Services required most healthcare facilities to document the need for proposed services before the state approves construction of a new facility. The agency determined that an ambulatory surgical facility seeking to relocate from Anchorage to Wasilla did not need to submit such documentation because it was moving within the same community as defined by the relevant statute. Competing medical facilities in the Matanuska-Susitna Borough objected to the determination, arguing that Anchorage and Wasilla were not the “same community” and that the proposed relocation required the usual certification of need. Because Anchorage and Wasilla were not the same community as contemplated by the statute, the Alaska Supreme Court reversed the determination that the facility was exempt from the required certification process. View "Alaska Spine Center, LLC v. Mat-Su Valley Medical Center, LLC" on Justia Law

In this Kansas Sexually Violent Predator Act (KSVPA) case, Kan. Stat. Ann. 59-29a01 et seq., the Supreme Court remanded Thomas Easterberg's action seeking a petition for writ of habeas corpus, holding that there was a fact question for the district court to resolve in order to determine whether Easterberg's writ should be granted. Easterberg pled guilty to kidnapping and aggravated battery. On the sentencing guidelines journal entry of judgment for these convictions, the district court indicated that Easterberg's crimes were not sexually motivated for purposes of the Kansas Offender Registration Act, Kan. Stat. Ann. 22-4902(c)(14). Thereafter, the Attorney General's Office filed a petition seeking to involuntarily commit Easterberg as a sexually violent predator. Easterberg moved to dismiss the action, arguing that the State had no statutory basis to file the petition for his commitment. The district court denied the motion to dismiss. Easterberg then filed this original action. The Supreme Court remanded this case to the district court for a determination of whether the issue of sexual motivation was litigated in Easterberg's criminal case. If so, the State would be estopped from relegating that point in the KSVPA proceeding and Easterberg would not be eligible for involuntary commitment. If not, the KSVPA proceeding would continue. View "In re Care & Treatment of Easterberg" on Justia Law