The Tennessee Hospital Association and three hospitals sued, challenging efforts by the Centers for Medicare and Medicaid Services (CMS) to direct states to recoup certain reimbursements made under the Medicaid program. The hospitals serve a disproportionate share of Medicaid-eligible patients and are thereby entitled to supplemental payments under the Medicaid Act, (DSH payments), 42 U.S.C. 1396a(a)(13)(A)(iv); 1396r-4(b). The Act limits the amount of DSH payments each hospital can receive in a given year. CMS contends that the hospitals miscalculated their DSH payment-adjustments for fiscal year 2012 and received extra payments. Plaintiffs argued, and the district court agreed, that CMS’s approach to calculating DSH payment adjustments is inconsistent with the Act and the regulations that CMS implemented in 2008. The Sixth Circuit affirmed, agreeing that CMS’s policy is inconsistent with its 2008 rule and cannot be enforced unless it is promulgated pursuant to notice-and-comment rulemaking. The court disagreed with the district court’s conclusion that CMS’s policy exceeds the agency’s authority under the Medicaid Act. CMS’s payment-deduction policy is a reasonable interpretation of an ambiguous section of the Act but is not a valid interpretative rule. CMS attempted to exercise its delegated discretion to “determine[]” the “costs incurred” in serving Medicaid-eligible patients—precisely the sort of agency action that requires notice-and-comment rulemaking. View "Tennessee Hospital Association v. Azar" on Justia Law

Plaintiff-petitioner Charissa Schultz was injured in a 2015 car accident in which the other driver failed to stop at a stop sign. The other driver’s insurance company settled for its $25,000 policy limit, and Schultz made a demand on her own uninsured/underinsured motorist benefits under her GEICO policy, which also had a $25,000 limit. In April 2017, after months of correspondence and apparent review of an MRI performed on Schultz in April 2015, GEICO offered Schultz its full policy limit, and it did so without requesting that she undergo an independent medical examination (“IME”). Indeed, GEICO’s claim logs reveal that at the time GEICO decided to offer Schultz its policy limits, it “concede[d] peer review wouldn’t be necessary,” indicating an affirmative decision not to request an IME. A few months later, Schultz filed the present lawsuit asserting claims for bad faith breach of an insurance contract and unreasonable delay in the payment of covered benefits. GEICO denied liability, disputing the extent and cause of Schultz’s claimed injuries and asserting that causation surrounding the knee replacement surgeries was “fairly debatable” because Schultz had preexisting arthritis, which GEICO claimed may independently have necessitated her surgeries. To establish its defense, GEICO ordered the IME and the district court granted that request. The Colorado Supreme Court concluded GEICO’s conduct had to be evaluated based on the evidence before it when it made its coverage decision and that, therefore, GEICO was not entitled to create new evidence in order to try to support its earlier coverage decision. The Court also concluded the district court abused its discretion when it ordered Schultz to undergo an IME over three years after the original accident that precipitated this case and a year and a half after GEICO had made the coverage decision at issue. View "Schultz v. GEICO Casualty Company" on Justia Law

The Supreme Court affirmed in part, reversed in part, and remanded the decision of the circuit court granting the demurrers filed by Carilion Clinic and Carilion Healthcare Corporation (collectively, Carilion) and dismissing all of Lindsey Parker’s claims against it, including both vicarious and direct liability claims, holding that the circuit court correctly dismissed the direct liability claims but erred in dismissing the vicarious liability claim on demurrer. Parker sued Carilion and two Carilion employees, alleging that they had disclosed her confidential medical information to others. Parker served process on Carilion but did not serve either employee. The circuit court sustained Carilion’s demurrers. The Supreme Court held (1) Parker’s notice of appeal was timely; (2) the circuit court erred in granting the demurrer to the extent that it dismissed Parker’s respondent superior claim against Carilion; and (3) the circuit court properly found that Carilion was not directly liable under Fairfax Hospital v. Curtis, 254 Va. 437, 442 (1997) or under the doctrine of negligence per se. View "Parker v. Carilion Clinic" on Justia Law

A federal grand jury indicted Steven DeLia on one count of healthcare fraud. But the government filed the indictment outside the ordinarily applicable statute of limitations. Notwithstanding this filing, the government argued the indictment was timely because: (1) the Wartime Suspension of Limitations Act suspended the limitations period from running in this case; and (2) DeLia waived his asserted statute-of-limitations defense. The Tenth Circuit rejected both reasons and concluded the prosecution was time-barred. DeLia’s conviction was vacated and the indictment was dismissed. View "United States v. DeLia" on Justia Law

After correcting one aspect of the judgment, the Supreme Judicial Court affirmed the judgment of the superior court granting Defendants’ motions to dismiss Plaintiff’s complaint stemming from a hospital’s decision not to employ her, holding that the superior court correctly granted the hospital's and a physician's separate motions to dismiss the complaint for failure to state claims upon which relief could be granted because some counts failed due to the absolute immunity provisions of the Maine Health Security Act, Me. Rev. Stat. 24, 2501-2988, and other counts were legally insufficient. Plaintiff filed a second amended complaint against a physician and a hospital, asserting various claims. The superior court dismissed the counts against the physician, determining he was entitled to immunity pursuant to Me. Rev. Stat. 24, 2511, and dismissed the claims against the hospital for failure to state claims upon which relief could be granted. On appeal, the Supreme Judicial Court held that the superior court correctly dismissed all claims against the physician because he was immune from civil liability, but the judgment dismissing the claims against the physician for defamation, slander per se, and negligent infliction of emotional distress was corrected as dismissals with prejudice. View "Argereow v. Weisberg" on Justia Law

This appeal arose from 532 product-liability claims filed against Hoffmann-La Roche Inc. and Roche Laboratories Inc. (collectively Roche), corporations with their principal places of business in New Jersey. Roche developed, manufactured, marketed, and labeled Accutane, a prescription medication for the treatment of severe and persistent cases of acne. Plaintiffs alleged Accutane caused them to contract inflammatory bowel disease (IBD) and that Roche failed to give adequate label warnings to advise them of the known risks of the medication. At issue for the New Jersey Supreme Court was : (1) what law governed whether Roche’s label warnings were adequate (the law of each of the 45 jurisdictions in which plaintiffs were prescribed and took Accutane or the law of New Jersey where the 532 cases are consolidated); and (2) the adequacy of the label warnings for the period after April 2002. The Court found that because Roche’s warnings received the approval of the FDA, they enjoyed a “rebuttable presumption” of adequacy under New Jersey’s Products Liability Act (PLA). The Court reversed all cases in which the Appellate Division reinstated plaintiffs’ actions against Roche. "New Jersey has the most significant interests, given the consolidation of the 532 cases for MCL purposes. New Jersey’s interest in consistent, fair, and reliable outcomes cannot be achieved by applying a diverse quilt of laws to so many cases that share common issues of fact. Plaintiffs have not overcome the PLA’s presumption of adequacy for medication warnings approved by the FDA. As a matter of law, the warnings provided physicians with adequate information to warn their patients of the risks of IBD." As a result, the 532 failure-to-warn cases brought by plaintiffs against Roche were dismissed. View "Accutane Litigation" on Justia Law

The Supreme Court affirmed in part and reversed in part the district court’s dismissal of Plaintiff’s complaint alleging negligence and violations of 42 U.S.C. 1983 after Linda Gelok was injured after being left unattended for twenty-five hours at the Wyoming State Hospital (WSH), holding that the complaint alleged sufficient facts to state a claim for relief under 42 U.S. C. 1983 against Paul Mullenax, WSH Administrator, in his individual capacity. On behalf of Linda Gelok, an involuntarily committed incompetent person, Plaintiff sued the WSH, the Wyoming Department of Health, and Mullenax, WSH Administrator, in his official and individual capacities, alleging negligence and violation of her constitutional rights under 42 U.S.C. 1983. The district court dismissed the negligence action as time-barred. As to the constitutional claims, the district court found that the WSH, the Department, and Mullenax in his official capacity were entitled to Eleventh Amendment immunity and that Mullenax was entitled to qualified immunity in his individual capacity. The Supreme Court held (1) Wyo. Stat. Ann. 1-3-107 barred Plaintiff’s negligent health care claim; (2) the district court properly dismissed Plaintiff’s 42 U.S.C. 1983 claims against most defendants; but (3) Plaintiff’s complaint alleged sufficient facts to state a claim for relief under 42 U.S.C. 1983 against Mullenax in his individual capacity. View "Wyoming Guardianship Corp. v. Wyoming State Hospital" on Justia Law

Fresenius Medical Care Holdings, Inc., and Fresenius USA, Inc., operated dialysis treatment clinics throughout the United States, including Mississippi. Fresenius also manufactured and sold dialysis products, including GranuFlo, a product administered to patients being treated for end-stage renal disease. GranuFlo was an acid concentrate mixed with bicarbonate and water to create a dialysis fluid. In 2014, the State of Mississippi brought a civil action against Fresenius, alleging that it had engaged in unfair and deceptive trade practices in connection with GranuFlo in violation of the Mississippi Consumer Protection Act. At issue before the Mississippi Supreme Court in this appeal were a batch of discovery disputes arising between the State and Fresenius brought on interlocutory appeal. The State filed a motion to compel discovery against Fresenius and requested a privilege log. Fresenius provided the State with a privilege log similar to the logs produced in other GranuFlo litigation pending elsewhere. Although the State had objected, Fresenius did not log each individual email and email attachment; rather, Fresenius logged “families” or aggregates of documents. The chancery court granted the State’s motion to compel and ordered Fresenius to produce a “full and complete privilege log” to the State. Fresenius produced a second amended privilege log to the State, continuing to use the family logging method. The State filed a second motion to compel, seeking: (1) all emails and email attachments not separately identified on Fresenius’s July 1, 2016, privilege log; (2) withheld documents referred to as attorney notifications (nurses’ memoranda sent to doctors and in-house counsel); and (3) withheld documents referred to as public comment advice (public relations documents). The chancery court ordered Fresenius to produce all emails and email attachments that were responsive to the State’s discovery requests, that had not been produced, and that had not been separately identified on Fresenius’s July 1, 2016, privilege log. The chancery court also ordered Fresenius to submit attorney notifications and public relations documents for in camera review, later ordering production of the notifications. Fresenius appealed these orders. The Mississippi Supreme Court reversed the chancery court's order with respect to the public relations documents; the Court affirmed in all other respects. View "Fresenius Medical Care Holdings, Inc. v. Hood" on Justia Law

A jury entered a verdict against defendant HealthSouth Rehabilitation Hospital of Gadsden, LLC in a medical malpractice case brought by plaintiff Regina Honts, as personal representative of the estate of Doris Green. HealthSouth Gadsden then filed a postjudgment motion seeking a judgment as a matter of law ("a JML"), a new trial, or a remittitur of the damages award. After an evidentiary hearing as to the request for a remittitur, the trial court denied the postjudgment motion. HealthSouth Gadsden appealed; Honts cross-appealed, challenging rulings on discovery issues. As to HealthSouth Gadsden's appeal, case no. 1160045, the Alabama Supreme Court reversed the trial court's judgment and remand the case for a new trial. As to Honts' cross-appeal, case no. 1160068, the Court affirmed. Honts' complaint pinpointed the start of Green's decline at a time during her residency at HealthSouth Gadsen, a nurse administered medication to Green that Green later had an adverse reaction to. Honts sought discovery of the nurse's personnel file; the trial court determined Honts failed to show what would have been in the personnel file that could establish a breach of the standard of care by HealthSouth Gasden with respect to Green. The Supreme Court determined the trial court erred in instructing the jury on the hospital standard of care, reversed the jury verdict as to that issue, and remanded for a new trial. View "HealthSouth Rehabilitation Hospital of Gadsden, LLC v. Honts" on Justia Law

The Supreme Court reversed the opinion of the court of appeals upholding the circuit court’s dismissal of this action alleging that a child’s developmental delays were caused by a doctor’s negligence in the mother’s prenatal care and the child’s delivery. The Court held (1) the trial court erred in permitting Plaintiffs’ attorney to withdraw; (2) the mother did not engage in the unauthorized practice of law, and the trial court erred in striking the pleadings; (3) summary judgment was improper; and (4) “next friend” cannot proceed pro se on behalf of a real party in interest. View "Azmat v. Bauer" on Justia Law