Justia Health Law Opinion Summaries

The Supreme Court of North Carolina ruled on a case involving Halikierra Community Services LLC (Halikierra), a provider of home personal care services to Medicaid beneficiaries and the North Carolina Department of Health and Human Services (DHHS). DHHS had placed Halikierra on Medicaid reimbursement prepayment review following several overbilling complaints, leading to several post-payment audits. The audits revealed that Halikierra had erroneously received excess Medicaid reimbursement funds on multiple occasions and found suspicious reimbursement claims.Halikierra filed a lawsuit against DHHS, alleging that the decision to place them on prepayment review violated their substantive due process and equal protection rights under the North Carolina Constitution. The trial court granted summary judgment in favor of DHHS, leading to an appeal from Halikierra.The Supreme Court of North Carolina affirmed the trial court's decision, holding that summary judgment was properly entered against Halikierra. The Court found that Halikierra’s evidentiary forecast failed to disclose any genuine issues of material fact in support of its claims. The Court concluded that DHHS's actions were not arbitrary or capricious, as the prepayment review was rationally related to a legitimate government interest, namely combating Medicaid fraud and ensuring that claims meet the requirements of federal and state laws and regulations. The Court also found no evidence of unequal treatment of Halikierra compared to other Medicaid providers. View "Halikierra Cmty. Servs. LLC v. N.C. Dep't of Health & Hum. Servs" on Justia Law

The Supreme Court affirmed the judgment of the trial court granting Defendants' motion for an award of attorneys' fees as part of their costs under N.C. R. Civ. P. 41(d) pursuant to N.C. Gen. Stat. 6-21.5 and the trial court's subsequent order awarding $599,262 in attorneys' fees as costs, holding that the trial court did not abuse its discretion.Plaintiffs, limited partners of the Fayetteville Ambulatory Surgery Center Limited Partnership (FASC), asserted five claims against Cape Fear Valley Ambulatory Surgery Center, LLC and its owner, Cumberland County Hospital System, Inc. Plaintiffs later voluntarily dismissed the case without prejudice. Defendants subsequently brought a motion for fees. The trial court granted the motion for attorneys' fees as part of Defendants' costs under Rule 41(d) pursuant to N.C. Gen. Stat. 6-21.5. The Supreme Court affirmed, holding that the trial court did not abuse its discretion granting the motion for attorneys' fees. View "Woodcock v. Cumberland County System, Inc." on Justia Law

The Supreme Court affirmed the decision of the court of appeals that Respondent's due process rights were not violated in the proceedings which led to the trial court's conclusion that Respondent had a mental illness and was dangerous to himself, holding that there was no error.At the end of a hearing, the trial court concluded that Respondent had a mental illness and was a danger to himself and entering a thirty-day commitment order. At issue was whether the trial court, in the absence of counsel for the state, called witnesses and elicited testimony during the hearing. The Supreme Court affirmed, holding that the trial court did not violate Respondent's due process right to an impartial tribunal. View "In re J.R." on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the judgment of the Industrial Commission denying the Department's motion to dismiss Plaintiffs' claims arising from certain regulatory actions taken by the North Carolina Department of Health and Human Services in response to deficiencies that Department employees had identified during inspections of Plaintiffs' facility, holding that the Commission erred in failing to dismiss Plaintiffs' claims.Plaintiffs, an adult care home and its owner, contested the Department's regulatory actions by initiating a contested case before the Office of Administrative Hearings. The parties settled. Thereafter, Plaintiffs filed a claim with the Commission pursuant to the North Carolina State Tort Claims Act, alleging negligence. The Department filed a motion to dismiss on the grounds that Plaintiffs' claims were barred by the doctrine of sovereign immunity. The Commission denied the motion, and the court of appeals affirmed. The Supreme Court reversed, holding (1) Plaintiffs' claims were barred by sovereign immunity; and (2) Plaintiffs failed to assert a viable negligence claim against the Department. View "Cedarbrook Residential Center, Inc. v. N.C. Dep't of Health & Human Services" on Justia Law

The Supreme Court affirmed the decision of the court of appeals concluding that the proceedings below did not result in a due process violation but reversed the court of appeals' decision to affirm the order of the trial court to have Respondent involuntarily committed, holding that the record evidence and the trial court's findings did not support that determination.The State filed a petition to have Respondent involuntarily committed for additional inpatient treatment pursuant to N.C. Gen. Stat. 122C-261 et seq. The court of appeals affirmed. The Supreme Court reversed in part, holding (1) the court of appeals properly found that there was no due process violation in the proceedings below; but (2) the trial court's findings could not be deemed sufficient to support a determination that Respondent posed a danger to himself given its failure to find a reasonable probability of Respondent suffering serious physical debilitation within the near future without immediate, involuntary commitment. View "In re C.G." on Justia Law

The Supreme Court held that the trial court did not violate Defendant's due process rights by proceeding with Defendant's involuntary commitment hearing when Defendant was not represented by counsel and that the trial court's factual findings were sufficient to support its conclusion that Defendant was dangerous to herself.Specifically, the Supreme Court held (1) the trial court did not violate Defendant's due process rights; (2) Defendant preserved her right to challenge the trial court's incorporation of a non-testifying physician's exam report into its findings of fact, and the trial court committed harmless error by incorporating the report into its findings of fact; and (3) the court of appeals correctly held that the trial court made sufficient findings of fact based on the evidence presented by the testifying witness to support its involuntary commitment decision. View "In re R.S.H." on Justia Law

In this dispute in which Plaintiffs sought reimbursement for healthcare costs based upon claims for restraint of trade and monopolization pursuant to N.C. Gen. Stat. Chapter 75 and N.C. Const. art. I, 34, the Supreme Court affirmed in part and reversed in part the order of the trial court deciding issues arising from the Charlotte-Mecklenburg Hospital Authority's motion for judgment on the pleadings, holding that the trial court erred in part.Plaintiffs were a group of current and former North Carolina residents who were covered under the commercial health insurance obtained through the Hospital Authority, a non-profit corporation providing healthcare services with a principal place of business in Charlotte. The trial court granted the Hospital Authority's motion for judgment on the pleadings with respect to Plaintiffs' restraint of trade and monopolization claims but denied the motion with respect to Plaintiffs' monopolization claim. The Supreme Court affirmed in part and reversed in part, holding that the trial court (1) did not err in granting judgment on the pleadings with respect to Plaintiffs' Chapter 75 restraint of trade and monopolization claims; but (2) erred by denying the motion for judgment on the pleadings with respect to Plaintiffs' claim pursuant to article I, section 34. View "DiCesare v. Charlotte-Mecklenburg Hosp. Auth" on Justia Law

In this case concerning civil liability based on insurer conduct affecting chiropractic services, the Supreme Court affirmed the order of the trial court dismissing all claims in this case, relying on and incorporating its reasoning in a companion case, Sykes v. Health Network Solutions, Inc., __ S.E.2d __ (N.C. 2019)(Sykes I), in holding that the decision in Sykes I met the criteria for collateral estoppel.This case was one of two putative class actions alleging that defendant insurers contracted with Health Network Solutions, Inc. (HNS) to provide or restrict insured chiropractic services in violation of state insurance and antitrust laws. Plaintiffs chose to bring this action against insurers separately from their claims against against HNS and its individual owners in Sykes I, but both actions presented essentially the same claims and relied on the same theories. The trial court dismissed Plaintiffs' claims in this case. The Supreme Court affirmed, holding that collateral estoppel barred Plaintiffs from litigating these matters given the Court's resolution of the issues in Sykes I. View "Sykes v. Blue Cross & Blue Shield of North Carolina" on Justia Law

The Supreme Court affirmed the Business Court's dismissal of Plaintiffs' claims against Defendants Health Network Solutions, Inc. (HNS) and HNS's individual owners alleging that HNS committed antitrust and other violations in its role as intermediary between individual chiropractors and several insurance companies and third-party administrators, holding that the Business Court did not err in dismissing Plaintiffs' entire complaint.Plaintiffs were licensed chiropractic providers in North Carolina who alleged that Defendants engaged in unlawful price fixing resulting in a reduction of output of chiropractic services in North Carolina. The Business Court granted in part and denied in part Defendants' motions to dismiss and for partial summary judgment and then dismissed Plaintiffs' remaining claims under N.C. R. Civ. P. 12(b)(6). The Supreme Court affirmed, holding that the Business Court did not err in dismissing each of Plaintiffs' substantive claims and their derivative claims. The Business Court's dismissal of Plaintiffs' antitrust claims, including the derivative claim of civil conspiracy, stands without presidential value because the members of the Court were equally divided as to these claims. View "Sykes v. Health Network Solutions, Inc." on Justia Law

The Supreme Court reversed the decision of the court of appeals concluding that N.C. Gen. Stat. 122C-266(a) imposes a statutory mandate that automatically preserves violation of that subsection for appellate review regardless of a failure to object in the trial court and that Respondent was automatically entitled to relief without having to demonstrate that she was prejudiced by the violation of section 122C-266(a), holding that Respondent's issue was not preserved for appellate review.Here, Respondent, who was involuntarily committed to a state health facility, did not receive an examination by a second physician, as mandated by section 122C-266(a). The court of appeals held that Respondent was not required to make a showing of prejudice resulting from the violation of the statue in order to have vacated the trial court's order authorizing her continued commitment. The Supreme Court reversed without deciding whether prejudice must be shown to obtain relief on appeal, holding (1) the alleged violation of section 122C-266(a) was not automatically preserved; and (2) Respondent failed to preserve the issue when she did not raise it during the district court hearing on her involuntary commitment. View "In re E.D." on Justia Law