Plaintiffs filed suit against defendant, in her official capacity as Interim Secretary for the Florida Agency for Health Care Administration (AHCA), alleging that defendant violated the Medicaid Act, 42 U.S.C. 1396 et seq., by denying Medicaid coverage of applied behavioral analysis (ABA) to treat plaintiffs' autism spectrum disorders. The court concluded that the district court did not abuse its discretion in issuing a permanent injunction that overruled AHCA's determination that ABA was experimental and required Medicaid coverage of this treatment. However, because the language in the injunction's final sections was out of step with the district court's analysis and what was actually decided, the court vacated the injunction in part and remanded to the district court to modify Paragraphs 2 and 6. View "Garrido, et al. v. Interim Secretary, FL Agency for Health Care Admin." on Justia Law
U.S. Steel appealed the award of benefits to plaintiff, the widow of a deceased miner, under the black lung benefits program. The Benefits Review Board affirmed the award, concluding that plaintiff did not need to show the cause of her husband's death. The court concluded that 30 U.S.C. 932(l), as amended by section 1556(b) of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 1556(b), 124 Stat. 119, 260, eliminated the need for survivors who could meet its requirements to prove that their associated miners died due to black lung disease; it applied retroactively to survivors' claims filed in the specified period; and this retroactive application did not violate the Due Process Clause of the Fifth Amendment. Accordingly, the court denied U.S. Steel's petition to review the Board's ruling. View "U.S. Steel Mining Co., LLC v. Director, OWCP, et al." on Justia Law
Posted in: Constitutional Law, Health Law, Labor & Employment Law, U.S. 11th Circuit Court of Appeals
This case stemmed from requests to the Nursing Facilities from spouses and attorneys-in-fact for medical records of deceased nursing home residents. At issue was whether section 400.145 of the Florida Statutes was preempted by the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d to d-9, and its implementing regulations. The court held that section 400.145 and HIPAA could not be reconciled and the court agreed with the district court that the Florida statute stood as an obstacle to the accomplishment and execution of the full purposes and objectives of HIPAA in keeping an individual's protected health information strictly confidential. Accordingly, the court affirmed the district court's judgment that the Florida statute was preempted and its grant of summary judgment in favor of the Nursing Facilities, explaining that the Florida statue afforded nursing home residents less protection than was required by the federal law. View "OPIS Mgmt. Res. LLC, et al v. Sec., FL Agency for Health Care Admin." on Justia Law
Plaintiffs challenged Florida's "Patient Self-Referral Act of 1992" (the Florida Act), Fla. Stat. 456.053, which prohibited Florida physicians from referring their patients for services to business entities in which the referring physicians have a financial interest. The court concluded that the conflict preemption doctrine did not apply, and the exemptions in federal law allowing physicians serving end-stage renal disease patients to engage in self-referral did not preempt Florida's more restrict law prohibiting such conduct. The court also concluded that the Florida Act did not discriminate against interstate commerce, nor did it impose a burden on interstate commerce that was clearly excessive when compared with the law's putative local benefits. Therefore, the Florida Act did not violate the dormant Commerce Clause. Further, plaintiffs' substantive due process claim failed to survive rational basis scrutiny, and an equal protection claim would fail as well. Accordingly, the court affirmed the judgment. View "Fresenius Medical Care Holding, et al v.Tucker, et al" on Justia Law
Plaintiffs appealed from the district court's dismissal of their amended complaint against Florida government defendants, SBHD, AHCA, and DCF. Plaintiffs alleged that defendants' billing practice violated both 42 U.S.C. 1396a(a)(25)(C), the "balance billing" provision of the federal Medicaid Act, and a similar Florida statute. The court concluded that section 1396a(a)(25)(C) did not confer upon plaintiffs a federal right enforceable under 42 U.S.C. 1983 and therefore, affirmed the district court's decision to dismiss the amended complaint. View "Martes, et al. v. CEO of South Broward Hospital Dist., et al." on Justia Law
Posted in: Civil Rights, Constitutional Law, Health Law, Public Benefits, U.S. 11th Circuit Court of Appeals
Plaintiffs, on behalf of themselves and their child, appealed the dismissal of their complaint against the United States and the denial of their motions for relief from judgment and to reopen the case. The primary issue on appeal was whether the United States was amendable to suit under the Federal Tort Claims Act (FTCA), 28 U.S.C. 1346(b), 2401(b), 2671-80, for the negligence of medical professionals employed by a federally supported health center when like private professionals would be immune from suit under the Florida Birth-Related Neurological Injury Compensation Act, Fla. Stat. 766.301-16. The United States claimed that the Compensation Act could not expand the liability of the United States under the FTCA beyond that to which an analogous private party would be amenable and that plaintiffs have waived any right to have the district court abate their action pending the determination by the ALJ. Because the court agreed with the United States, the court affirmed the dismissal of plaintiffs' complaint and the denial of their motions for relief from judgment and to reopen the case. View "Maradiaga, et al. v. United States" on Justia Law
Alabama sued CMS claiming that it violated the federal Administrative Procedures Act (APA), 5 U.S.C. 500-596, 701-706, by issuing - without notice and an opportunity for public comment - an October 28, 2008 letter to state health officials (SHO letter). The district court held that the SHO letter constituted a substantive administrative rule issued without the notice-and-comment procedures mandated by the APA. Because the district court did not abuse its discretion in denying injunctive relief in addition to vacating the SHO letter, and because Alabama's remaining claims were unripe, the district court's judgment was affirmed. View "State of Alabama v. Centers For Medicare And Medicaid, et al." on Justia Law
Posted in: Government & Administrative Law, Health Law, Public Benefits, U.S. 11th Circuit Court of Appeals
Defendant, a medical doctor licensed by the State of Florida, appealed his convictions for dispensing controlled substances in violation of the Controlled Substances Act (CSA), 21 U.S.C. 801, et seq., and for health care fraud. Defendant's convictions resulted in three separate but related appeals including his contention that the district court erred or abused its discretion by allowing the introduction of autopsy reports or handwritten medical notes without requiring testimony by their authors. The court reversed defendant's convictions because the admission of the autopsy reports and testimony about those reports, without live in-court testimony from the medical examiners who actually performed the autopsies, violated the Confrontation Clause under the facts of the case. Because the court concluded that this issue was dispositive, the court declined to address the other issues raised in defendant's merits appeal, except for the sufficiency of the evidence claim. While the court ultimately concluded that the evidence was sufficient, the degree to which the court viewed the government's case as less than overwhelming compelled the court's conclusion that the Confrontation Clause violation was not harmless in this case.
Plaintiff appealed the district court's dismissal of her two-count complaint alleging interference and retaliation under the Family and Medical Leave Act of 1993 (FMLA), 29 U.S.C. 2601 et seq., against defendant. It was undisputed that plaintiff, at the time she requested leave, was not eligible for FMLA protection because she had not worked the requisite hours and had not yet experienced a triggering event, the birth of her child. It is also undisputed that she would have been entitled to FMLA protection by the time she gave birth and began her requested leave. The court held that because the FMLA required notice in advance of future leave, employees were protected from interference prior to the occurrence of the triggering event; a pre-eligible employee had a cause of action if an employer terminated her in order to avoid having to accommodate that employee with rightful FMLA leave rights once that employee became eligible; a pre-eligible request for post-eligible leave was protected activity because the FMLA aimed to support both employees in the process of exercising their FMLA rights and employers in planning for the absence of employees on FMLA leave; and because plaintiff engaged in protected activity by discussing her maternity plans with her employer, she has alleged a valid cause of action for retaliation.
Plaintiff, suing on behalf of her husband, obtained a judgment against defendant for benefits payable under a home health care insurance policy. Defendant appealed and following a judgment, the district court awarded plaintiff attorney's fees and costs. Defendant again appealed. The court held that the district court properly granted summary judgment to plaintiff, rejecting defendant's contention that the custodial care expenses claimed were not covered expenses under the policy. Case No. 10-15115 was affirmed. Because defendant challenged the award of attorneys' fees and costs in Case No. 10-15878 on the sole ground that summary judgment was improperly granted in Case No. 10-15115, the award of attorneys' fees and costs in Case No. 10-15878 was affirmed.