Justia Health Law Opinion Summaries

The city and stopped paying full reimbursement of certain medical expenses for former firefighters and police officers who had retired on disability pensions. The retirees alleged that the decision violated state statutes, constituted an ultra vires act, contradicted principles of equity, and offended the Due Process Clause.The district court entered summary judgment against all but three of the plaintiffs and resolved the remaining claims after trial. The First Circuit affirmed the summary judgment rulings. The state injured-on-duty statute does not require the benefit and there was no evidence that the city ever authorized such a benefit on a global basis or made specific promises to retirees, other than the three that went to trial.

Plaintiff claimed that her employer since 1990, the Puerto Rico Ports Authority, violated the Americans with Disabilities Act, 42 U.S.C. 12101, when it failed to provide her with reasonable accommodations (flexible schedule) for her chronic fatigue syndrome disabilities and retaliated against her, including by terminating her employment, for engaging in protected activities. The district court granted the Ports Authority's motion for judgment as a matter of law at the close of plaintiff's case-in-chief. The First Circuit vacated and remanded, concluding that a reasonable jury could have found facts supporting plaintiff's claims. The district court erred finding that plaintiff was not "qualified" under the ADA without considering that the accommodation she requested was a flexible schedule.

An inmate of the Maine corrections system, sought a civil rights remedy (42 U.S.C. 1983) for alleged denial of adequate medical care for human immunodeficiency virus (HIV) by healthcare professionals at a jail and the state prison. The district court entered summary judgment for the defendants. The First Circuit affirmed with respect to the contractor that provides care, stating that the evidence could not establish Eighth Amendment violations, but reversed with respect to a physicians' assistant. Although the contractor acknowledged that its care "fell short of the mark," carelessness or inadvertence falls short of the Eighth Amendment standard of deliberate indifference. There was a material dispute about deliberate indifference by the physicians' assistant, who had a financial interest in limiting care and a disciplinary history.

Plaintiff brought action under the False Claims Act, 31 U.S.C. 3729, claiming that the company used a kickback scheme and knowingly caused submission of false Medicare, Medicaid, and TRICARE claims by hospitals and doctors. The district court held that hospital claims at issue were not false or fraudulent, and that doctor claims were false or fraudulent, but not materially so. The First Circuit reversed. If kickbacks affected the transactions underlying the claims, the claims failed to meet a condition of payment and were false, regardless of the hospital's participation in or knowledge of the kickbacks. It cannot be said, as a matter of law, that the alleged misrepresentations were not capable of influencing Medicare's decision to pay the claims.