Justia Health Law Opinion SummariesArticles Posted in U.S. 3rd Circuit Court of Appeals
B&G Constr. Co Inc. v. Dir., Office of Workers Comp. Programs
Husband worked as a miner from 1970 to 1987. In 2000, he was found to be totally disabled by coal workers' pneumoconiosis and was awarded benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He died in 2005. His widow sought survivor’s benefits. At the time, she was required to prove that pneumoconiosis caused, contributed to, or hastened husband's death. An ALJ denied the claim. The Board vacated. On remand, the ALJ again denied benefits. While appeal was pending, Congress amended the Act, retroactively applicable to claims filed after January 1, 2005. The Board reversed and remanded for an order awarding survivor's benefits, holding that section 932(l), as amended, entitled the widow to benefits because husband was receiving black lung benefits at the time of his death and her claim was filed after January 1, 2005. The First Circuit denied the company's petition for review. Under the amendment, the widow is entitled to benefits without having to file a new claim or otherwise revalidate husband's claim because she filed her claim after January 1, 2005. The company's claim that she failed to establish the cause of death is irrelevant. Section 932(l) as amended does not violate the Due Process Clause or Takings Clause.
Sec’y of Labor v. ConocoPhillips Bayway Ref.
The Secretary of Labor cited the refinery for nine "serious" violations of the asbestos in construction standard, which prescribes protective requirements based on measurable concentration of asbestos fibers to which employees are or may be exposed. The ALJ affirmed the violations and the classification. The Occupational Safety and Health Review Commission reduced the classification to "other than serious" under 29 U.S.C. 666, in part because the Secretary failed to present case-specific evidence of possible employee exposure to asbestos. The Third Circuit vacated and remanded for the citations to be affirmed as "serious." Precedent only requires that there could be exposure to asbestos that is substantially probable to lead to serious harm. Applying this standard, the violations were "serious;" there is no need for case-specific evidence. If the Secretary has shown violations of regulations involving Class II work and the presence of asbestos, the burden shifts to the employer to show that the violations were not "serious."
NJ Physicians, Inc. v. President of United States
Doctors and a patient challenged the Patient Protection and Affordable Care Act requirement, effective in 2014, that all non-exempt applicable individuals either maintain a certain minimum level of health insurance or pay a monetary penalty (26 U.S.C. 5000A) and a provision that penalizes certain employers if they fail to offer full-time employees the opportunity to enroll in an employer-sponsored insurance plan that satisfies the individual mandate's minimum essential coverage requirement (26 U.S.C. 4980H(a)).The district court dismissed for lack of standing. The Third Circuit affirmed. There is no evidence that the patient-plaintiff or doctors are in any way currently impacted by the law or that harm is imminent.
Brown v. Astrue
A 51-year-old man with a history of violent crime and drug abuse, applied for SSI (42 U.S.C. 1381). He alleged disability beginning in April 2002 due to bipolar disorder and anxiety. The application was denied in October 2006. An ALJ determined that petitioner was not disabled because he has been capable of making a successful adjustment to other work that exists in significant numbers in the national economy. The appeals council denied review. The district court upheld the decision and the Third Circuit affirmed. Any error in the district court's articulation of the standard of review was harmless, and the commissioner's determination was supported by substantial evidence.
Wilkins v. United Health Group, Inc.
Defendants are health service providers that receive reimbursement from Medicare and Medicaid under 42 U.S.C. 1395, 1396. Plaintiffs, former employees of defendants, filed a qui tam action, alleging violations of various federal laws. After investigation, the government declined to intervene. The district court dismissed. The Third Circuit affirmed dismissal of False Claims Act, 31 U.S.C. 3729 claims based on violation of Medicare marketing regulations and reversed with respect to allegations that the defendants submitted false claims to the government by violating the Anti-Kickback Statute, 42 U.S.C. 1320. Payment of Medicare claims was not conditioned on compliance with marketing regulations.
Tristani, et al. v. Richman, et al.
This appeal involved a putative class action filed by three Pennsylvania Medicaid beneficiaries subject to the Pennsylvania Department of Public Welfare's (DPW) liens against future settlements or judgments. At issue was whether state agencies responsible for administering the Medicaid program have the authority to assert such liens and, if so, whether Pennsylvania's statutory framework was consistent with the Supreme Court's decision in Arkansas Department of Health and Human Services v. Ahlborn. The court examined the text, structure, history, and purpose of the Social Security Act, 42 U.S.C. 301 et seq., and held that liens limited to medical costs were not prohibited by the anti-lien and anti-recovery provisions of the Act, 42 U.S.C. 1396p(a)-(b). Accordingly, the court upheld Pennsylvania's longstanding practice of imposing such liens. The court also held that Pennsylvania's current statutory framework, which afforded Medicaid recipients a right of appeal from the default allocation, was a permissible default apportionment scheme.
Warren Gen. Hosp. v. Amgen, Inc.
The hospital filed the proposed class action, alleging that the pharmaceutical company violate antitrust "tying" prohibitions by using its knowledge of insurance reimbursement rates to leverage its market power in one marketâWhite Blood Cell Growth Factor drugsâto impair competition in the market for Red Blood Cell Growth Factor drugs (Sherman Act, 15 U.S.C. 1 and Clayton Act, 15 U.S.C. 14, 15). The district court dismissed on the ground that the hospital was not a "direct purchaser." The Sixth Circuit affirmed. The mechanics of the hospital's contracts for acquiring the drugs show it to be an indirect purchaser that placed orders and received the drugs through a middleman, despite some direct communications between the manufacturer and the hospital and a rebate program between the two. The court rejected the hospital's claim that it should be granted standing as the first party in the distribution chain to suffer injury from the anti-competitive conduct.
Pennsylvania v. U.S. Dept. of Health and Human Servs.
Under Medicaid, the federal government reimburses between 50% and 83% of state costs for patient care for eligible low-income individuals, including developmentally-disabled individuals receiving care in home- and community-based settings.42 U.S.C.1396n(c). In 2001 Pennsylvania obtained a waiver that authorized reimbursement of state expenses for "habilitation services" for developmentally-disabled individuals. Until 2006, Pennsylvania did not seek reimbursement for occupancy costs for Medicaid recipients living in nonprofit and county facilities, but paid for room and board using state funds and the residents' Supplemental Security Income. The Center for Medicare and Medicaid Services rejected the state's 2006 claim that more than 54 percent of the occupancy costs were for reimbursable habilitation services. The appeals board and district court upheld the denial. The Third Circuit affirmed, based on the plain meaining of the statutory exclusion of costs for "room and board," and noting consistent interpretation of the statute