Justia Health Law Opinion SummariesArticles Posted in U.S. 5th Circuit Court of Appeals
Planned Parenthood, et al. v. Abbott, et al.
Planned Parenthood filed suit against the State for declaratory judgment and to enjoin provisions of 2013 Texas House Bill No. 2 (H.B. 2). H.B. 2 pertains to the regulation of surgical abortions and abortion-inducing drugs. Two provisions of H.B.2 were at issue: first, the requirement that a physician performing or inducing an abortion have admitting privileges at a hospital no more than thirty miles from the location where the abortion is provided; and second, the limitations on the use of abortion-inducing drugs to a protocol authorized by the FDA. The district court held that parts of both provisions were unconstitutional and granted, in substantial part, the requested injunctive relief. A motions panel of this court granted a stay pending appeal, and the Supreme Court upheld the stay. As a preliminary matter, the court concluded that the physician-plaintiffs had standing on behalf of their patients, as well as standing to assert their own rights. The court concluded that the district court applied the wrong legal standards under rational basis review and erred in finding that the admitting-privileges requirement amounts to an undue burden for a large fraction of women that it affects. The court also concluded that the district court erred in holding that H.B. 2's rejection of the off-label protocol from fifty to sixty-three days LMP (last menstrual period) facially imposes an undue burden on the abortion rights of certain women. Accordingly, the court reversed and rendered judgment for the State, except that the admitting privileges requirement may not be enforced against abortion providers who timely applied for admitting privileges under the statute but are awaiting a response from the hospital. View "Planned Parenthood, et al. v. Abbott, et al." on Justia Law
Planned Parenthood, et al. v. Abbott, et al.
Planned Parenthood and others filed suit seeking a permanent injunction against the enforcement of two amendments to the laws of Texas concerning abortions (H.B. 2). Two provisions of H.B.2 were at issue: first, the requirement that a physician performing or inducing an abortion have admitting privileges at a hospital no more than thirty miles from the location where the abortion is provided; and second, the limitations on the use of abortion-inducing drugs to a protocol authorized by the FDA. The district court held that parts of the legislation were unconstitutional and granted the requested injunctive relief. The State appealed and filed an emergency motion to stay the district court's permanent injunction. The court concluded that the State has made a strong showing that it was likely to succeed on the merits in regards to the hospital-admitting privileges provision. There was a substantial likelihood that the State would prevail in its argument that Planned Parenthood failed to establish an undue burden on women seeking abortions or that the hospital-admitting-privileges requirement created a substantial obstacle in the path of a woman seeking an abortion. The court also concluded that the State has made a strong showing of likelihood of success on the merits, at least in part, as to its appeal of the injunction pertaining to medication abortions. Accordingly, the court stayed the injunction pertaining to medical abortions with certain exceptions. The State has made an adequate showing as to the other factors considered in determining a stay pending appeal. The court granted the motion for stay pending appeal. View "Planned Parenthood, et al. v. Abbott, et al." on Justia Law
K. P., et al. v. LeBlanc, et al.
Louisiana's Patient's Compensation Fund served two objectives: (1) fostering a stable market for affordable insurance and (2) ensuring that victims of malpractice could recover for their injuries. Louisiana's Act 825 provided that any person who performed an abortion was liable to the mother of the unborn child for any damage occasioned or precipitated by the abortion. Plaintiffs, three healthcare providers, challenged the constitutionality of Act 825 facially, as applied to physicians enrolled in the Fund "who face or will face medical malpractice claims related to abortion," and as applied under the circumstances of this case. The court concluded that plaintiffs lacked standing to challenge subsection (A) of Act 825; plaintiffs had standing to challenge subsection (C)(2); the case was not moot; and the Eleventh Amendment did not bar plaintiffs' challenge to subsection (C)(2). On the merits, the court concluded that Act 825 did not violate the Equal Protection Clause of the Fourteenth Amendment where subsection (C)(2) was rationally related to the promotion of informed consent. Accordingly, the court reversed the judgment of the district court striking down subsection (C)(2). The court vacated its judgment regarding subsection (A) and dismissed the claim for want of jurisdiction. View "K. P., et al. v. LeBlanc, et al." on Justia Law
Elgin Nursing Center v. U.S. Dept. of Health and Human Services
Elgin sought review of a final decision by DHHS upholding a ruling of an ALJ affirming a determination by the CMS that Elgin had violated certain safety requirements by serving "undercooked" eggs to its elderly residents. The court concluded it would not defer to DHHS's interpretation of the State Operations Manual (SOM); there was not substantial evidence to find that Elgin violated the SOM; and DHHS could not issue ambiguous interpretative documents and then interpret those in enforcement actions. Accordingly, the court granted the petition for review and set aside the finding of deficiency and resultant penalties. View "Elgin Nursing Center v. U.S. Dept. of Health and Human Services" on Justia Law
Southwest Pharmacy Solutions, Inc. v. Centers for Medicare & Medicaid, et al
Southwest appealed the district court's dismissal of its claim regarding the Medicare Part D statute, 42 U.S.C. 1395w-101 et seq., for lack of subject matter jurisdiction. Citing Shalala v. Illinois Council on Long Term Care, Southwest argued that its claim provided a narrow exception to 42 U.S.C. 405(h)'s requirement that required a plaintiff to exhaust administrative remedies before filing a claim in federal court. The court concluded that caselaw interpreting the application of section 405(h) to Medicare claims emphasized that the Illinois Council exception was extremely narrow and appropriately applied only in cases where judicial review would be entirely unavailable through the prescribed administrative procedures. Because Southwest has not carried its heavy burden of showing that the Illinois Council exception applied, the court affirmed the district court's order dismissing the suit. View "Southwest Pharmacy Solutions, Inc. v. Centers for Medicare & Medicaid, et al" on Justia Law
United States v. Sharma
Defendants pleaded guilty to defrauding health-care insurers by billing for pain injections that they never administered. Defendants appealed the district court's order that they pay over $43 million in restitution to 32 victims defrauded by the scheme. The court concluded that the record did not support the entire restitution amount recommended and therefore the district court abused its discretion in adopting the unsupported figure. The court held, however, that the district court did not abuse its discretion in declining to apply a restitution credit. Accordingly, the court vacated the order of restitution and remanded for recalculation. As defendants' plea agreements stipulated to a forfeiture money judgment in the same amount as the restitution award, the court also vacated the amount of the forfeiture award and remanded for recalculation. The court further held that the government did not breach the plea agreements with defendants. View "United States v. Sharma" on Justia Law
Physician Hosps. of Am. v. Sebelius
A trade group and a physician-owned hospital sued the Secretary of the Department of Health and Human Services. They sought injunctive relief to remedy multiple alleged constitutional infirmities with Section 6001 of the Patient Protection and Affordable Care Act. Section 6001 limits Medicare reimbursement for services furnished to a patient referred by a physician owner. Although it denied the Secretary's motion to dismiss for lack of jurisdiction, the district court granted summary judgment to the Secretary, concluding that Congress had a rational basis for enacting Section 6001, the new law did not constitute a real or regulatory taking, and the law's requirements were not unconstitutionally vague. The plaintiffs appealed. The Fifth Circuit Court of Appeals vacated the district court's decision and dismissed the appeal, holding that the district court lacked subject matter jurisdiction over this case. View "Physician Hosps. of Am. v. Sebelius" on Justia Law
Ayton v. Holder
Petitioner pled guilty to the charge of conspiring to possess cocaine with intent to distribute. He was not informed that his conviction made him eligible for deportation. Later, an immigration judge conducted a hearing and ordered Petitioner's removal. On appeal to the Board of Immigration Appeals (BIA), Petitioner claimed derivative citizenship under 321 of the former Immigration and Nationality Act (INA). The BIA denied Petitioner's appeal. The Fifth Circuit Court of Appeals affirmed, holding (1) because Petitioner's parents never legally separated, and because Petitioner failed to carry his burden of proving that his mother was deceased, Petitioner failed to satisfy INA 321; and (2) INA 321 did not violate Petitioner's equal protection rights. View "Ayton v. Holder" on Justia Law
Paladin Commty Mntl Hlth Ctr, et al. v. Sebelius, et al.
This appeal involved a challenge to the 2011 Medicare payment rate set by the Secretary of Health and Human Services for partial hospitalization services. Paladin claimed that the Secretary's use of both hospital-based and community mental health center cost data in establishing and adjusting the 2011 relative payment weights and ultimate payment rate was in excess of her statutory authority. Paladin filed suit in district court without first presenting an administrative claim, alleging jurisdiction was proper under 28 U.S.C. 1331. The court found that Congress expressly precluded judicial review of the Secretary's determinations and that her actions were not a facial violation of a clear statutory mandate. Accordingly, the court affirmed the district court's dismissal for lack of subject matter jurisdiction. View "Paladin Commty Mntl Hlth Ctr, et al. v. Sebelius, et al." on Justia Law
Koehler v. Aetna Health, Inc.
Plaintiff appealed the district court's summary judgment dismissing her suit to recover health insurance benefits under an employee plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001-1461. Aetna, a Texas health maintenance organization (HMO), provided and administered the plan's health insurance benefits under an agreement giving Aetna discretion to interpret the plan's terms. Aetna refused to reimburse plaintiff for care she received from a specialist outside of the Aetna HMO to whom she had been referred by a physician in the HMO. Aetna denied her claim because the referral was not pre-authorized by Aetna. The district court found as a matter of law that Aetna did not abuse its discretion in denying coverage. The court found, however, that the plan was ambiguous and the need for pre-authorization was not clearly stated in Aetna's summary description of the plan. And under the circumstances of the case, it could not be said as a matter of law that Aetna did not abuse its discretion in denying coverage. View "Koehler v. Aetna Health, Inc." on Justia Law