Justia Health Law Opinion Summaries

This case stemmed from the discovery in an unrelated case that the Center for Medicare & Medicaid Services ("CMS") had paid hospitals less than they were due because it had miscalculated the disproportionate share hospital ("DSH") payment. Appellants, a group of hospitals that received DSH payments, filed claims with the Provider Reimbursement Review Board ("PRRB") seeking full payments for the fiscal years 1987-1994. At issue was whether the district court lacked jurisdiction in the matter and whether the Medicare statute, 42 U.S.C. 1395oo(a), allowed for equitable tolling. The court held that a decision by the PRRB denying jurisdiction was a final decision subject to judicial review by the district court. The court also held that, given the factors emphasized in United States v. Brockamp did not apply to the facts presented, and without any other reasons for rebutting the presumption of equitable tolling, the court found that equitable tolling was available under 1395oo(a). The court noted that whether tolling was appropriate in this particular case, however, was a different question for the district court to answer on remand. The court also rejected appellants' alternative arguments and therefore, reversed and remanded for further proceedings.

This case involved cost-saving tools that Congress had devised for Medicare payments to cancer hospitals and specifically concerned Medicare reimbursements paid to one cancer hospital, appellant, in 2000 and 2001. The first issue on appeal related to the cancer hospitals' inpatient costs where appellant requested an increase to its target amount in 2000 and 2001 due to the high cost of certain new cancer drugs and where the Department of Health and Human Services ("HHS") denied that request. Appellant argued that it did not receive proper notice of the new net financial impact requirement and thus did not have a fair opportunity to satisfy the requirement at the administrative hearing. The court agreed and held that appellant did not receive timely notice of the requirement and, on remand to HHS, must be given an opportunity to satisfy it. The second issued on appeal concerned cancer hospitals' outpatient costs where appellant contended that HHS misapplied the statutory formula that provided hospitals a fraction of their reasonable costs and undercompensated appellant. The court rejected appellant's arguments and affirmed summary judgment in favor of HHS.

New York Presbyterian Hospital ("Hospital") petitioned for review of a decision and order by the National Labor Relations Board ("Board") finding the Hospital in violation of section 8(a)(5) of the National Labor Relations Act ("Act"), 29 U.S.C. 158(a)(5), for failing to produce information requested by the labor union with which the Hospital had a collective bargaining agreement, the New York State Nurses Association ("NYSNA" or "Union"). The Hospital asserted that NYSNA failed to demonstrate the relevance of its request for information, attacked the evidentiary foundation of the Board's decision and order, and raised a number of additional arguments. The court held that NYSNA adequately demonstrated the relevance of its request for information where the nub of NYSNA's request for information was the Union's concern that non-Union NPs, licensed nurses, were performing bargaining unit work in the Hospital. The court also held that the Board's order that the Hospital be required to furnish information about shifts worked by bargaining unit NPs was supported by substantial evidence. The court rejected or declined to reach the Hospital's remaining arguments. Accordingly, the petition for review was denied and the court granted the Board's cross-application for enforcement.

Appellant, a primary care physician who served Medicaid patients in the District of Columbia, appealed his convictions for health care fraud and for making false statements relating to health care matters, as well as his 53 month prison sentence. At issue was whether the district court committed evidentiary errors and improperly refused to give the good faith instruction appellant requested. Also at issue was whether appellant's sentence was procedurally unreasonable. The court found no merit in appellant's assertions of trial errors and affirmed the judgment of conviction. The court held, however, that because the district gave an inadequate explanation for its above-Guidelines sentence and because this procedural defect amounted to plain error, the court vacated the sentence and remanded for further proceedings.

Plaintiffs, two scientists, brought a suit to enjoin the National Institutes of Health ("NIH") from funding research using human embryonic stem cells ("ESCs") pursuant to the NIH's 2009 Guidelines ("Guidelines"). At issue was whether the preliminary injunction was properly granted where the district court concluded that plaintiffs were likely to succeed in showing that the Guidelines violated the Dickey-Wicker Amendment, an appropriations rider that barred federal funding for research in which a human embryo was destroyed. The court vacated the preliminary injunction and held that plaintiffs were unlikely to prevail because Dickey-Wicker was ambiguous and the NIH seemed reasonably to have concluded that, although Dickey-Wicker barred funding for the destructive act of deriving an ESC from an embryo, it did not prohibit funding a research project in which an ESC would be used.

Forsyth Memorial Hospital, Inc. and other providers (collectively "appellants") appealed the district court's grant of summary judgment in favor of the Secretary of Health and Human Services ("HHS") upholding the denial of their reimbursement claims arising from the merger of Presbyterian Health Services Corporation ("Presbyterian") and Carolina Medicorp, Inc. ("Carolina"). At issue was whether the denial of the reimbursement claims was arbitrary and capricious, an abuse of discretion, contrary to law, or unsupported by substantial evidence. The court affirmed the denial of the reimbursement claims and held that the district court properly concluded that it was neither arbitrary and capricious nor contrary to law for the Administrator of the Centers for Medicare & Medicaid Services ("Administrator") to find that appellants were not entitled to reimbursement where, in the merger between Carolina and Presbyterian, no bona fide sale took place and the parties were related.