Justia Health Law Opinion Summaries

Troy Olhausen, a former Senior Vice President of Business Development and Marketing at Arriva Medical, LLC, filed a qui tam action under the False Claims Act against his former employers, Arriva, Alere, Inc., and Abbott Laboratories, Inc. He alleged that the defendants submitted fraudulent claims to the Center for Medicare and Medicaid Services (CMS) for reimbursement. Specifically, Olhausen claimed that Arriva submitted claims without obtaining required assignment-of-benefits signatures and failed to disclose or accredit certain call-center locations that processed claims.The United States District Court for the Southern District of Florida dismissed Olhausen’s third amended complaint, holding that he failed to plead with the particularity required under Federal Rule of Civil Procedure 9(b) that any fraudulent claims were actually submitted to the government. The district court found that Olhausen did not provide sufficient details to establish that false claims had been submitted, as he did not work in the billing department and lacked firsthand knowledge of the claim submissions.On appeal, the United States Court of Appeals for the Eleventh Circuit reviewed the case. The court concluded that Olhausen adequately pled with particularity that allegedly false claims were submitted under Count II, which involved claims for heating pads that lacked assignment-of-benefits signatures. The court found that the internal audit allegations provided sufficient indicia of reliability to satisfy Rule 9(b). However, the court upheld the dismissal of Count IV, which alleged that Arriva failed to disclose or accredit certain call-center locations, as Olhausen did not adequately allege that any claims involving these locations were actually submitted. Consequently, the court vacated the dismissal of Counts II and VI (conspiracy) and remanded them for further proceedings, while affirming the dismissal of Count IV. View "Olhausen v. Arriva Medical, LLC" on Justia Law

The plaintiffs, co-personal representatives of the estate of Sara Schleider, filed a lawsuit in Florida state court against GVDB Operations, LLC, and JSMGV Management Company, LLC. They alleged that the defendants failed to prevent the spread of COVID-19 at their assisted living facility, resulting in Sara Schleider contracting the virus and subsequently dying. The plaintiffs asserted state-law claims for survival and wrongful death under Florida Statute § 429.28, alleging negligence and, alternatively, willful misconduct or gross negligence.The defendants removed the case to the United States District Court for the Southern District of Florida, claiming federal subject matter jurisdiction on three grounds: acting under a federal officer, complete preemption by the Public Readiness and Emergency Preparedness (PREP) Act, and an embedded federal question concerning the PREP Act. The district court concluded it lacked subject matter jurisdiction and remanded the case to state court, finding that the defendants' arguments did not establish federal jurisdiction.The United States Court of Appeals for the Eleventh Circuit reviewed the district court's decision. The appellate court affirmed the remand, holding that the defendants did not act under a federal officer, as their compliance with federal guidelines did not equate to acting under federal authority. The court also determined that the PREP Act did not completely preempt the plaintiffs' state-law claims, as the Act's willful misconduct provision did not wholly displace state-law causes of action for negligence. Lastly, the court found that the plaintiffs' claims did not raise a substantial federal question under the Grable doctrine, as the federal issues were not necessarily raised by the plaintiffs' well-pleaded complaint. Thus, the district court's remand to state court was affirmed. View "Howard Schleider v. GVDB Operations, LLC" on Justia Law

The case involves John Holland, William Moore, and Ed Cota, who were accused of participating in an illegal healthcare kickback scheme. The government alleged that Holland and Moore, hospital executives for Tenet Healthcare, paid the Cotas to refer Medicaid or Medicare-covered pregnant women to Tenet hospitals. The payments were purportedly disguised as contracts for translation services. Tracey Cota, Ed Cota's wife, pleaded guilty to violating the Anti-Kickback Statute (AKS) by participating in this scheme. However, the other defendants argued that their business relationship did not violate the AKS because they lacked the requisite mental state or mens rea.The United States District Court for the Northern District of Georgia held a pretrial "paper" hearing to determine the admissibility of out-of-court statements made by the defendants' alleged coconspirators. The district court concluded that the government needed to prove by a preponderance of the evidence that the defendants' conduct was illegal to admit the statements under Rule 801(d)(2)(E). The court found that the government failed to prove the defendants' knowledge of illegality and thus excluded the coconspirator statements.The United States Court of Appeals for the Eleventh Circuit reviewed the district court's decision. The appellate court held that the district court erred in requiring proof of an illegal conspiracy to admit coconspirator statements. The court clarified that under Rule 801(d)(2)(E), it is sufficient to show that the statements were made during and in furtherance of a joint venture, regardless of the venture's legality. The Eleventh Circuit reversed the district court's decision and remanded the case for further proceedings consistent with this opinion. View "United States v. Holland" on Justia Law

The case involves a class action lawsuit brought by several minor children, through their legal guardians, against the Commissioner of the Georgia Department of Community Health. The plaintiffs challenged the Department's practices regarding the provision of skilled nursing services under the Medicaid Act. Specifically, they contested the Department's use of a scoresheet to determine the number of skilled nursing hours and the practice of reducing those hours as caregivers learn to perform skilled tasks.The United States District Court for the Northern District of Georgia granted summary judgment in favor of the plaintiffs. The court ruled that the Department's review process did not give appropriate weight to the recommendations of treating physicians and that the practice of reducing skilled nursing hours as caregivers learn skilled tasks violated the Medicaid Act. The district court issued permanent injunctions requiring the Department to approve the skilled nursing hours prescribed by the patients' treating physicians.The United States Court of Appeals for the Eleventh Circuit reviewed the case and reversed the district court's decision. The appellate court held that the Department's review process, which includes the use of a scoresheet to determine a presumptive range of skilled nursing hours, complies with the Medicaid Act. The court also found that the practice of reducing skilled nursing hours as caregivers learn skilled tasks is reasonable and does not violate the Act. The court vacated the permanent injunctions and remanded the case for further proceedings. The appellate court did not address the plaintiffs' challenge regarding the consideration of caregiver capacity, as the district court had ruled that issue moot. The appeal of the preliminary injunctions was deemed moot following the vacatur of the permanent injunctions. View "M.H. v. Commissioner, Georgia Dept. of Community Health" on Justia Law

Elizabeth Peters Young was convicted of conspiring to pay and receive kickbacks from federal reimbursements for medical creams and lotions dispensed by pharmacies she worked with. The district court sentenced her to 57 months in prison and ordered her to pay $1.5 million in restitution and forfeiture, representing the gross proceeds she controlled during the conspiracy.The United States District Court for the Southern District of Florida initially reviewed the case. Young challenged her conviction, restitution order, and forfeiture judgment, arguing insufficient evidence for her conspiracy conviction, improper calculation of restitution, and errors in the forfeiture amount. The district court denied her motion to set aside the verdict and sentenced her, including the contested financial penalties.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court affirmed Young’s conspiracy conviction, finding sufficient evidence that she conspired with others, including a pharmacy, to receive kickbacks. The court also upheld the forfeiture judgment, ruling that Young was liable for the gross proceeds she controlled, even if she distributed some to co-conspirators. However, the court vacated the restitution order, agreeing with Young that the government did not prove the amount of loss it experienced due to her conduct. The court remanded the case for further proceedings to determine the correct restitution amount. View "USA v. Young" on Justia Law

The case revolves around an employment discrimination suit filed by Dr. Tara Loux against her former employers, BayCare Medical Group and St. Joseph’s Hospital. Dr. Loux sought to discover BayCare’s internal documents about the performance of other doctors who were not fired despite also committing errors. BayCare objected to disclosing certain documents, such as its “quality files” and “referral logs,” arguing that they were privileged under the Patient Safety and Quality Improvement Act of 2005. The Act creates a statutory privilege for work product prepared for or reported to patient safety organizations.The district court ordered BayCare to produce the disputed documents, concluding that the Act does not privilege documents if they have a “dual purpose,” only one of which relates to making reports to a patient safety organization. The court held that these documents were not privileged because BayCare used information in the documents for other purposes, such as internal safety analysis and peer review.The United States Court of Appeals for the Eleventh Circuit disagreed with the district court's interpretation of the Act. The appellate court found that the district court had applied an incorrect "sole purpose" standard to assess whether BayCare’s quality files and referral logs fell under the privilege. The court held that the Act does not require that privileged information be kept solely for provision to a Patient Safety Organization. The court granted BayCare's petition for a writ of mandamus, directing the district court to vacate its orders compelling the disclosure of the privileged documents and reconsider BayCare’s assertion of privilege consistent with the appellate court's opinion. View "In re: Baycare Medical Group, Inc." on Justia Law

The case revolves around Anna Lange, a transgender woman employed by the Houston County Sheriff's Office in Georgia. Lange was diagnosed with gender dysphoria in 2017 and her healthcare providers recommended a treatment plan that included hormone therapy and gender-affirming surgery. In 2018, her healthcare providers determined that a vaginoplasty was medically necessary. However, Lange's request for coverage was denied based on the health insurance plan's exclusion of services and supplies for sex change and/or the reversal of a sex change. Lange filed claims against Houston County with the Equal Employment Opportunity Commission and subsequently sued Houston County and the Sheriff of Houston County in the Middle District of Georgia.The district court granted summary judgment to Lange on the Title VII claim, finding the Exclusion facially discriminatory as a matter of law. The Title VII claim then proceeded to trial, and a jury awarded Lange $60,000 in damages. After trial, the district court entered an order declaring that the Exclusion violated Title VII and permanently enjoined the Sheriff and Houston County from any further enforcement or application of the Exclusion.The United States Court of Appeals for the Eleventh Circuit affirmed the district court's decision. The court held that a health insurance provider can be held liable under Title VII of the Civil Rights Act of 1964 for denying coverage for gender-affirming care to a transgender employee because the employee is transgender. The court also held that Houston County is liable under Title VII as an agent of the Sheriff's Office. The court affirmed the district court's order permanently enjoining Houston County and the Sheriff from further enforcement or application of the Exclusion. View "Lange v. Houston County, Georgia" on Justia Law

The case involves Haitham Yousef Alhindi, the defendant-appellant, who was charged with five counts of cyberstalking. Alhindi's counsel requested a competency evaluation, which was conducted by the Bureau of Prisons (Bureau), albeit late. Based on limited information and caution, the Bureau's report deemed Alhindi incompetent. The court ordered Alhindi to be hospitalized for treatment under 18 U.S.C. § 4241(d)(1). However, before Alhindi was hospitalized, the Bureau reported that he was not exhibiting any signs of mental illness and recommended a second competency evaluation, which the court ordered over Alhindi's objection. The second evaluation also concluded that Alhindi was incompetent. Alhindi appealed, arguing that the district court lacked authority to order a second competency evaluation and commitment for hospitalization.The U.S. Court of Appeals for the Eleventh Circuit disagreed, holding that 18 U.S.C. § 4241 authorizes district courts to order multiple competency evaluations and commitments for hospitalization when appropriate under the statute's terms. The court also found that the four-month limit in § 4241(d)(1) applies to the period of hospitalization, not the entire commitment period. The court emphasized the importance of district courts’ continued close supervision of competency proceedings. The court affirmed the district court's entry of the commitment order. View "USA v. Haitham Alhindi" on Justia Law

The case involved an appeal by two brothers, Jonathan and Daniel Markovich, who were convicted for operating fraudulent drug rehabilitation clinics in Florida. They were found guilty of various charges, including health-care fraud, wire fraud, kickbacks, money laundering, and bank fraud, resulting in fraudulent claims of over $100 million.The brothers appealed their convictions on several grounds. They argued that the district court violated their constitutional rights by denying their motion to compel the prosecution to obtain and disclose confidential medical records possessed by third parties. They also claimed that the court violated Federal Rules of Evidence by admitting unreliable and confusing expert testimony about the clinics' medical and billing practices. Additionally, they argued that the court abused its discretion by admitting lay summary testimony about medical and billing records.The United States Court of Appeals for the Eleventh Circuit affirmed the convictions. The court ruled that the prosecution had no duty to seek out potentially exculpatory evidence not in its possession. It also determined that the expert testimony was clear and reliable, and the summary testimony was proper. The court found that any challenge to bank-fraud counts was forfeited due to a lack of explanation or supporting legal authority. Finally, the court ruled that the district court did not abuse its discretion by denying the brothers' motion for a new trial based on newly discovered evidence. View "United States v. Markovich" on Justia Law

The case pertains to Thomas Ukoshovbera A. Gbenedio, a licensed pharmacist, who was charged with 72 counts of unlawful drug dispensing and one count of refusing an inspection of his pharmacy, essentially operating a "pill mill." The district court sentenced Gbenedio to 188 months of imprisonment and imposed a $200,000 fine.Gbenedio appealed, arguing that the lower court erred in denying his motion to dismiss the indictment due to insufficient notice of the charges against him, and in making certain evidentiary rulings. He also contested the fine imposed, stating he was unable to pay.The United States Court of Appeals for the Eleventh Circuit affirmed the district court's decision. The court found that the indictment provided enough facts for Gbenedio to understand the charges against him. It also deemed the district court's evidentiary rulings as non-abusive and found that Gbenedio failed to prove his inability to pay the fine. View "USA v. Gbenedio" on Justia Law