Justia Health Law Opinion Summaries

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

The case involves Andre Dubois, who was convicted on several federal firearm offenses. These offenses arose when Dubois attempted to ship a box containing firearms from Georgia to Dominica. The United States Court of Appeals for the Eleventh Circuit was asked to address five issues on appeal.Firstly, the court dismissed Dubois's argument that a recent Supreme Court case overturned the precedent upholding a ban on felons possessing firearms. The court held that the Supreme Court case did not abrogate the precedent, and therefore Dubois's argument failed.Secondly, the court affirmed that there was sufficient evidence for a reasonable jury to find that Dubois knew he was in possession of a firearm.Thirdly, the court found that Dubois's prior conviction for possession with intent to distribute marijuana under Georgia law qualified as a "controlled substance offense" under the federal Sentencing Guidelines, triggering a higher base offense level.Fourthly, the court rejected Dubois's argument that the application of a sentencing enhancement for possession of a stolen gun violated his due process rights.Finally, the court held that the district court had not erred in imposing a $25,000 fine on Dubois, as there was sufficient evidence to suggest that he could afford to pay the fine.Therefore, Dubois's convictions and sentence were affirmed. View "USA v. Dubois" on Justia Law

In the United States Court of Appeals for the Eleventh Circuit, the Court reviewed a case involving the estates of two patients who passed away after undergoing liposuction procedures at CJL Healthcare, LLC in Georgia. After the patients' deaths, their estates filed lawsuits against the clinic and its doctor. The clinic's insurer, Prime Insurance Co., defended the clinic under a reservation of rights but ultimately withdrew its defense after the costs of defending the lawsuits exhausted the insurance coverage.The estates of the patients and the clinic then filed a lawsuit against the insurers, Prime Insurance Co., Prime Holdings Insurance Services, and Evolution Insurance Brokers, claiming they had breached their duties, contract, and acted negligently. They also claimed the insurers had unlawfully sold surplus lines insurance. The district court dismissed the case, and the plaintiffs appealed.The Court of Appeals affirmed the district court's decision. The Court held that the policy unambiguously provided a $50,000 limit for a single professional liability claim and a $100,000 aggregate limit for all claims. The Court further held that the insurers' duty to defend the clinic ended when the policy limits were exhausted by payment of damages and claim expenses. The Court also affirmed the district court's finding that the Georgia Surplus Lines Insurance Act did not provide a private cause of action for the unauthorized sale of surplus lines insurance. View "Jumlist v. Prime Insurance Co." on Justia Law

In this appeal, Marcus Raper contested the Social Security Administration’s (SSA) 2020 denial of his claim for disability insurance benefits. Raper raised three arguments: (1) that the administrative law judge's (ALJ) initial lack of constitutional appointment under the Appointments Clause tainted his later constitutionally appointed review of his case, (2) that the ALJ failed to clearly articulate good cause for not fully crediting his treating physician’s medical opinion, and (3) that the ALJ wrongly discredited his subjective complaints of pain by not properly considering evidence other than objective medical evidence.The United States Court of Appeals for the Eleventh Circuit affirmed the lower court’s decision. First, the court found no Appointments Clause violation as the ALJ's initial decision, made when he was unconstitutionally appointed, had been vacated on the merits and the case was remanded to the same ALJ who was then constitutionally appointed. Second, the court held that the ALJ articulated good cause for discounting Raper's treating physician’s opinion, finding the opinion inconsistent with the record. Lastly, the court found that the ALJ had properly considered Raper’s subjective complaints in light of the record as a whole and adequately explained his decision not to fully credit Raper’s alleged limitations on his ability to work. View "Raper v. Commissioner of Social Security" on Justia Law

Defendants Gladden and Linton were convicted of conspiracy to commit health care fraud and mail fraud, and the substantive offenses of health care fraud, mail fraud, and aggravated identity theft, for their roles in a multi-year scheme to defraud insurance companies. The government alleged Defendants received inflated reimbursement payments by billing for medically unnecessary and fraudulent prescriptions.The Eleventh Circuit found that the evidence presented at trial was sufficient to support the jury’s verdict as to all of Linton’s convictions and as to Gladden’s convictions for conspiracy, health care fraud, and mail fraud. In addition, the Eleventh Circuit found that the district court did not clearly err in calculating Gladden’s restitution and forfeiture amounts. The Court also vacated Galdden's conviction for aggravated identity theft and remanded for further proceedings consistent with this opinion. View "USA v. John Gladden, et al" on Justia Law