Justia Health Law Opinion Summaries

In the winter of 2020, the Secretary of Health and Human Services (HHS) determined that the threat posed by the novel SARS-CoV-2 virus constituted a public health emergency. The CDC published the rule at issue—the Requirement for Persons to Wear Masks While on Conveyances and at Transportation Hubs, 86 Fed. Reg. 8025-01 (Feb. 3, 2021) (“Mandate”). Plaintiffs initiated this litigation, arguing that the Mandate was unlawful under the Administrative Procedure Act, 5 USC Section 706(2) (APA), and unconstitutional under non-delegation and separation-of-powers tenets.   The Eleventh Circuit vacated the district court’s judgment and instructed the district court to dismiss the case as moot. The court explained that it found Plaintiffs’ contention that there is a reasonable expectation that the CDC will issue another nationwide mask mandate for all conveyances and transportation hubs to be speculative. Conjectures of future harms like these do not establish a reasonable expectation that a mask mandate from the CDC will reissue. Further, the court reasoned that there is no “reasonable expectation or a demonstrated probability that the same controversy will recur involving the same complaining party.” View "Health Freedom Defense Fund, et al v. President of the United States, et al" on Justia Law

Eight South Florida hospitals dutifully provided out-of-network emergency treatment to numerous Cigna customers. When Cigna reimbursed the hospitals just 15% of what they had charged, the hospitals sued, accusing Cigna of paying less than the “community” rate. As proof, the hospitals showed that they normally receive five times as much for the care they provided here. In response, Cigna asserted that the hospitals’ data proved nothing because, it insisted, the relevant “community” necessarily includes more than just the eight plaintiff hospitals. The district court agreed and granted Cigna summary judgment.   The Eleventh Circuit reversed. The court explained that even if the relevant “community” here extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the “community” rates are. The court reasoned that to survive summary judgment, a plaintiff needn’t present evidence that compels a single, airtight inference—just evidence that allows a reasonable one. The court explained that the way to rebut an inference allegedly skewed by limited data is to add data. And Cigna can do just that—at trial. If it can show there that most other providers in the “community” charge less than the plaintiff hospitals do, then it may well debunk the hospitals’ estimate. But unless and until that happens, it remains the case that a reasonable jury could conclude that the eight plaintiff hospitals’ rates reflect the prevailing community rate—and thus that Cigna shortchanged them. View "North Shore Medical Center, Inc., et al v. Cigna Health and Life Insurance Company" on Justia Law

Based in Auburn, Alabama, Plaintiff and her pharmacy were one of the thousands of businesses that answered the call to provide Covid-19 tests to the public. However, the Alabama Board of Pharmacy (the Board) concluded that Plaintiff’s administration of these tests fell short of the medical safety standards required under Alabama law. When the Board instituted an administrative enforcement proceeding against Plaintiff, she sought to avail herself of the legal immunity provided by the Secretary’s PREP Act Declaration. Plaintiff filed a federal suit, seeking to enjoin the Board from even considering the charges against her. The district court exercised its discretion to abstain under Younger v. Harris, 401 U.S. 37 (1971) and declined to intervene in the Board’s proceedings.   The Eleventh Circuit affirmed the district court’s decision to abstain under Younger. The court concluded that Plaintiff has not established that she lacks an adequate opportunity to present her federal claims to the Alabama Board of Pharmacy or an adequate opportunity to obtain judicial review of her claims in Alabama’s courts, and so Younger abstention is warranted. The court wrote that it did not decide today whether Plaintiff is immune from the Board’s charges or if they are, in fact, preempted by the PREP Act. All the court concluded is that this is not one of the “extraordinary circumstances” that would justify federal intervention in a state proceeding that is adequate to hear Plaintiff’s claims. View "Lisa Hill Leonard, et al. v. The Alabama State Board of Pharmacy, et al." on Justia Law

Several states challenged the portion of the vaccine mandate as it pertains to employees who work on or in connection with a covered contract, or share a workplace with another employee who does. The district court determined that Plaintiffs were entitled to a preliminary injunction.On appeal, the Eleventh Circuit agreed with the district court that Plainitffs were likely to prevail on the merits. However, the court also found that the injunction’s nationwide scope was too broad. Thus, the Eleventh Circuit affirmed the district court’s order to the extent that it enjoins federal agencies from enforcing the mandate against the plaintiffs and to the extent that it bars the federal government from considering a bidder’s compliance with the mandate when deciding whether to grant a contract to a plaintiff or to a nonparty bidder. However, the Eleventh Circuit vacated the remaining portion of the preliminary injunction. View "State of Georgia, et al v. President of the United States, et al" on Justia Law

Defendants 1 and 2 are siblings and were indicted on substantive counts of health care fraud, conspiracy to commit health care fraud, money laundering, and conspiracy to commit money laundering related to their activities running a "pill mill." The District Court precluded evidence that Defendant 1 provided good care to his patients. The court also precluded evidence proffered by Defendant 2 (the younger sibling) that it is part of the Nigerian culture to defer to older siblings' decisions. Following their convictions, Defendant's challenged the court's evidentiary rulings as well as the sufficiency of the evidence.The Eleventh Circuit affirmed Defendants' convictions, rejecting all claims of error. The court also determined that the evidence was sufficient to support their convictions. View "USA v. Patrick Emeka Ifediba, et al" on Justia Law

Various actors in the Medicare Advantage program assigned claims for failure to pay or reimburse medical expenses owed under the Medicare Secondary Payer Act to Plaintiffs—MSP Recovery Claims, Series LLC; MSPA Claims 1, LLC; and MAO-MSO Recovery II LLC, Series PMPI, (collectively, “MSP Recovery”). MSP Recovery then asserted those claims against Metropolitan General Insurance Company, Metropolitan Casualty Insurance Company, Metropolitan Group Property & Casualty Insurance Company, Metlife Auto & Home Group, and Metropolitan P&C Insurance Company (collectively, “Defendants”).   The district court dismissed MSP Recovery’s claims because the complaint failed to show that Defendants had a “demonstrated responsibility” to reimburse MSP Recovery’s assignors for the medical expenses at issue. The Eleventh Circuit held that at this procedural stage MSP Recovery’s complaint plausibly alleged that Defendants had a demonstrated responsibility to pay the claims, and the court, therefore reversed and remanded this case to the district court for further proceedings consistent with this opinion.   The court explained that the district court found that it would not consider Exhibit A, which was attached to and referenced by incorporation in the factual allegations of MSP Recovery’s complaint. Because “documents attached to a complaint or incorporated in the complaint by reference can generally be considered by a federal court in ruling on a motion to dismiss under Rule 12(b)(6),” the court concluded that the district court erred in failing to consider whether the complaint and Exhibit A, taken together, plausibly alleged that Defendants’ responsibility to pay had been demonstrated prior to suit. View "MSP Recovery Claims, Series LLC, et al v. Metropolitan General Insurance Company, et al" on Justia Law

Defendant was convicted of conspiracy and substantive health care fraud for fraudulently billing Medicare and Medicaid for millions of dollars for visits to nursing home patients that he never made. He challenged the convictions, sentence, restitution amount, and forfeiture amount on appeal. In an April 12, 2022 opinion, the Eleventh Circuit affirmed Defendant's convictions and sentence.Following the court's initial opinion, Defendant filed a petition for rehearing en banc. The Eleventh Circuit considered Defendant's petition as a petition for a panel rehearing. The court granted Defendant's petition, vacated its previous opinion and issued a revised opinion that did not change the court's judgment or Defendant's sentence. Defendant was given 21 days to file a supplemental brief. View "USA v. Douglas Moss" on Justia Law

Relators brought qui tam claims against dozens of defendants alleging healthcare fraud against the federal government in April 2017. H.I.G. Capital, LLC and H.I.G. Surgery Centers, LLC (“H.I.G.”) were among the defendants. Plaintiffs amended their complaint in January 2019.Previously, another group of relators filed qui tam claims against several of the same defendants; however, they did not name H.I.G. in their initial complaint. The federal government intervened, resulting in a $41 million settlement which included the defendants and both sets of relators. The settlement agreement released H.I.G. insofar as any independent conduct outside their status as investors in or owners of the defendants included in the settlement. Relators then amended their complaint a second time, narrowing their allegations to focus only on H.I.G.The district court granted H.I.G.’s motion to dismiss based on the first-to-file rule. The district court determined that, because the settled claim was pending at the time Relators filed their initial complaint, Relators’ complaint was barred if the actions were related. The district court found the cases were related and dismissed Relators’ claims.The Eleventh Circuit affirmed. Relators filed their complaints while the action that was eventually settled was pending. Thus, Relators’ case must be dismissed if the actions were related. The court then adopted the “same material elements” test relied upon by other circuit courts. Finding that the two cases contained the same material elements of fraud, the court concluded the district court properly dismissed Relators’ claims. View "Sheldon Cho, et al v. H.I.G. Capital, LLC, et al" on Justia Law

In this qui tam action, after the jury found that Pinellas violated the False Claims Act and that the United States sustained damages, the district court trebled the damages and imposed statutory minimum penalties of $1,177,000 ($5,500 for each of the 214 violations).The Eleventh Circuit affirmed in part and reversed in part. The court upheld the district court's admission of Exhibit 24 where Pinellas failed to argue that the admission of the evidence constituted plain error. The court concluded that there was sufficient evidence for the jury to have found that, had Medicare known of Pinellas's misrepresentations, it would not have paid the refiled reimbursement claims. Furthermore, viewed in the light most favorable to the verdict, the evidence on scienter is not overwhelmingly in favor of Pinellas. Therefore, the jury's decision stands. The court also upheld the jury's findings on damages where the court concluded that the proper measure of damages in this case is the difference between what the United States paid and what it would have paid had Pinellas' claims been truthful. The court rejected the remaining challenges to the jury's verdict. The court further concluded that the monetary award imposed does not violate the Excessive Fines Clause. Finally, the court dismissed Pinellas' appeal as to the allocation of the monetary award between Ms. Yates and the United States. View "Yates v. Pinellas Hematology & Oncology, P.A." on Justia Law

In November 2021, the Secretary of Health and Human Services issued an interim rule that requires facilities that provide health care to Medicare and Medicaid beneficiaries to ensure that their staff, unless exempt for medical or religious reasons, are fully vaccinated against COVID-19, 86 Fed. Reg. 61,555. Under the rule, covered staff must request an exemption or receive their first dose of a two-dose vaccine or a single-dose vaccine by December 6, 2021. Florida unsuccessfully sought a preliminary injunction to bar the interim rule’s enforcement.The Eleventh Circuit upheld the denial of the motion, first deciding not to apply the mootness doctrine and to exercise jurisdiction despite another district court’s issuance of a nationwide injunction. Florida failed to demonstrate a substantial likelihood that it will prevail on the merits, that it will suffer irreparable injury absent an injunction, or that the balance of the equities favors an injunction. The Secretary has express statutory authority to require facilities voluntarily participating in the Medicare or Medicaid programs to meet health and safety standards to protect patients. The Secretary provided a detailed explanation for why there was good cause for dispensing with the notice-and-comment requirement. Ample evidence supports the Secretary’s determination that facility staff vaccination will provide important protection for patients. View "State of Florida v. Department of Health and Human Services" on Justia Law