Justia Health Law Opinion Summaries

Defendant was convicted of conspiracy to commit healthcare fraud, conspiracy to solicit and receive healthcare kickbacks, and two counts of false statements relating to healthcare matters. On appeal, Defendant challenged the sufficiency of evidence and her sentence.   The Fifth Circuit affirmed Defendant’s conviction and sentence. The court explained that the government was required to prove beyond a reasonable doubt “(1) an agreement between two or more persons to pursue an unlawful objective; (2) the defendant’s knowledge of the unlawful objective and voluntary agreement to join the conspiracy; and (3) an overt act by one or more of the members of the conspiracy in furtherance of the objective of the conspiracy.” The evidence was sufficient to prove that Defendant made an agreement to and did receive $60 kickbacks in exchange for home healthcare certifications. Thus, it was not unreasonable for the jury to conclude that the $60 payments were kickbacks, rather than legitimate co-pays, based on the evidence that patients rarely paid the fee, and that Defendant charged a uniform $60 fee regardless of the services rendered.   In Defendant’s challenge to the PSR’s calculation of the loss amount and its effect on her Sentencing Guidelines range, the court held that the district court did not err by overruling Defendant’s objection to the inclusion of Medicare Part A claims in the loss amount. However, the district court did err by overruling Defendant’s objection to the inclusion of the non-certification Medicare Part B claims in the loss amount because absent the fraud Medicare would have paid for these claims. Nonetheless, this error was harmless. View "USA v. Hamilton" on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment in favor of the HHS Defendants in an action challenging HHS's risk-adjustment program, implemented under the Patient Protection and Affordable Care Act (ACA), and repromulgation of the 2017 and 2018 rules. In this case, Vista Health Plan, a health insurance company in Texas, was assessed risk-adjustment fees that exceeded its premium revenue, causing the company to cease operations.After determining that it has jurisdiction over the appeal, the court concluded that the 2017 and 2018 Final Rules adopted by HHS were not impermissibly retroactive under Landgraf v. USI Film Prods., 511 U.S. 244, 268 (1994). The court also concluded that HHS's failure to follow the Administrative Procedure Act's notice-and-comment procedures in its repromulgation of the 2017 Final Rule was at worst harmless error. Rather, the new rule actually maintained the settled expectations of insurers covered by the previous version of the rule. Finally, the court concluded that Vista's other issues on appeal regarding the administrative record before the district court, Chevron deference as to HHS's interpretation of the governing law, and the district court's "sua sponte" summary judgment on Vista's regulatory taking claim lack merit. View "Vista Health Plan, Inc. v. United States Department of Health and Human Services" on Justia Law

The Fifth Circuit denied defendants' motion for a partial stay of the district court's preliminary injunction enjoining the Department of Defense, United States Secretary of Defense Lloyd Austin, and United States Secretary of the Navy Carlos Del Toro from enforcing certain COVID-19 vaccination requirements against 35 Navy special warfare personnel and prohibiting any adverse actions based on their religious accommodation requests. Specifically, defendants seek a partial stay pending appeal insofar as the injunction precludes them from considering plaintiffs' vaccination statuses "in making deployment, assignment and other operational decisions."The court weighed the Mindes abstention factors and determined that this dispute is justiciable. However, the court concluded that defendants have not carried their burden to warrant the issuance of the stay. The court agreed with the district court that defendants have not shown a compelling interest to deny religious accommodations under the Religious Freedom Restoration Act of 1993 to each of the 35 plaintiffs at issue. Rather, the "marginal interest" in vaccinating each plaintiff appears to be negligible and thus defendants lack a sufficiently compelling interest to vaccinate plaintiffs. The court also concluded that the preliminary injunction does not irreparably damage the Navy and the public; partially staying the preliminary injunction pending appeal would substantially harm plaintiffs; and issuance of the requested stay would disserve the public interest. View "U.S. Navy SEALs 1-26 v. Biden" on Justia Law

D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

The Secretary of DHS and other federal government defendants moved to stay the district court's nationwide, preliminary injunction barring enforcement of one of the federal COVID-19 vaccination mandates related to the staff of many Medicare- and Medicaid-certified providers such as hospitals, long-term care facilities, home-health agencies, and hospices.The Fifth Circuit denied the motion insofar as the order applies to the 14 Plaintiff States, concluding that the Secretary has not made a strong showing of likely success on the merits in light of BST Holdings, L.L.C. v. OSHA, 17 F.4th 604 (5th Cir. 2021). In BST, the Fifth Circuit relied in part on the "major questions doctrine" in staying the COVID-19 vaccination mandate OSHA issued for employers of a certain size. In this case, the Secretary identifies meaningful distinctions between its rule for Medicare and Medicaid-funded facilities and the broader OSHA rule — the statutory authority for the rule is different; Medicare and Medicaid were enacted under the Spending Clause rather than the Commerce Clause; and the targeted health care facilities, especially nursing homes, are where COVID-19 has posed the greatest risk. Nonetheless, the court concluded that the first stay factor requires more than showing a close call. Therefore, the court could not say that the Secretary has made a strong showing of likely success on the merits. Furthermore, the other three factors for a stay — injury to the movant, injury to the opponent, and the public interest — are important but, regardless of the outcome of analyzing them, they will not overcome the court's holding that the merits of the injunction will not likely be disturbed on appeal.Applying principles of judicial restraint, the court granted the stay as to the order's application to any other jurisdiction, concluding that the district court gave little justification for issuing an injunction outside the 14 States that brought this suit. View "Louisiana v. Becerra" on Justia Law

Med-Cert filed suit against federal officials in charge of administering the Medicare program, alleging that HHS sought to recoup overpaid Medicare funds from Med-Cert before its hearing with an ALJ in violation of Med-Cert's due process rights. The district court enjoined the federal officials from recouping funds until after the hearing. While this case was on appeal, the Fifth Circuit issued Sahara Health Care Inc. v. Azar, 975 F.3d 523 (5th Cir. 2020), which held that a similarly situated health-care provider was not denied due process. Because Sahara is controlling in this case, the court reversed and remanded for the district court to consider Med-Cert's alternative claims. View "Med-Cert Home Care, LLC v. Becerra" on Justia Law

The Fifth Circuit granted the Texas Attorney General a stay pending appeal of the permanent injunction that bars him from enforcing Texas Governor Greg Abbott's Executive Order GA-38, which prohibits local governmental entities from imposing mask mandates.After determining that plaintiffs have likely failed to demonstrate standing, the court concluded that the Attorney General has demonstrated a strong likelihood of success on the merits as a matter of law. In this case, the district court lacked jurisdiction over plaintiffs' claims where plaintiffs have not exhausted their administrative remedies under the Individuals with Disabilities Education Act (IDEA). Furthermore, even if a failure to exhaust remedies does not bar plaintiffs' claims, plaintiffs likely failed to make out a prima facie case under the Americans with Disabilities Act (ADA) or the Rehabilitation Act. The court explained that, given the availability of vaccines, voluntary masking, and other possible accommodations, the record before the court likely does not support the conclusion that a mask mandate would be both necessary and obvious under the ADA or the Rehabilitation Act. The court also held that it was likely erroneous for the district court to hold that GA-38 was preempted by either the ADA or the Rehabilitation Act. To the extent that it is even properly before the court, the court did not read the American Rescue Plan Act to preempt GA-38's prohibition of local mask mandates, as the district court did. The court further concluded that, assuming plaintiffs' claims are otherwise viable, at a minimum, the district court's blanket injunction prohibiting the enforcement of GA-38 in all public schools across the State of Texas is overbroad. Finally, the court concluded that the Attorney General has demonstrated the prospect of irreparable injury absent a stay; has shown that maintaining the status quo ante pending appeal will not risk substantial injury to plaintiffs; and that the public interest favors a stay. View "E.T. v. Paxton" on Justia Law

This case concerns OSHA's November 5, 2021 Emergency Temporary Standard requiring employees of covered employers to undergo COVID-19 vaccination or take weekly COVID-19 tests and wear a mask.The Fifth Circuit granted petitioners' motion for a stay pending review, holding that the Nken factors favored a stay. The court concluded that petitioners' challenges to the Mandate are likely to succeed on the merits. The court stated that, on the dubious assumption that the Mandate does pass constitutional muster, it is nonetheless fatally flawed on its own terms. The court wrote that the Mandate's strained prescriptions combine to make it the rare government pronouncement that is both overinclusive (applying to employers and employees in virtually all industries and workplaces in America, with little attempt to account for the obvious differences between the risks facing, say, a security guard on a lonely night shift, and a meatpacker working shoulder to shoulder in a cramped warehouse) and underinclusive (purporting to save employees with 99 or more coworkers from a "grave danger" in the workplace, while making no attempt to shield employees with 98 or fewer coworkers from the very same. The court found that promulgation of the Mandate grossly exceeds OSHA's statutory authority and found arguments to the contrary unavailing.The court also concluded that it is clear that denial of petitioners' proposed stay would do them irreparable harm where the Mandate threatens to substantially burden the liberty interests of reluctant individuals, companies, and the States. In contrast, the court stated that a stay will do OSHA no harm whatsoever. Finally, the court concluded that a stay is firmly in the public interest. View "BST Holdings, LLC v. Occupational Safety and Health Administration" on Justia Law

Family Rehab brought a procedural due process claim arguing that it is entitled to third step review before recoupment of Medicare overpayments. The district court granted summary judgment in favor of Family Rehab, and entered a permanent injunction barring HHS from recouping the disputed funds until the completion of third step review under 42 C.F.R. 405.1036(c)–(d).However, in reaching its decision, the district court did not have the benefit of the Fifth Circuit's decision in Sahara Health Care Inc. v. Azar, 975 F.3d 523 (5th Cir. 2020), in which the court rejected a similar due process claim under nearly identical facts. In this case, Family Rehab's claims all involve documentation issues that do not require cross-examination and credibility determinations. The court explained that Family Rehab's claims could have been resolved in the first two steps of administrative review by producing the relevant documents. Accordingly, the court reversed the district court's judgment. View "Family Rehabilitation, Inc. v. Becerra" on Justia Law

Dr. Narang and Moparty were convicted of Conspiracy to Commit Health Care Fraud, 18 U.S.C. 1349; Health Care Fraud, section 1347, and Engaging in Monetary Transactions in Property Derived from Specified Unlawful Activity, section 1957. Narang is an internist who practiced at his Texas self-owned clinic, North Cypress. Moparty co-owned Red Oak Hospital and served as an administrator for Trinity Health Network, which provided staffing and administrative services to health care entities. Narang ordered unnecessary medical tests for patients and then authorized Moparty to bill for these tests at the higher hospital rate even though these patients were seen and treated at Narang’s North Cypress office. The indictment alleged that this scheme resulted in fraudulent billing of over $20 million to Blue Cross Blue Shield, Aetna, and Cigna. Those companies paid Moparty at least $3.2 million in reimbursement for those claims which he allegedly split with Narang through a series of financial transactions.The court sentenced Moparty to 108 months and Narang to 121 months of imprisonment, with joint and several liability for $2,621,999.04 in restitution. The Fifth Circuit affirmed, rejecting challenges to the sufficiency of the evidence and finding that, although the government made repeated errors, those errors did not warrant reversal. View "United States v. Moparty" on Justia Law