Justia Health Law Opinion Summaries
Articles Posted in US Court of Appeals for the Fifth Circuit
D&G Holdings, LLC v. Becerra
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
Louisiana v. Becerra
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 Home Care, LLC v. Becerra
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
E.T. v. Paxton
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
BST Holdings, LLC v. Occupational Safety and Health Administration
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 Rehabilitation, Inc. v. Becerra
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
United States v. Moparty
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
Whole Woman’s Health v. Paxton
The Fifth Circuit, en banc, vacated the district court's permanent injunction declaring Senate Bill 8 (SB8), which prohibits a particular type of dilation and evacuation (D&E) abortion method, facially unconstitutional.The district court held that SB8 imposes an undue burden on a large fraction of women, primarily because it determined that SB8 amounted to a ban on all D&E abortions. However, viewing SB8 through a binary framework—that either D&Es can be done only by live dismemberment or else women cannot receive abortions in the second trimester—is to accept a false dichotomy. Rather, the en banc court concluded that the record shows that doctors can safely perform D&Es and comply with SB8 using methods that are already in widespread use. The en banc court also concluded that the district court, in permanently enjoining SB8, committed numerous, reversible legal and factual errors: applying the wrong test to assess SB8, disregarding and misreading the Supreme Court's precedents in Planned Parenthood of Southeastern Pennsylvania v. Casey and Gonzales v. Carhart, and bungling the large-fraction analysis. Because remanding to the district court would be futile as the record permits only one conclusion, the en banc court concluded that plaintiffs have failed to carry their heavy burden of proving that SB8 would impose an undue burden on a large fraction of women. View "Whole Woman's Health v. Paxton" on Justia Law
Valentine v. Collier
Shortly after COVID-19 struck the Wallace Pack Unit, plaintiffs filed suit seeking injunctive relief on behalf of three certified classes of inmate for violations of the Eighth Amendment, the Americans with Disabilities Act (ADA), and the Rehabilitation Act. Specifically, plaintiffs alleged that defendants acted with deliberate indifference to their health and safety in violation of the Eighth Amendment in light of the dangers of COVID-19 for a geriatric prison population, and that defendants violated the ADA and Rehabilitation Act by failing to accommodate for specific risks to wheelchair-bound and other mobility-impaired inmates.On April 16, 2020, the district court entered a preliminary injunction which was stayed by the Fifth Circuit on April 22 and then vacated on June 5. On September 29, 2020, the district court issued a permanent injunction, concluding that plaintiffs did not need to exhaust administrative remedies; defendants were deliberately indifferent; and defendants violated the ADA and the Rehabilitation Act.The Fifth Circuit reversed the district court's permanent injunction and rendered judgment for defendants. The court concluded that the prison officials were not deliberately indifferent based on a lack of a systemic approach. After considering Policy B-14.52, its unwritten additions, and its administration, the court explained that the record does not support a finding of deliberate indifference in the way the officials considered and adopted a response to COVID-19. The court also concluded that the prison officials were not deliberately indifferent based on a failure to abide by basic public health guidance regarding testing, social distancing, mask use, handwashing, sanitation, and cleaning. Finally, the court concluded that the mobility-impaired inmates failed to establish their prima facie ADA claim, and consequently their Rehabilitation Act claim. View "Valentine v. Collier" on Justia Law
Texas v. United States
The Fifth Circuit withdrew its prior opinion and substituted the following opinion.The States filed suit against the United States, raising constitutional challenges to Section 9010 of the Affordable Care Act (ACA), as well as statutory and constitutional challenges to an HHS administrative rule (Certification Rule).As a preliminary matter, the Fifth Circuit affirmed the district court's ruling that the States had standing. The court reversed the district court's ruling that the States' Administrative Procedure Act (APA) claims were not time-barred and dismissed those claims for lack of jurisdiction. On the merits, the court held that the Certification Rule and Section 9010 are constitutional and lawful. As a result, the court explained that there can be no equitable disgorgement, regardless of whether such a remedy would be otherwise appropriate. Accordingly, the court affirmed the district court's judgment on the Section 9010 claims and reversed the district court's judgment that the Certification Rule violated the nondelegation doctrine. Therefore, the court rendered judgment in favor of the United States. Because the court held that neither the Certification Rule nor Section 9010 are unlawful, the court vacated the district court's grant of equitable disgorgement to the States. View "Texas v. United States" on Justia Law