Justia Health Law Opinion Summaries

Articles Posted in US Court of Appeals for the Second Circuit
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Carlos Esteras and Raphael Frias were convicted of fentanyl trafficking charges and appealed their sentences, arguing that the district court erred in calculating their respective Guidelines ranges. Esteras contended that the district court wrongly calculated his base offense level by applying a two-level increase for maintaining a premises for narcotics trafficking and declining to apply a two-level reduction for being a minor participant in the trafficking scheme. He also argued that the district court wrongly applied a two-point increase to his criminal history score after finding that he was on parole at the time of the offense. Frias argued that the district court erred in applying the two-level premises enhancement and a four-level increase for being an organizer or leader of the scheme, and failed to adequately consider his mitigating evidence in declining to vary downwards.The United States District Court for the Northern District of New York had sentenced Esteras to 84 months' imprisonment and Frias to 135 months' imprisonment. The court had applied several sentencing enhancements, including a two-level enhancement for maintaining a premises for narcotics trafficking and a four-level enhancement for being an organizer or leader of the scheme.The United States Court of Appeals for the Second Circuit affirmed each of the district court’s sentencing decisions except its application of the organizer or leader enhancement to Frias. The court affirmed Esteras’s sentence and vacated and remanded Frias’s sentence for further proceedings consistent with its opinion. The court found that Esteras's home qualified for the stash-house enhancement and that he was not a minor participant in the conspiracy. The court also found that Esteras was on parole when he committed his offenses, warranting a two-point increase to his criminal history score. However, the court found that Frias did not qualify as an organizer or leader under the Guidelines, warranting a remand for further proceedings. View "United States v. Frias" on Justia Law

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The United States Court of Appeals for the Second Circuit heard a case initiated by Adam Hart, who filed a qui tam action under the False Claims Act (FCA) against pharmaceutical distributor McKesson. Hart alleged that McKesson provided business management tools to its customers for free in exchange for commitments to purchase drugs, which he claimed violated the federal anti-kickback statute (AKS) and several analogous state laws. The district court dismissed Hart's FCA claim, determining he failed to allege McKesson acted "willfully" as required by the AKS.On appeal, the Second Circuit held that to act "willfully" under the AKS, a defendant must knowingly act in a way that is unlawful. The court found that Hart failed to provide sufficient facts to meet this standard. However, the court disagreed with the district court's assertion that Hart's state claims were premised solely on a violation of the federal AKS. Consequently, the Second Circuit affirmed the dismissal of Hart’s federal FCA claim, vacated the dismissal of the remaining state claims, and remanded for further proceedings. View "United States, ex rel. Hart v. McKesson Corp." on Justia Law

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The plaintiff, Dr. Misty Blanchette Porter, had been a staff physician at Dartmouth-Hitchcock Medical Center (DHMC) since 1996. She specialized in reproductive medicine and was highly regarded in her field. In November 2015, Dr. Porter developed a medical condition that required her to take a medical leave of absence and subsequently work reduced hours. In 2017, DHMC decided to close the Reproductive Endocrinology and Infertility Division (REI) where Dr. Porter worked and terminate her employment. Dr. Porter claimed that her termination was due to her disability and her whistleblowing activity, in violation of the Americans with Disabilities Act (ADA), the Rehabilitation Act, and the laws of Vermont and New Hampshire.The United States Court of Appeals for the Second Circuit found that the district court erred in granting summary judgment to DHMC. The court found that there was direct evidence that the decision to terminate Dr. Porter's employment was based, in whole or in part, on her disability. The court also found that a jury could reasonably infer that Dr. Edward Merrens, the chief decision-maker in the termination, was aware of Dr. Porter's whistleblowing activity. The case was affirmed in part, vacated and remanded in part. View "Porter v. Dartmouth-Hitchcock Medical Center" on Justia Law

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In this case, a group of patients initiated a class action lawsuit against various hospitals and vendors who provide medical record production services to the hospitals. The plaintiffs alleged that the hospitals and vendors were involved in an illegal kickback scheme, where the vendors charged patients excessive prices for their medical records and used the profits to offer free and discounted pages to the hospitals for other types of medical records. The plaintiffs alleged violations of New York Public Health Law (PHL) § 18(2)(e) (which restricts the price that can be charged for medical records), New York General Business Law (GBL) § 349 (which prohibits deceptive business practices), and unjust enrichment. However, the New York Court of Appeals had previously ruled in Ortiz v. Ciox Health LLC that PHL § 18(2)(e) does not provide a private right of action.The United States Court of Appeals for the Second Circuit affirmed the district court's dismissal of all the plaintiffs' claims. It found that the patients' GBL § 349 and unjust enrichment claims were essentially repackaging their PHL § 18(2)(e) claims, and therefore not cognizable as they attempted to circumvent the Ortiz ruling. The court also held that the plaintiffs failed to allege any actionable wrongs independent of the requirements of PHL § 18(2)(e). The court concluded that the plaintiffs failed to state a claim, and as such, the district court did not err in granting the defendants' motions for judgment on the pleadings, in denying the plaintiffs' cross-motion for summary judgment as moot, and in denying the plaintiffs' leave to file a second amended complaint. View "McCracken v. Verisma Systems, Inc." on Justia Law

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The United States Court of Appeals for the Second Circuit upheld the life imprisonment sentence of Azibo Aquart, who was found guilty of multiple federal homicide and drug trafficking crimes. The court had previously affirmed his conviction but vacated his death sentence, remanding the case for a new penalty proceeding. On remand, the government decided not to pursue the death penalty, and Aquart was resentenced to life imprisonment. Aquart appealed, arguing that the district court erred in refusing to address new challenges to his conviction and in sentencing him for both drug-related murder and drug conspiracy, which he argued constituted double jeopardy. The Appeals Court rejected both arguments, ruling that the district court correctly applied the mandate rule and that Aquart's double jeopardy argument was without merit. View "United States v. Aquart" on Justia Law

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Plaintiffs appealed the district court’s judgment dismissing claims against Defendants, challenging Public Act 21-6, which revised the Connecticut General Statutes to repeal religious exemptions from state immunization requirements for schoolchildren, college and university students, and childcare participants. Plaintiffs are two organizations and three individuals who allege that the Act violates the Free Exercise Clause of the First Amendment of the U.S. Constitution and other federal constitutional and statutory guarantees. The district court granted the motions of Defendants to dismiss certain of Plaintiffs’ claims against the state agencies as barred by the Eleventh Amendment, to dismiss the organizational Plaintiffs' claims for lack of standing, and to dismiss all counts of the complaint for failure to state a claim.   The Second Circuit affirmed in part and vacated and remanded in part. The court explained the district court's distinction between "special services" and "special education" was overly strict. The IDEA and its associated regulations do not use the phrase "special services." A reasonable inference from the allegation that Plaintiff’s son suffers from "a speech and learning disorder for which he now receives special services," combined with the allegation that he "is disabled within the meaning of the IDEA," is that the "special services" the complaint mentions constitute "special education" rather than "related services." Therefore, the court concluded that because the district court parsed the complaint too restrictively, failing to draw reasonable inferences in Plaintiff’s favor, the court erred when it found Plaintiff had not stated a plausible claim for relief under the IDEA. The court, therefore, vacated this portion of the judgment. View "We The Patriots USA, Inc. et al. v. Conn. Office of Early Childhood Dev." on Justia Law

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Third-Party Plaintiff Dynasty Healthcare, LLC, a medical billing firm, claimed that a Medicare Administrative Contractor (“MAC”) negligently processed and misclassified the enrollment and payment application of one of Dynasty’s clients, a medical services supplier, and that. As a result, the client was underpaid for providing Medicare services. When the client sued Dynasty for the error, Dynasty sued the MAC, blaming it for the error. The district court dismissed Dynasty’s claims for lack of subject matter jurisdiction because Dynasty failed to pursue administrative channels through the United  States Department of Health and Human Services before seeking judicial review. At issue on appeal is whether Dynasty’s claims “arise under” the Medicare Act, such that the administrative channeling requirement set forth in 42 U.S.C. 14 Section 405(h) applies; and second, if so, whether the district court nonetheless had jurisdiction based on a narrow exception to the  Medicare Act’s jurisdiction stripping provision recognized in Shalala v. Illinois Council on Long Term Care, Inc.   The Second Circuit affirmed. The court concluded that the claims arise under the Medicare Act and that the Illinois Council exception does not apply to these claims. The court explained that Dynasty is not entitled to the exception because Retina’s financial interests in the claims alleged in this case were aligned with Dynasty’s interests at all relevant times, and Retina had both the incentive and the ability to seek administrative review. That Retina pursued a different course is irrelevant to the court's analysis under Illinois Council’s “objective inquiry.” View "Dynasty Healthcare, LLC v. Nat'l Gov't Services, Inc." on Justia Law

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Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law

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The Evergreen Association brought an action against New York officials, seeking to enjoin the enforcement of New York Labor Law Sec. 203-e, which prohibits employers from taking adverse employment actions against employees for their reproductive health decisions. Evergreen claimed that Sec. 203-e unconstitutionally burdens its right to freedom of expressive association, preventing it from employees who seek abortions. The district court granted the New York defendants' motion to dismiss, and Evergreen appealed.On appeal, the Second Circuit affirmed the district court's dismissal of Evergreen's claims that Sec. 203-e violates its right to freedom of speech, violates its right to the free exercise of religion, and is impermissibly vague. However, the court reversed Evergreen's claim that the statute violates its freedom of expressive association. More specifically, the panel held that the district court should have applied strict scrutiny. Because the state did not show that Sec. 203-e is the least restrictive means to achieve its governmental interest, the panel reversed on this issue alone. View "Slattery v. Hochul" on Justia Law

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Yale New Haven Hospital (“YNHH”) receives federal funds under the Medicare Act. As part of the statutory formula for determining appropriate funding, the Medicare Act directs the Secretary of Health and Human Services (the “Secretary”) to “estimate” the “amount of uncompensated care” that each hospital will provide to indigent patients in a given federal fiscal year (“FFY”). Here, YNHH contended that the Secretary failed to conduct adequate notice-and-comment rulemaking before choosing to use only YNHH’s historical data – and not that of a hospital that had recently merged into YNHH – to estimate YNHH’s amount of uncompensated care for FFY 2014. The Secretary moved to dismiss for lack of subject-matter jurisdiction under 42 U.S.C Section 1395ww(r)(3), which prohibits “judicial review” of “[a]ny estimate of the Secretary.” The district court denied the Secretary’s motion, reasoning that section 1395ww(r)(3) applies only to substantive challenges to estimates, but not to procedural challenges like YNHH’s. The district court subsequently granted summary judgment in favor of YNHH.   The Secretary appealed, disputing (1) the district court’s ruling that it had jurisdiction to consider YNHH’s procedural challenge, and alternatively (2) the district court’s merits ruling that the Secretary’s estimate was procedurally unlawful.   The Second Circuit reversed the district court’s denial of the Secretary’s motion to dismiss YNHH’s procedural challenge for lack of subject-matter jurisdiction; vacated, for lack of subject-matter jurisdiction, the district court’s grant of summary judgment for YNHH on its procedural challenge; REMAND the case to the district court with instructions to dismiss the remainder of YNHH’s action for lack of subject-matter jurisdiction; and dismissed YNHH’s cross-appeal disputing the district court’s chosen remedy. View "Yale New Haven Hosp. v. Becerra" on Justia Law