Justia Health Law Opinion Summaries

Articles Posted in US Court of Appeals for the Second Circuit
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Plaintiffs, a group of nursing homes that participate in both the Medicare and Medicaid programs, challenge the legality of DHS's Final Rule permitting survey teams conducting certain inspections of nursing homes not to include a registered nurse. The district court dismissed plaintiffs' claims, brought under the Medicare and Medicaid Acts, for lack of subject-matter jurisdiction based on claim-channeling and jurisdiction-stripping provisions governing claims arising under the Medicare Act.The Second Circuit reversed, concluding that the district court has jurisdiction under 28 U.S.C. 1331 over plaintiffs' claim arising under the Medicaid Act, which does not incorporate the same claim-channeling and jurisdiction-stripping provisions as the Medicare Act. The court explained that the Medicare Act's review provisions do not preclude plaintiffs from challenging the Final Rule in federal court because their challenge is independently rooted in the Medicaid Act. Furthermore, plaintiffs' Medicaid Act claim is not inextricably intertwined with a Medicare Act claim for benefits or compliance determination, and the government's policy rationale does not support claim channeling and jurisdiction stripping in this case. Accordingly, the court remanded for further proceedings. View "Avon Nursing & Rehabilitation v. Becerra" on Justia Law

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Defendants appealed the district court's judgment certifying a plaintiff class and enjoining state defendants from conducting Medicaid fair hearings in a manner that does not result in final determinations of Medicaid eligibility within 90 days of hearing requests. At issue is the phrase "final administrative action" in the context of a federal Medicaid regulation that requires a state agency to take such action within a specified time limit following a Medicaid applicant's request for a fair hearing. 42 C.F.R. 431.244(f).The Second Circuit held that the federal regulatory requirement of "final administrative action" within 90 days requires the state to determine Medicaid eligibility within that time. However, the court explained that such determinations may be made in hearing decisions or on remand to local agencies. Therefore, the regulation mandates that states meet the applicable deadline, but it does not limit states as to the administrative level at which that deadline is met. The court affirmed in part and remanded for further proceedings. View "Lisnitzer v. Zucker" on Justia Law

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The Second Circuit originally resolved the motions that are the subject of this opinion in an order entered November 9, 2020. Except in unusual circumstances, the court resolves such motions by order, not opinion. The court converted the original order and the dissent into opinions per the dissent's request.These appeals challenge Governor Andrew Cuomo's issuance of an executive order directing the New York State Department of Health to identify yellow, orange, and red "zones" based on the severity of COVID-19 outbreaks and imposing correspondingly severe restrictions on activity within each zone. Appellants, Agudath Israel and the Diocese, each challenged the executive order as a violation of the Free Exercise Clause of the First Amendment. After the district court denied appellants' motion for a preliminary injunction against enforcement of the order, appellants moved for emergency injunctions pending appeal and to expedite their appeals.Preliminarily, the Second Circuit concluded that Agudath Israel did not move first in the district court for an order granting an injunction while an appeal is pending before filing with this court its present motion for an injunction pending appeal. Rather, Agudath Israel moved for a preliminary injunction pending the district court’s final judgment. Furthermore, Agudath Israel has not explained or otherwise justified its failure to comply with the straightforward requirement of Federal Rule of Appellate Procedure 8(a). Agudath Israel has also failed to demonstrate that moving first in the district court would be impracticable, or even futile, particularly in light of the fact that a full eleven days elapsed after the district court's ruling before Agudath Israel sought relief from this court. Therefore, the court denied Agudath Israel's motion for procedural reasons.The court also denied the Diocese's motion, concluding that appellants cannot clear the high bar necessary to obtain an injunction pending appeal. The court stated that, while it is true that the challenged order burdens appellants' religious practices, the order is not substantially underinclusive given its greater or equal impact on schools, restaurants, and comparable secular public gatherings. To the contrary, the executive order extends well beyond isolated groups of religious adherents to encompass both secular and religious conduct. View "Agudath Israel of America v. Cuomo" on Justia Law

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Plaintiff, a Medicare beneficiary who uses a Continuous Glucose Monitoring device (CGM) to manage his Type I diabetes, sought Medicare coverage to offset the costs associated with his CGM. After the Medicare Appeals Council rejected plaintiff's requests for coverage, he challenged the adverse decisions in federal court. The district court concluded that two of the three challenged decisions failed to meet the $1,500 amount-in-controversy threshold for federal court jurisdiction and that the Medicare Act did not permit plaintiff to cure the jurisdictional deficiency by aggregating the three separate amounts.The Second Circuit held, based on the text of the statute and reinforced by its regulatory and legislative history, that the Medicare Act does not prohibit plaintiff from aggregating his claims for the first time in district court. Therefore, the district court erred in refusing to let plaintiff aggregate his claims to satisfy the Act's amount-in-controversy requirement. The court vacated the district court's judgment and remanded for further proceedings. View "Bloom v. Azar" on Justia Law

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The Second Circuit affirmed the district court's dismissal, based on Federal Rule of Civil Procedure 12(b)(6), of plaintiff's amended complaint alleging that defendants violated Connecticut and District of Columbia law in entering into a licensing agreement with respect to a group plan for Medicare supplement insurance. Plaintiff claimed that defendants' royalty fee arrangement constituted an unlawful "premium rebate" in violation of Connecticut and District of Columbia anti-rebating insurance laws.The court held that plaintiff did not state an unlawful rebate claim under Connecticut or D.C. law because he failed to plausibly allege any ascertainable loss or injury as a result of his purchase of Medicare supplement insurance ("Medigap") or the AARP royalty fee. Likewise, the court held that plaintiff failed to plausibly allege a cognizable claim based on his purchase of Medigap insurance through the AARP-UnitedHealthcare plan. In regard to plaintiff's consumer protection claims, he failed to show any concrete and particularized injury because he paid only the regulator-approved rate and received the Medigap insurance he contracted for. Finally, plaintiff failed to plausibly allege the requisite elements for his remaining common law claims and his statutory theft claim under Connecticut law. View "Dane v. UnitedHealthcare Insurance Co." on Justia Law

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Plaintiffs filed suit challenging the quarantine decisions of certain Connecticut state officials in response to an Ebola epidemic in West Africa. On appeal, plaintiffs challenged the district court's denial of their motion for class certification and dismissing their suit for lack of standing and based on qualified immunity. Plaintiffs primarily argue that they suffered actual or imminent injuries that create standing to seek prospective relief to avert allegedly unconstitutional future quarantines; clearly established law required that any quarantine imposed be medically necessary and comport with certain procedural safeguards; and their class is sufficiently numerous to merit certification.The Second Circuit affirmed and held that the district court properly deemed plaintiffs' injuries too speculative to support standing. In this case, plaintiffs failed to plead a sufficient likelihood that, under the revised policy, any of them faces a substantial risk of suffering a future injury. The court also held that the law surrounding quarantines was not clearly established such that a state official may be held liable for the actions taken here. The court did not reach the class certification issue because it is mooted by the court's conclusion as to standing. Accordingly, the court remanded with instructions to amend the judgment to clarify that the state law claims were dismissed without prejudice. View "Liberian Community Ass'n v. Lamont" on Justia Law

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Healthcare insurers filed suit challenging an emergency regulation promulgated in 2017 by New York's Superintendent of the Department of Financial Services that would have significantly reduced the amount of risk adjustment funding to which plaintiffs were entitled in 2017 under the Patient Protection and Affordable Care Act (ACA) and subsequent years using HHS's federal methodology.The Second Circuit held that New York's emergency regulation was preempted by the ACA and HHS's regulations. The court held that New York's regulation interferes with, indeed reverses, some of the central "criteria and methods" that HHS, acting within its statutory authority, established for implementing a risk adjustment program and methodology. Accordingly, the court reversed the portion of the district court's judgment that dismissed plaintiffs' preemption claim and remanded with instructions to grant summary judgment in plaintiffs' favor on that claim. The court also vacated the district court's dismissal of plaintiffs' takings and exaction claims, remanding for further proceedings. View "UnitedHealthcare of New York, Inc. v. Lacewell" on Justia Law

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Plaintiff filed two actions arising from defendants' provision of mental health services to him, alleging violations of his First and Ninth Amendment rights and the Health Insurance Portability and Accountability Act (HIPAA). The district court dismissed the suits.The Second Circuit dismissed plaintiff's appeals because they lack an arguable basis either in law or in fact and denied his motions to proceed in forma pauperis for the appointment of counsel and for a writ of certiorari. In this case, plaintiff failed to plausibly allege that defendants engaged in state action by violating his constitutional rights under 42 U.S.C. 1983. Furthermore, there is no private cause of action, express or implied, under HIPAA. View "Meadows v. United Services, Inc." on Justia Law

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The Second Circuit certified the following question to the New York Court of Appeals: Does Section 18(2)(e) of the New York Public Health Law provide a private right of action for damages when a medical provider violates the provision limiting the reasonable charge for paper copies of medical records to $0.75 per page? View "Ortiz v. Ciox Health LLC" on Justia Law

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The State and City of New York filed suit charging UPS with violating the Contraband Cigarette Trafficking Act (CCTA), the Prevent All Cigarette Trafficking Act (PACT Act), and New York Public Health Law 1399-ll (PHL 1399-ll), as well as breaching its settlement agreement, the Assurance of Discontinuance (AOD), with the New York State Attorney General.The court held that UPS did not honor the AOD and was therefore subject to liability under the PACT Act and PHL 139-ll; UPS was liable for violations of the AOD's audit requirement; and UPS violated the CCTA by knowingly transporting more than 10,000 unstamped cigarettes. In regard to damages and penalties awards, the court held that the district court did not abuse its discretion in allowing plaintiffs to present their damages case nor did it clearly err in making factual findings based on record evidence; the district court erred in awarding plaintiffs only half of the unpaid taxes on cigarettes UPS unlawfully shipped; and the district court abused its discretion in awarding per-violation penalties under both the PACT Act and PHL 1399-ll.Therefore, the court affirmed the judgment of liability and attendant penalties under PHL 1399-ll; affirmed the judgment of liability, but vacated the imposition of the penalties under the PACT Act; affirmed the judgment of liability, but modified the award of damages under the CCTA; affirmed the judgment of liability, but modified the award of penalties under the AOD; and affirmed the judgment as modified. View "New York v. United Parcel Service, Inc." on Justia Law