Justia Health Law Opinion Summaries

Articles Posted in US Court of Appeals for the Second Circuit
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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

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Plaintiff appealed the district court's grant of Healthport's motion for summary judgment in an action involving claims of excessive charges for medical records under the New York Public Health Law.The Second Circuit vacated the district court's judgment, because the court anticipates certifying certain questions to the New York Court of Appeals after a final judgment is entered, and wishes to avoid multiple, unnecessary proceedings. Therefore, the court remanded to the district court with instructions to reinstate Beth Israel as a party and to adjudicate the case to a final judgment. The court also remanded along the lines of the procedures set out in United States v. Jacobson, 15 F.3d 19, 22 (2d Cir. 1994), so that any new appeal will be referred to this panel. View "Ruzhinskaya v. HealthPort Technologies, LLC" on Justia Law

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The Second Circuit certified the following question to the New York Court of Appeals: Does New York Public Health Law Section 230(11)(b) create a private right of action for bad faith and malicious reporting to the Office of Professional Medical Conduct? View "Haar v. Nationwide Mutual Fire Insurance Co." on Justia Law

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The Second Circuit affirmed the district court's grant of a permanent injunction enjoining the government from continuing to apply the requirement that government funds assisting plaintiffs' efforts to fight HIV/AIDS abroad could not be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.In Agency for Int'l Dev. v. Alliance for Open Soc. Int'l, Inc., 570 U.S. 205 (2013), the Supreme Court concluded that the requirement compelled speech in violation of the First Amendment. Applying the Supreme Court's reasoning in AOSI to this case, the court held that the speech of a recipient who rejects the government's message was unconstitutionally restricted when it has an affiliate who is forced to speak the government's contrasting message. The court rejected the remaining claims and held that the district court did not abuse its discretion. View "Alliance for Open Society International v. United States Agency for International Development" on Justia Law