Justia Health Law Opinion Summaries

A False Claims Act, 31 U.S.C. 3729(a)(1)(A), “qui tam” lawsuit against SuperValu claimed that SuperValu knowingly filed false reports of its pharmacies’ “usual and customary” (U&C) drug prices when it sought reimbursements under Medicare and Medicaid. SuperValu listed its retail cash prices as its U&C drug prices rather than the lower, price-matched amounts that it charged qualifying customers under its discount program. Medicaid regulations define “usual and customary price” as the price charged to the general public. The district court held that SuperValu’s discounted prices fell within the definition of U&C price and that SuperValu should have reported them but held that SuperValu did not act with scienter.The Seventh Circuit affirmed, joining other circuits in holding that the Supreme Court’s 2007 “Safeco” interpretation of the Fair Credit Reporting Act’s scienter provision applies with equal force to the False Claims Act’s scienter provision. There is no statutory indication that Congress meant its usage of “knowingly,” or the scienter definitions it encompasses, to bear a different meaning than its common-law definition. SuperValu did not act with the requisite knowledge. SuperValu’s interpretation of “usual and customary price” was objectively reasonable under Safeco. View "Yarberry v. Supervalu Inc." on Justia Law

Kent Turner suffered from multiple sclerosis (MS), which caused loss of his motor skills. When his wife, Kathy Turner, could not, due to her own health issues, provide necessary in-home assistance, Kent moved into a nursing home and then into an apartment, where he died in a fire. Kent’s estate, through Kathy Turner, sued the Washington State Department of Social and Health Services (DSHS) and Lewis-Mason-Thurston Area Agency on Aging (LMTAAA) (the area agency on aging) with case management responsibilities for Kent’s care, for negligence and for abuse or neglect. DSHS and LMTAAA moved for summary judgment, which the trial court granted. The trial court ruled that no special relationship was formed and only an ordinary duty of care was owed. The trial court further held that no breach occurred and causation was lacking. After review, the Washington Supreme Court affirmed the trial court’s summary judgment dismissal of the claims against DSHS and LMTAAA. View "Turner v. Dep't of Soc. & Health Servs." on Justia Law

Healthcare revenue cycle management contractors manage billing and behind-the-scenes aspects of patient care, from pre-registering patients to reviewing and approving documentation upon release. Reid Hospital contracted with Dell, a revenue cycle management contractor. Their contract limited both sides’ damages in a breach of contract action in the absence of willful misconduct or gross negligence. Dell sold much of its portfolio to Conifer in 2012 while Dell was still losing money on the Reid contract. Conifer began reducing staff and neglecting duties; there was a slowdown throughout the revenue-management cycle and in processing patients’ discharge forms, leading to longer hospital stays that third-party payors refused to reimburse fully. After two years, Reid took its revenue operation back in-house. Reid's consultant found significant errors in Conifer’s work. Reid sued for breach of contract, claiming that Conifer’s actions caused the hospital to lose tens of millions of dollars. The court granted Conifer summary judgment, reading the contract as defining all claims for lost revenue as claims for “consequential damages,” prohibited absent “willful misconduct.”The Seventh Circuit reversed. Even if lost revenue is often considered consequential, this was a contract for revenue collection services and did not define all lost revenue as an indirect result of any breach. Lost revenue would have been the direct and expected result of Conifer’s failure to collect and process that revenue as required under the contract. The parties did not intend to insulate Conifer entirely from damages. View "Reid Hospital and Health Care, Inc. v. Conifer Revenue Cycle Solutions, LLC" on Justia Law

The Sixth Circuit previously affirmed the Federal Trade Commission’s decision to block a merger of ProMedica and St. Luke’s Hospital in Lucas County, Ohio. As part of the unwinding of the merger, ProMedica and St. Luke’s signed an agreement in which ProMedica’s insurance subsidiary, Paramount, agreed to maintain St. Luke’s as a within-network provider; Paramount could drop St. Luke’s if ownership of the hospital changed. A large healthcare company based in Michigan, McLaren, subsequently merged with St. Luke’s. Paramount ended its relationship with St. Luke’s, removing the hospital from its provider network. St. Luke’s then alleged that ProMedica’s refusal to do business with it violated the antitrust laws. The district court preliminarily enjoined ProMedica from ending the agreement. The Sixth Circuit vacated. Because ProMedica had a legitimate business explanation for ending the relationship, St. Luke’s is unlikely to show that ProMedica unlawfully refused to continue doing business with it. St. Luke’s has little likelihood of establishing an irreparable injury given the option of money damages. View "St. Luke's Hospital v. ProMedica Health System, Inc." on Justia Law

Bettye McNutt filed a complaint against Dr. Vivian Sze Ting Lo, Methodist-Olive Branch Hospital (Methodist), and others asserting the wrongful death of her son due to medical malpractice. Because Dr. Lo had not been served with a presuit notice of claim, the circuit court dismissed the claims against Dr. Lo and, because the statute of limitations had expired, the dismissal was with prejudice. After Dr. Lo’s dismissal, Methodist filed a motion for partial summary judgment, arguing that McNutt’s vicarious liability claims based on Dr. Lo’s conduct were extinguished when Dr. Lo was dismissed with prejudice. The circuit court denied the motion for partial summary judgment, and Methodist appealed. The Mississippi Supreme Court found the circuit court properly denied partial summary judgment. Although Dr. Lo was dismissed with prejudice, the dismissal was not an adjudication on the merits, and McNutt did not enter into a settlement release and indemnity agreement with Dr. Lo. View "Methodist Healthcare-Olive Branch Hospital v. McNutt" on Justia Law

The Supreme Judicial Court remanded this case for a new hearing held pursuant to Mass. Gen. Laws ch. 123, 7 and 8, holding that the trial judge erred in allowing an expert witness to testify on direct examination about the basis of his opinion when the facts were neither within the expert's personal knowledge nor otherwise admitted into evidence during the proceeding.The Department of Mental Health filed a petition pursuant to Mass. Gen. Laws ch. 123, 7 and 8 to recommit P.R. to a mental health facility. The judge held a full hearing on the merits of the petition. During the hearing, P.R.'s psychiatrist testified for the Department. The judge ultimately found that P.R.'s commitment should continue, and the appellate division affirmed. The Supreme Judicial Court remanded the case, holding (1) the trial court erred by allowing the psychiatrist to testify about unadmitted medical reports on direct examination, and the error was prejudicial, requiring a new hearing; and (2) the judge did not err by not making a statement of written or oral findings before ordering commitment under sections 7 and 8. View "In re P.R." on Justia Law

Tennessee Code 39-15-202(a)–(h) requires that women be informed, orally and in-person by the attending physician or by the referring physician that she is pregnant; of the fetus’s probable gestational age; whether the fetus may be viable; of services “available to assist her”; and of “reasonably foreseeable medical benefits, risks, or both of undergoing an abortion or continuing the pregnancy.” There is a 48-hour waiting period, beginning when the woman receives the mandated information, which can be reduced to 24 hours by court order.The district court declared the waiting period unconstitutional and permanently enjoined its enforcement. The Sixth Circuit denied a stay pending appeal but subsequently, “en banc,” reversed. The facial attack fails as a matter of law. Given Tennessee’s strong “interest in protecting the life of the unborn,” there was a rational basis to enact a waiting period, which is not a substantial obstacle to abortion in a large fraction of cases. The plaintiffs claimed that the law—even if facially valid— is unconstitutional as applied to women who will miss the cutoff date for an abortion because of the waiting period; women whose medical conditions increase the risk of delaying the procedure; and women who are survivors of rape, incest, or violence. But, although the law has been in effect for five years, the plaintiffs failed to identify any “discrete and well-defined instances” where women in these groups faced (or were likely to face) a particular burden because of Tennessee’s waiting period. View "Bristol Regional Women's Center, P.C. v. Slatery" on Justia Law

The Supreme Judicial Court reversed the order of the superior court denying Defendant's motion to dismiss the counts of breach of fiduciary duty and conversion, holding that a conservator acting pursuant to judicial approval is a quasi judicial officer and is entitled to absolute immunity for conduct that is authorized or approved by the probate court.Plaintiff, acting as guardian and next of friend for his mother, filed a complaint against defendant, the mother's permanent conservator, alleging breach of fiduciary duty, malpractice, conversion, and fraud. Defendant filed a motion to dismiss the complaint. The judge allowed the motion as to the malpractice and fraud counts but denied the motion as to the remaining counts. The Supreme Court reversed and remanded for entry of an order allowing the motion to dismiss in its entirety, holding that Plaintiff did not allege that Defendant acted outside the authorized scope of her duties as conservator, and therefore, the superior court judge erred in denying Defendant's motion to dismiss the remaining counts of breach of fiduciary duty and conversion. View "Hornibrook v. Richard" on Justia Law

Starting next semester, Indiana University students must be vaccinated against COVID-19 unless they are exempt for medical or religious reasons. Exempted students must wear masks and be tested for the disease twice a week. The district court rejected a due process challenge to those rules.The Seventh Circuit denied an injunction pending appeal. The court noted that vaccinations and other public health requirements are common, that the University has allowed for exemptions, and that the students could choose to attend a school that has no vaccination requirement. View "Klaassen v. Trustees of Indiana University" on Justia Law

The Supreme Judicial Court affirmed the decision of the superior court denying this action in the nature of mandamus as well as certiorari review of the decision of the city of Salem to reject Mederi, Inc.'s application to enter into a host community (HCA) agreement, holding that there was no error.When Mederi applied for an HCA with the city to open a retail marijuana establishment in Salem it was one of eight applications vying for four available spots. The city of Salem denied Merderi's application. Merderi then filed a complaint seeking relief in the nature of mandamus as well as certiorari review of the city's decision, claiming that by rejecting it as an HCA partner, the city effectively precluded Mederi from being considered for a license to sell marijuana. A superior court judge dismissed the mandamus claim and granted judgment on the pleadings on the remaining certiorari claim. The Supreme Judicial Court affirmed, holding (1) the city made a rational choice to reject Mederi's application in favor of other prospective retail marijuana establishments; and (2) the city's application process was not contrary to law. View "Mederi, Inc. v. Salem" on Justia Law