Justia Health Law Opinion Summaries

The Court of Appeals affirmed a superior court decision to certify a class action lawsuit against The Medical Center, Inc. ("TMC"). Class representatives were uninsured patients who received medical treatment from TMC and who claimed that TMC charged them unreasonable rates for their medical care, which rates TMC then used as a basis for filing hospital liens against any potential tort recovery by the patients. The Court of Appeals also ruled on the causes of action raised by the plaintiffs. The Georgia Supreme Court granted certiorari to answer three questions: (1) whether the Court of Appeals erred in its determination that class certification was proper; (2) whether the Court of Appeals erred in affirming the denial of summary judgment for TMC on common law claims of fraud and negligent misrepresentation; and (3) whether the Court of Appeals erred in reversing the denial of summary judgment to TMC on claims brought under the Georgia RICO Act. The Supreme Court concluded the Court of Appeals erred with regard to the first two questions, but not the third. Therefore, judgment was reversed in part, affirmed in part and remanded for further proceedings. View "Bowden v. The Medical Center" on Justia Law

Plaintiff sought declaratory and injunctive relief to prevent the Florida Agency for Health Care Administration (FAHCA) from recovering beyond that portion of her settlement specifically designated by the settling parties as compensation for her past medical expenses.The Eleventh Circuit reversed the district court's grant of summary judgment in favor of plaintiff. As a preliminary matter, the court held that the parties' unilateral allocation does not bind FAHCA. On the merits, the court held that federal medicaid law does not preempt FAHCA's practice of seeking reimbursement from portions of a settlement that represent all medical expenses. The court also held that federal law does not preempt Florida's method of allocating the share of a personal injury settlement from which it is entitled to seek reimbursement: its formula of half the settlement after 25 percent attorney's fees, combined with the procedure in which a recipient may challenge that allocation in an administrative hearing by clear and convincing evidence. View "Gallardo v. Mayhew" on Justia Law

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

In section 901 of the Family Smoking Prevention and Tobacco Control Act (TCA), Congress authorized the Secretary of Health and Human Services to determine which other products should be governed by the TCA's regulatory scheme. Plaintiffs filed suit against the FDA, its Commissioner, and the Secretary, asserting that Congress's delegation to the Secretary was unconstitutional.The Fifth Circuit affirmed the district court's dismissal of the complaint, holding that section 901's delegation to the Secretary does not violate the nondelegation doctrine. The court held that Congress undeniably delineated its general policy in the TCA; Congress plainly limited the authority that it delegated; and the relevant caselaw supports these conclusions. View "Big Time Vapes, Inc. v. FDA" on Justia Law

General’s clinicians perform services in long-term care facilities. General bills Medicare under 42 U.S.C. 1395. A Centers for Medicare and Medicaid Services (CMS) contractor, AdvanceMed, initiated audits in 2002 after the CMS fraud unit received complaints about General’s billing practices. In 2004 AdvanceMed initiated an audit of General’s physicians without providing any notice to General. AdvanceMed sent records requests to physicians at 12 General facilities, covering 382 claims involving 278 patients in 2002-2004. General was not notified of these requests. AdvanceMed did not request any records from General. AdvanceMed determined that 35 of the 382 claims were allowed as billed; 33 claims were allowed at different levels than billed. The remaining 314 claims were denied: 3 did not meet policy guidelines, 73 had no documentation to support the services, and 238 were medically unnecessary.General learned of this audit when it received a letter in 2007, indicating that General had been overpaid by $16,778.80; the overpayment was extrapolated to a universe of 41,818 claims. The total amount of overpayment demanded was $1,836,646.56. The Appeals Council determined and the Sixth Circuit affirmed that no remedy should be granted because the lack of notice was inconsequential and did not prevent General from ably and thoroughly arguing the principal issues resulting from the audit, the validity of the sampling methodology, and the coverage of the reviewed claims. The addition of more medical records would not have materially impacted its findings. View "General Medicine, P.C. v. Azar" on Justia Law

Objector, a conservatee subject to conservatorship under the Lanterman-Petris-Short Act, contested the petition to reappoint a public guardian as his conservator. On appeal, objector contends the trial court violated Welfare and Institutions Code section 5350, subdivision (d)(2), and denied him due process by failing to commence the jury trial within 10 days of his demand for trial.The Court of Appeal was deeply troubled by the significant delay of over four months in holding a trial on objector's petition, especially given the lack of any justification by the court for most of the delay. The court emphasized the statutory obligation of trial courts to hold a jury trial within 10 days, with only a limited exception for a 15-day continuance if requested by the proposed conservatee. However, the court held that the trial court's failure to commence trial within 10 days of the jury trial demand did not support dismissal of the petition. Rather, the time limit in section 5350, subdivision (d)(2), is directory, not mandatory, because the Legislature has not expressly provided for dismissal of the conservatorship petition if a trial is not held within 10 days. Furthermore, objector was not prejudiced and denied due process. Accordingly, the court affirmed the judgment. View "Conservatorship of Jose B." on Justia Law

Plaintiffs, a Louisiana church and its pastor, filed suit seeking to enjoin stay-at-home orders restricting in-person church services to ten congregants.The Fifth Circuit held that the appeal of the denial of injunctive relief and related request for an injunction under Federal Rule of Appellate Procedure 8(a)(1) are moot because the challenged orders expired more than a month ago. In this case, plaintiffs failed to cite any authority applying the "capable of repetition" exception to support an injunction against an order that is no longer in effect. View "Spell v. Edwards" on Justia Law

At issue before the Pennsylvania Supreme Court was a challenge to a local judicial district’s policy prohibiting the use of medical marijuana by individuals under court supervision, such as probationers. Relevant here, the applicable statutory authority, the Pennsylvania Medical Marijuana Act, contained an immunity provision protecting patients from government sanctions. In September 2019, the 52nd Judicial District -- comprised of the Lebanon County Court of Common Pleas (the “District”) -- announced a “Medical Marijuana Policy” under the issuing authority of the president judge. The Policy prohibited “the active use of medical marijuana, regardless of whether the defendant has a medical marijuana card, while the defendant is under supervision by the Lebanon County Probation Services Department.” Petitioners were individuals under the supervision of the Lebanon County probation agency who filed suit in the Commonwealth Court's original jurisdiction to challenge the validity of the Policy in light of the MMA's immunity provision. Separately, Petitioners filed an application for special relief in the nature of a preliminary injunction. Soon thereafter, the Commonwealth Court proceeded, sua sponte, to transfer the case to this Court, concluding that it lacked jurisdiction to grant the requested relief. The District then filed its response in this Court opposing preliminary injunctive relief. It claimed, among other things, that Petitioners were unlikely to prevail on the merits, arguing, inter alia, that the General Assembly didn’t intend the MMA to override the courts’ ability to supervise probationers and parolees. After review, the Pennsylvania Supreme Court granted Petitioners' request for declaratory and injunctive relief. The Policy was deemed to be contrary to the immunity accorded by the MMA, and as such, should not be enforced. "[N]othing impedes a revocation hearing or other lawful form of redress, where there is reasonable cause to believe that a probationer or other person under court supervision has possessed or used marijuana in a manner that has not been made lawful by the enactment." View "Gass et al. v. 52nd Judicial District" on Justia Law

Drug manufacturers challenged the Department's rule that broadly requires drug manufacturers to disclose in their television advertisements the wholesale acquisition cost of many prescription drugs and biological products for which payment is available under Medicare or Medicaid.The DC Circuit affirmed the district court's judgment in favor of the drug manufacturers, holding that the Department acted unreasonably in construing its regulatory authority to include the imposition of a sweeping disclosure requirement that is largely untethered to the actual administration of the Medicare or Medicaid programs. The court explained that, in the overwhelming majority of cases, the price that the rule compels manufacturers to disclose bears little resemblance to the price beneficiaries actually pay under the Medicare and Medicaid programs. Therefore, the court held that there is no reasoned statutory basis for the Department's far-flung reach and misaligned obligations, and thus the rule is invalid and is hereby set aside. View "Merck & Co., Inc. v. United States Department of Human and Health Services" on Justia Law

The Oregon Governor issued executive orders in response to the coronavirus pandemic in early 2020. Because the virus spread through close personal contact and through the air, some of the orders have restricted the size of gatherings and required that people maintain specified distances between themselves and others. Relatedly, other orders have closed schools and businesses. The restrictions have had substantial consequences for individuals and entire economies. "It is unknown how long those consequences will last, just as it is unknown how long it will be before there is a cure or vaccine for COVID-19." Plaintiffs Elkhorn Baptist Church and several other churches and individual churchgoers, challenged the executive orders that the Governor issued, asking the circuit court to enjoin the enforcement of the Governor’s orders while their civil action was pending. They based their request on their claim that the orders have expired by operation of law. Among other things, they argued that the orders violated a statutory time limit. The circuit court issued the requested preliminary injunction. It did so based on its conclusion that, as plain- tiffs argued, the duration of the orders had exceeded a statutory time limit. The Governor sought mandamus relief from the Oregon Supreme Court to vacate the preliminary injunction. The Supreme Court concluded the circuit court erred in concluding that the Governor’s executive orders violated a statutory time limit as plaintiffs had argued. "The circuit court’s statutory analysis cannot be reconciled with the statutory text and context, and is directly at odds with how the legislature intended the statute to apply." Because the circuit court’s conclusion about the statutory time limit was fundamental to its issuance of the preliminary injunction, the Supreme Court deemed it necessary to vacate the preliminary injunction. View "Elkhorn Baptist Church v. Brown" on Justia Law