Justia Health Law Opinion Summaries

Elizabeth Holt, a former insurance agent for Medicare Medicaid Advisors, Inc. (MMA), alleged that MMA and several insurance carriers (Aetna, Humana, and UnitedHealthcare) violated the False Claims Act (FCA). Holt claimed that MMA engaged in fraudulent practices, including falsifying agent certifications and violating Medicare marketing regulations, which led to the submission of false claims to the Centers for Medicare and Medicaid Services (CMS).The United States District Court for the Western District of Missouri dismissed Holt's complaint. The court found that no claims were submitted to the government, the alleged regulatory violations were not material to CMS’s contract with the carriers, and the complaint did not meet the particularity standard required by Federal Rule of Civil Procedure 9(b). The court also denied Holt's motion for reconsideration, which introduced a fraudulent inducement theory and requested leave to amend the complaint.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Holt's allegations did not meet the materiality requirement under the FCA. The court applied the materiality standard from Universal Health Services, Inc. v. United States ex rel. Escobar, considering factors such as whether the government designated compliance as a condition of payment, whether the violations were minor or substantial, and whether the government continued to pay claims despite knowing of the violations. The court found that the alleged violations did not go to the essence of CMS’s contract with the carriers and were not material to the government's payment decisions.The Eighth Circuit also upheld the district court's denial of Holt's motion for reconsideration and request to amend the complaint, concluding that adding a fraudulent inducement claim would be futile given the immateriality of the alleged violations. View "United States ex rel. Holt v. Medicare Medicaid Advisors" on Justia Law

A licensed professional counselor in Colorado challenged the state's Minor Conversion Therapy Law (MCTL), which prohibits mental health professionals from providing conversion therapy to minors. Conversion therapy is defined as any practice attempting to change an individual's sexual orientation or gender identity. The plaintiff argued that the MCTL violates the Free Speech and Free Exercise Clauses of the First Amendment and sought a preliminary injunction to prevent its enforcement.The United States District Court for the District of Colorado denied the plaintiff's motion for a preliminary injunction, finding that the plaintiff had standing but failed to demonstrate a likelihood of success on the merits of her First Amendment claims. The court concluded that the MCTL regulates professional conduct that incidentally involves speech and is therefore subject to rational basis review, which it survives.The United States Court of Appeals for the Tenth Circuit affirmed the district court's decision. The Tenth Circuit held that the MCTL regulates professional conduct by prohibiting a specific therapeutic treatment (conversion therapy) provided by licensed mental health professionals to minors. The court found that the MCTL does not target speech based on its content but regulates the practice of conversion therapy, which incidentally involves speech. The court concluded that the MCTL is subject to rational basis review and serves legitimate state interests in protecting minors from harmful and ineffective therapeutic practices and maintaining the integrity of the mental health profession. The court found that the MCTL is rationally related to these interests, as the record showed that conversion therapy is harmful to minors and lacks clinical utility. View "Chiles v. Salazar" on Justia Law

O.L.K. was admitted to Montana State Hospital in January 2022 following a disturbance at a mental health treatment center. The petition for involuntary commitment was based on an evaluation by Michale McLean, LCSW, which included observations and reports from medical staff and law enforcement. O.L.K. had been brought to the hospital twice in one day for aggressive behavior, including threatening his therapist and threatening to burn down the treatment center. During his second hospital visit, he made several threatening statements, including threats to kill someone.The Fourth Judicial District Court, Missoula County, appointed Shannon McNabb, a Licensed Clinical Professional Counselor, to evaluate O.L.K. McNabb testified that O.L.K. exhibited disorganized and delusional behavior and diagnosed him with Bipolar I disorder. She relied on various records, including the St. Patrick’s Report, and testified about O.L.K.’s threats and delusional statements. The District Court overruled hearsay objections raised by O.L.K.’s attorney, admitting the St. Patrick’s Report under the medical records exception. The court found that O.L.K. presented an imminent risk to others and committed him to Montana State Hospital for up to 90 days.The Supreme Court of the State of Montana reviewed the case and affirmed the District Court’s decision. The Supreme Court held that while the District Court erred in admitting the St. Patrick’s Report as a hearsay exception, there was substantial admissible evidence from McNabb’s testimony to support the finding of an overt act. The court concluded that O.L.K.’s statements to McNabb, which included threats to kill someone, were sufficient to demonstrate an imminent threat of injury to others. The decision to commit O.L.K. was therefore upheld. View "In re O.L.K." on Justia Law

A self-described "lay midwife" was charged by the State of Nebraska with practicing a profession without a credential after being ordered to cease and desist. The midwife, who did not hold a state-issued credential, provided prenatal and postnatal care and assisted with childbirth. The charges were based on her alleged violation of the Uniform Credentialing Act (UCA).In Madison County, the district court sustained the midwife's plea in abatement, finding that "nurse midwives" were not required to hold credentials under the UCA. The court also suggested that the UCA would be unconstitutionally vague if it required a credential for practicing "nurse midwifery." Similarly, in Douglas County, the district court sustained a plea in abatement on the same grounds, dismissing the charges against the midwife.The Nebraska Supreme Court reviewed the case and found that the district courts had misconstrued the UCA. The court held that the UCA requires individuals to hold a credential to engage in practices such as attending childbirth and providing related care, which fall under the scope of medicine and surgery, advanced practice registered nursing, and certified nurse midwifery. The court also found that the evidence presented was sufficient to show probable cause that the midwife had committed the charged crime.The Nebraska Supreme Court reversed the district courts' orders sustaining the pleas in abatement and dismissing the charges. The case was remanded for further proceedings consistent with the opinion, including consideration of the midwife's motions to quash and demurrers. View "State v. Jones" on Justia Law

Chadrick Perry was indicted for being a felon in possession of a firearm and ammunition. After pleading not guilty, he was detained pending trial. Concerns about his competency led to evaluations by two forensic psychologists, who reached different conclusions. The district court committed Perry to the custody of the Attorney General for competency restoration. Perry experienced significant delays in being transported to a federal facility for treatment. Eventually, he was deemed competent, pleaded guilty to being a felon in possession of ammunition, and was sentenced to 57 months in prison.The United States District Court for the Western District of Michigan denied Perry's motion to dismiss the indictment based on alleged violations of the Speedy Trial Act. Perry argued that the 152-day delay between his designation for treatment and his arrival at the facility should count against the Act's 70-day clock. The district court ruled that the entire period from when Perry was deemed incompetent until his competency was restored was excludable under the Act.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that the entire period of delay resulting from Perry's mental incompetence was excludable under 18 U.S.C. § 3161(h)(4). This exclusion applied even during the transportation delay, thus not violating the Speedy Trial Act. Additionally, the court upheld Perry's sentence, determining that his prior conviction for aggravated domestic violence qualified as a "crime of violence" under U.S.S.G. § 4B1.2(a), justifying the increased Guidelines range. The court affirmed both the conviction and the sentence. View "United States v. Perry" on Justia Law

Artak Ovsepian participated in a healthcare fraud scheme at Manor Medical Imaging, Inc., a sham clinic in Glendale, California. The clinic generated prescriptions for unnecessary medications, which were billed to Medicare and Medi-Cal. Manor employees used the identifying information of Medicare and Medi-Cal beneficiaries, often without their knowledge, to fill these prescriptions. Ovsepian joined the conspiracy in 2010, managing drivers who transported beneficiaries to pharmacies to fill fraudulent prescriptions.The government charged Ovsepian with conspiracy to commit healthcare fraud and aggravated identity theft under 18 U.S.C. § 1028A(a)(1). At trial, the government narrowed the aggravated identity theft charge to the possession of one victim’s identifying information. The jury found Ovsepian guilty on all counts, and he was sentenced to 180 months, including a mandatory 24-month sentence for aggravated identity theft. Ovsepian’s direct appeals were unsuccessful, and the Supreme Court denied his petition for a writ of certiorari.Ovsepian filed a 28 U.S.C. § 2255 motion to vacate his aggravated identity theft conviction, arguing actual innocence. The district court denied the motion, and the Ninth Circuit initially denied a certificate of appealability. However, the Supreme Court remanded the case for reconsideration in light of Dubin v. United States, which clarified the interpretation of the aggravated identity theft statute.The Ninth Circuit reversed the district court’s denial of Ovsepian’s § 2255 motion. The court held that a petitioner convicted under a divisible statute must demonstrate actual innocence only for the prong under which they were convicted. The court found that the jury instructions were erroneous because they did not convey that possession of another’s identifying information must be central to the healthcare fraud to sustain a conviction. Consequently, the Ninth Circuit vacated Ovsepian’s conviction and sentence for aggravated identity theft. View "USA V. OVSEPIAN" on Justia Law

Lake Region Healthcare Corporation operates a hospital in Minnesota and experienced a significant decrease in Medicare inpatient discharges in 2013, qualifying it for a volume-decrease adjustment (VDA). The hospital sought an adjustment of $1,947,967 using a method that estimates the portion of Medicare payments attributable to fixed costs. A Medicare contractor denied the adjustment, applying a method that treats all Medicare payments as compensation for fixed costs, resulting in no adjustment. The Provider Reimbursement Review Board (PRRB) reversed the contractor's decision, but the Centers for Medicare & Medicaid Services (CMS) reinstated it.The United States District Court for the District of Columbia ruled in favor of the government, deferring to CMS's method under Chevron deference. The court found that the statute did not specify how to calculate the VDA and that CMS's method was a reasonable interpretation, even if not the best one. The court concluded that CMS's approach was consistent with the statutory requirement to compensate only for fixed costs.The United States Court of Appeals for the District of Columbia Circuit reviewed the case de novo. The court held that CMS's method of attributing all Medicare payments to fixed costs did not comply with the statutory requirement to fully compensate hospitals for their fixed costs. The court noted that Medicare payments cover both fixed and variable costs and that CMS's method overstates the amount of reimbursed fixed costs, thus understating unreimbursed fixed costs. The court found that reasonable proxies exist to estimate the fixed-cost component of Medicare payments and that CMS's method was not a reasonable approximation of full compensation for fixed costs.The court reversed the district court's decision, granted summary judgment to Lake Region, and remanded the case to the agency for further proceedings consistent with the opinion. View "Lake Region Healthcare Corporation v. Becerra" on Justia Law

Marcus Millsap was convicted by a jury of conspiracy to violate the Racketeer Influenced and Corrupt Organizations Act (RICO), aiding and abetting attempted murder in aid of racketeering, and conspiracy to distribute and possess with intent to distribute 500 grams or more of methamphetamine. Millsap was involved with the New Aryan Empire, a white-supremacist organization engaged in drug trafficking. He assisted the organization's president, Wesley Gullett, in drug operations and attempted to retaliate against Bruce Hurley, a police informant, by offering money to have him killed. Gullett attempted to kill Hurley but failed, and Hurley was later murdered by an unknown perpetrator.The United States District Court for the Eastern District of Arkansas sentenced Millsap to life imprisonment. Millsap appealed, arguing that his indictment should have been dismissed due to a violation of the Interstate Agreement on Detainers Act, and that the district court made several errors regarding evidentiary issues and juror intimidation. He also challenged his sentence if the convictions were upheld.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court found that the Interstate Agreement on Detainers Act did not apply because Millsap was transferred to federal custody via a writ of habeas corpus ad prosequendum before a detainer was lodged. The court also held that there was no sufficient showing of juror intimidation to justify a mistrial. The court found the evidence sufficient to support Millsap's convictions on all counts, including his association with the drug-trafficking enterprise and his involvement in the attempted murder of Hurley.The court also ruled that the district court did not err in admitting co-conspirator statements and other evidence, and that any potential errors were harmless. The court upheld the district court's application of sentencing enhancements and the calculation of Millsap's criminal history points. Consequently, the Eighth Circuit affirmed the judgment of the district court. View "United States v. Millsap" on Justia Law

A woman experiencing psychotic delusions was admitted to the Alaska Psychiatric Institute (API) for a mental health evaluation. Her treating psychiatrist identified three possible causes of her delusions, including psychosis secondary to lupus. Despite showing signs of improvement with antipsychotic medication, she was discharged against medical advice but was readmitted five days later. The superior court ordered a 30-day involuntary commitment, concluding there was clear and convincing evidence that she was gravely disabled due to mental illness.The superior court found that the woman was mentally ill and gravely disabled, based on the psychiatrist's testimony about her delusional beliefs and behaviors, such as believing she had psychic powers and was the subject of a non-consensual documentary. The psychiatrist also noted her refusal to eat or drink adequately, posing a medical concern. Despite the possibility of lupus, the psychiatrist recommended the same treatment for her psychosis and testified that a lupus diagnosis would not change his commitment recommendation.The Supreme Court of the State of Alaska reviewed the case and affirmed the superior court's commitment order. The court held that the statutory definition of "mental illness" does not exclude mental or emotional impairments resulting from physical conditions like lupus. The court also concluded that due process does not require ruling out physical conditions as the cause of mental illness. The psychiatrist's testimony provided clear and convincing evidence of the woman's mental illness, and the court found that involuntary commitment to API was the least restrictive alternative treatment available. View "In re Hospitalization of Kara K." on Justia Law

In a juvenile wardship proceeding, the minor's counsel declared a doubt about the minor's competency to stand trial. Consequently, the juvenile court suspended the proceedings and referred the minor for a competency evaluation. The court's protocol mandated the disclosure of the minor's mental health records to the court-appointed expert for evaluation. The minor objected, citing the psychotherapist-patient privilege under California Evidence Code section 1014. The court overruled the objection and ordered the disclosure, prompting the minor to file a writ petition challenging this decision.The Contra Costa County Superior Court overruled the minor's objection, stating that Welfare and Institutions Code section 709 permits the compelled disclosure of all available records, including mental health records, for competency evaluations. The court also referenced Evidence Code section 1025, which it interpreted as allowing such disclosures in competency proceedings. The minor's request for a stay to seek appellate review was denied, leading to the filing of the writ petition.The California Court of Appeal, First Appellate District, reviewed the case. The court held that Evidence Code section 1016 renders the psychotherapist-patient privilege inapplicable in juvenile competency proceedings once the minor's counsel declares a doubt about the minor's competency. The court reasoned that the issue of the minor's mental or emotional condition is tendered by the minor through their counsel, thus falling under the patient-litigant exception to the privilege. The court denied the minor's writ petition and dissolved the partial stay of the juvenile court's order. View "T.M. v. Superior Court" on Justia Law