Justia Health Law Opinion Summaries

The Supreme Court reversed the judgment of the court of appeals reversing the trial court's dismissal of Plaintiff's complaint with prejudice, holding that dismissal of the lawsuit was required because this falsified-medical-records claim was a health care liability claim subject to the expert-report requirements of the Texas Medical Liability Act. See Tex. Civ. Prac. & Rem. Code 74.351(a).Plaintiff sued two individuals and a hospital alleging that he was indicted for aggravated assault only because the medical record of the victim of the assault had been falsified. The hospital invoked the civil-liability limitations in Chapter 74 of the Texas Civil Practice and Remedies Code, which requires the claimant to serve an adequate expert report within 120 days after the defendant's original answer has been filed. When Plaintiff did not subsequently serve an expert report, the trial court granted the hospital's motion to dismiss. The court of appeals reversed, concluding that claims involving alteration and fabrication of medical records are not healthcare liability claims and therefore do not trigger the expert report requirement of section 74.351. The Supreme Court reversed, holding that Plaintiff's action was a health care liability claim, and Plaintiff's failure to timely serve an expert report necessitated dismissal with prejudice. View "Scott v. Weems" on Justia Law

This case arose due to the failure of a New Jersey couple to pay for their adult son’s stay at a Pennsylvania nonprofit residential facility. It primarily raised a choice-of-law issue in relation to the two states’ filial-support statutes. Alexander Schutt (“Alex”), born in 1986, had severe mental and physical disabilities, including autism and obsessive-compulsive disorder. Alex's parents lived in New Jersey. In 2001, Alex was placed at Melmark, a non-profit residential care facility for intellectually and physically disabled persons, in Delaware County, Pennsylvania. Once Alex turned 21, the Princeton Regional School District stopped paying for his care at Melmark; at that point, payment for his care shifted to the New Jersey Department of Human Services, Division of Developmental Disabilities (NJ-DDD). In July 2011, NJ-DDD informed the Parents Alex would have to be relocated because the agency disapproved Melmark’s rates. NJ-DDD stated that the Parents, as guardians, should pick Alex up at Melmark and NJ-DDD would provide him with an emergency placement pursuant to New Jersey law. Parents did not retrieve Alex from Melmark. In December 2011, NJ-DDD wrote to Parents, stating it would fund Alex’s residence on a permanent basis at an identified facility in New Jersey beginning in January 2012. Unsatisfied, the Parents asked NJ-DDD instead to continue paying for Alex’s care at Melmark. NJ-DDD denied the request and advised the Parents it would stop paying Melmark as of December 31, 2011. Parents filed an administrative appeal in New Jersey in an effort to keep Alex at Melmark. NJ-DDD granted extensions of time to allow for Alex’s transfer to a New Jersey facility, but the agency ultimately informed Parents it would make no further payments to Melmark after March 31, 2012. When that date arrived, neither Parents nor NJ-DDD accepted custody of Alex, leaving Melmark to care for him uncompensated. Nevertheless, Parents continued to pay for off-campus speech classes, art classes, and equestrian therapy for Alex, all of which took place in Pennsylvania. In addition, Parents continued to visit Alex at Melmark almost every weekend even after NJ-DDD’s payments ceased. The Pennsylvania Supreme Court's resolution of the choice-of-law issue vitiated the trial court's basis for concluding the parents did not, in the individual capacity, appreciate Melmark's services. "[I]n weighing the equities, we conclude that it would be inequitable for Parents to retain the benefits they received from Melmark without paying for them. Thus, Melmark has established all three prerequisites for its equitable claims." As such, the Court held the Superior Court erred in finding the trial court properly denied relief on Melmark's equitable claims. View "Melmark, Inc. v. Schutt" on Justia Law

MCEP, an acute care, for-profit hospital owned by 60 physicians and one corporate shareholder, opened in 2006. By 2009, MCEP’s existence as a physician-owned enterprise ended when it sold an ownership interest to Kettering Health Network, a competitor in the Dayton healthcare market. MCEP alleges that it failed because of the anticompetitive actions of Premier, a dominant healthcare network in the Dayton area. MCEP alleges that Premier contracted with area physicians and payers (insurers and managed-care plan providers) on the condition that they did not do business with MCEP. MCEP claims that Premier engaged in a conspiracy so devoid of benefit to the market as to be per se illegal under the Sherman Act, 15 U.S.C. 1. The Sixth Circuit affirmed summary judgment in favor of the defendants. To be per se illegal, a defendant’s conduct has to be so obviously anticompetitive that it has no plausibly procompetitive features. Premier’s contracts with payers and physicians had plausibly procompetitive features. It is plausible that panel limitations, which prohibited referrals to MCEP, lower the cost of defendants’ services and improve “cost effectiveness and efficiencies in the delivery of health care services.” View "Medical Center at Elizabeth Place, LLC v. Atrium Health System" on Justia Law

Genesis Hospice LLC provided outpatient hospice care to Medicaid beneficiaries in the Mississippi Delta. Claims Genesis submitted outside the norm, prompting a Mississippi Division of Medicaid audit. A statistical sample of 75 of the 808 billed claims were reviewed, and of that 75, 68 claims were not substantiated by the patients’ records and thus not eligible for payment. The auditing physicians specifically found that the patient records for the 68 rejected claims lacked sufficient documentation to support the given terminal-illness diagnosis and/or lacked documentation of disease progression. Medicaid’s statistician extrapolated that 68 of 75 unsupported claims represented a total overpayment of $1,941,285 for the 808 claims Genesis billed during the relevant time period. And Medicaid demanded Genesis repay this amount. Medicaid’s decision has been affirmed in an administrative appeal before Medicaid and by the Hinds County Chancery Court, sitting as an appellate court. On further appeal to the Mississippi Supreme Court, Genesis essentially argued Medicaid unfairly imposed documentation requirements not found in the federal or state Medicaid regulations. Genesis insisted the only requirement was a physician’s certification that in his or her subjective clinical judgment the patient was terminally ill, which Genesis provided. The Supreme Court found the regulations were clear: a physician’s certification of terminal illness is indeed required, but so is documentation that substantiates the physician’s certification. Because Genesis’ records failed to support 90 percent of its hospice claims, Medicaid had the administrative discretion to demand these unsupported claims be repaid. Therefore, the Supreme Court affirmed. View "Genesis Hospice Care, LLC v. Mississippi Division of Medicaid" on Justia Law

The Supreme Court affirmed a circuit court judgment denying validation of revenue bonds, holding that Halifax Hospital Medical Center, a special tax district, was not authorized to carry out the project for which it sought to issue the bonds.Halifax sought validation of bonds that it intended to issue for the purpose of financing the construction of a hospital outside the geographic boundaries established in the special act creating Halifax. The circuit court denied the complaint for bond validation on the grounds that Halifax lacked the authority operate a facility outside its geographical boundaries. The Supreme Court affirmed, holding that the circuit court properly denied the bond validation because neither Halifax's enabling act nor the Interlocal Act gave Halifax the authority to operate outside its geographic boundaries. View "Halifax Hospital Medical Center v. State" on Justia Law

Over seven years, Dr. Greenspan referred more than 100,000 blood tests to Biodiagnostic Laboratory, which made more than $3 million off these tests. In exchange, the Lab gave Greenspan and his associates more than $200,000 in cash, gifts, and other benefits. A jury convicted Greenspan of accepting kickbacks, 42 U.S.C. 1320a-7(b)(1)(A); using interstate facilities with the intent to commit commercial bribery, 18 U.S.C. 1952(a)(1), (3); honest-services wire fraud, 18 U.S.C. 1343, 1346; and conspiracy to do all of those things. The Third Circuit affirmed, characterizing the evidence of his guilt as overwhelming. The district court erred in instructing the jury that Greenspan had to “demonstrate” the prerequisites for an advice-of-counsel defense; in excluding as hearsay some of his testimony about that legal advice; in asking only Greenspan’s counsel, not Greenspan personally, whether he wished to speak at sentencing; and in limiting the scope of the defense to five particular agreements rather than all eight, but all of those errors were harmless. The court properly excluded evidence that the blood tests were medically necessary. That evidence was only marginally relevant and risked misleading the jury. View "United States v. Greenspan" on Justia Law

The Fifth Circuit affirmed the district court's decision to affirm the revocation of two physicians' Medicare privileges. The court held that the physicians billed for services using their own Medicare National Provider Identifiers without providing direct supervision while traveling outside of the country; the ALJ's summary judgment dismissal of the physicians' claims was supported by substantial evidence; the physicians' constitutional claims were rejected; the court agreed with its sister circuits that have determined that participation in the federal Medicare reimbursement program is not a property interest; and the court deferred to CMS's decision to bar the physicians from re-enrolling in the Medicare program for three years. View "Shah v. Azar" on Justia Law

Ace, a licensed physician, and Lesa Chaney owned and operated Ace Clinique in Hazard, Kentucky. An anonymous caller told the Kentucky Cabinet for Health and Family Services that Ace pre-signed prescriptions. An investigation revealed that Ace was absent on the day that several prescriptions signed by Ace and dated that day were filled. Clinique employees admitted to using and showed agents pre-signed prescription blanks. Agents obtained warrants to search Clinique and the Chaneys’ home and airplane hangar for evidence of violations of 21 U.S.C. 841(a)(1), knowing or intentional distribution of controlled substances, and 18 U.S.C. 1956(h), conspiracies to commit money laundering. Evidence seized from the hangar and evidence seized from Clinique that dated to before March 2006 were suppressed. The court rejected arguments that the warrants’ enumeration of “patient files” was overly broad and insufficiently particular. During trial, an alternate juror reported some “concerns about how serious[ly] the jury was taking their duty.” The court did not tell counsel about those concerns. After the verdict, the same alternate juror—who did not participate in deliberations—contacted defense counsel; the court conducted an in camera interview, then denied a motion for a new trial. To calculate the sentencing guidelines range, the PSR recommended that every drug Ace prescribed during the relevant time period and every Medicaid billing should be used to calculate drug quantity and loss amount. The court found that 60 percent of the drugs and billings were fraudulent, varied downward from the guidelines-recommended life sentences, and sentenced Ace to 180 months and Lesa to 80 months in custody. The Sixth Circuit affirmed, rejecting challenges to the constitutionality of the warrant that allowed the search of the clinic; the sufficiency of the evidence; and the calculation of the guidelines range and a claim of jury misconduct. View "United States v. Chaney" on Justia Law

The Supreme Court reversed the judgment of the circuit court entered on the jury's verdict finding that Davis Life Care Center (DLCC), a long-term care facility, was not entitled to charitable immunity and denying DLCC's motion for new trial, holding that the circuit court erred in submitting the charitable-immunity question to the jury.Plaintiff sued DLCC alleging negligence, medical malpractice, breach of an admission agreement, and other causes of action. DLCC filed a motion for summary judgment claiming entitlement to charitable immunity. The circuit court granted the motion. The court of appeals reversed and remanded for further proceedings, concluding that reasonable persons could reach different conclusions based on the undisputed facts presented. The circuit court submitted the question of charitable immunity to the jury, which returned a verdict against DLCC. The Supreme Court reversed, holding that the issue of charitable immunity is a question of law for the court, rather than the jury, to decide. View "Davis Nursing Ass'n v. Neal" on Justia Law

Kentucky’s “Ultrasound Informed Consent Act,” KRS 311.727, directs a doctor, before performing an abortion, to perform an ultrasound; display the ultrasound images for the patient; and explain, in the doctor’s own words, what is being depicted. There is no requirement that the patient view the images or listen to the description. The doctor also must auscultate the fetal heartbeat but may turn off the volume if the patient requests. The Act does not penalize a doctor if the patient requested that the heartbeat sound be turned off or chose not to look at the ultrasound images or if the doctor makes any other statement, including advising a patient that she need not listen to or view the disclosures, or that the patient should have an abortion. A doctor need not make any disclosures if an abortion is medically necessary or in a medical emergency. Doctors brought a First Amendment challenge. The district court permanently enjoined enforcement of the Act. The Sixth Circuit reversed, citing the Supreme Court’s 2018 decision, National Institute of Family & Life Advocates, clarifying that no heightened First Amendment scrutiny should apply to abortion-informed-consent statutes. Even though an abortion-informed-consent law compels a doctor’s disclosure of certain information, it should be upheld so long as the disclosure is truthful, non-misleading, and relevant to abortion. View "EMW Women's Surgical Center P.S.C. v. Beshear" on Justia Law