Justia Health Law Opinion Summaries

In 2010, the defendants formed PremierTox, a urinalysis testing company: Doctors Peavler and Wood owned a substance abuse treatment company, SelfRefind; Doctor Bertram previously worked for SelfRefind. Bottom and Walters owned a drug testing service and laboratory. Physicians at clinics ordered urinalysis tests to check if their patients used illicit drugs and to monitor their medications. PremierTox was to receive those urine samples, perform the testing, and report back. In October 2010, SelfRefind began to send frozen urine samples to PremierTox for testing, but PremierTox did not have the correct equipment. In 2011, after PremierTox bought the necessary, expensive machines, they broke down. Urine samples from SelfRefind piled up. PremierTox started testing them between February and April 2011 and finished testing them in October. Over the same period, it tested and billed for fresh samples as they came in, aiming for a 48-hour turnaround. PremierTox billed insurers, saying nothing about the delays. The defendants were charged with 99 counts of health care fraud and with conspiracy. A jury acquitted them of conspiracy and 82 of the health care fraud charges and convicted them of 17 health care fraud charges. The trial judge imposed sentences of 13-21 months in prison. The Sixth Circuit affirmed the convictions. A reasonable jury could find that the defendants violated 18 U.S.C. 1347 by requesting reimbursement for tests that were not medically necessary. View "United States v. Walters" on Justia Law

The Eighth Circuit affirmed the district court's partial grant of summary judgment for Children's Hospitals and decision to vacate a Medicaid policy, Frequently Asked Question 33, which explained how to calculate a hospital's uncompensated medical care costs. The court held that by imposing new reporting requirements for private insurance payments, Question 33 expanded the footprint of 42 C.F.R. 447.299 and thus constituted a substantive change in the regulation. The court explained that section 447.299 has specific language explicitly stating what payments must be deducted from each hospital's "total cost of care," and the Secretary's own definition of "uncompensated care costs" did not include private insurance payments. The court declined to read substantive changes into the regulation under the guise of interpretation. Furthermore, the court joined the First and Fourth Circuits in concluding that Question 33 was a legislative rule that was not adopted in accordance with the procedure required by law and thus must be set aside, notwithstanding the Secretary's policy arguments to the contrary. View "Children's Health Care v. Centers for Medicare and Medicaid Services" on Justia Law

In April 2009, E.O. visited a pediatrician for his six-month visit and received several vaccinations. That night, Mrs. Oliver found E.O. seizing in his bed and called 9-1-1. At the emergency room, E.O. presented with a fever, red eyes with discharge, and a runny nose. The next day, E.O.’s pediatrician diagnosed E.O. with “complex febrile seizure and conjunctivitis.” E.O. did not have any health issues or seizures for two months but had several seizures over the summer and began to experience prolonged seizures in March 2010. Each seizure resulted in an emergency room visit. A pediatric neurologist diagnosed E.O. with an SCN1A gene defect. E.O. exhibited developmental delay. A pediatric neurologist performed examinations, which demonstrated “intractable, symptomatic childhood absence and complex partial seizures of independent hemisphere origin secondary to SCN1A gene defect (borderline SMEI syndrome) and encephalopathy characterized by speech delay.” E.O.’s family sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-2–300aa-33, alleging that E.O. developed Dravet syndrome as a result of the vaccinations. The Claims Court and Federal Circuit affirmed the rejection of their claim. The government’s expert provided strong evidence that Dravet syndrome will develop in children with the SCN[1]A mutation, whether or not they receive vaccinations; the Olivers failed to establish that their theory has garnered widespread acceptance, as evidenced by an extensive discussion of articles with contradictory findings. View "Oliver v. Secretary of Health and Human Services" on Justia Law

In 2017, R.M. and C.W., were committed to the South Mississippi State Hospital (SMSH) to be treated for mental illness. As required under the commitment statute, both R.M. and C.W. were evaluated by court-appointed physicians, one a medical doctor, the other a psychologist. In the cases of both individuals, the evaluating physicians were the same two physicians. And in both cases, the physicians’ recommendations were the same: the medical doctor found that both individuals were, to some degree, mentally ill and thus needed treatment; the psychologist found that both individuals were not mentally ill and did not need treatment. The issue this case presented for the Mississippi Supreme Court’s review centered on whether Mississippi Code Section 41-21-77 allows a director of a state hospital independently to override a commitment order of a chancery court for treatment of mental illness. The Court held it does not. Because this statutory question came to the Court by way of a citation of contempt, this case also required the Court to review the citation of contempt to determine whether the chancery court’s classification of the contempt was correct and whether correct procedures were followed in the finding of contempt. To this, the Court found the chancery court erred in its contempt determination. Accordingly, the Court reversed the chancery court’s contempt finding, remanded the case for an entry of an order of recusal, and otherwise ordered further proceedings. View "In the Matter of C. W." on Justia Law

The 2013 Public Employment Labor Relations Act (PELRA) did not infringe on the First Amendment rights of a group of parents who provide home care services to their disabled children. PELRA applied to persons who provide in-home care to disabled Medicaid recipients, and authorized covered employees to organize and to designate by majority vote an exclusive representative to negotiate employment terms with the state. The parents complained that the Act unconstitutionally compelled them to associate with the exclusive negotiating representative.Determining that the parents had Article III standing, the Eighth Circuit affirmed the district court's judgment and held that, under Minnesota State Board for Community Colleges v. Knight, the current version of PELRA allowed the homecare providers to form their own advocacy groups independent of the exclusive representative, and it did not require any provider to join the union. Therefore, the state did not impinge on the parents' right not to associate by recognizing an exclusive negotiating representative. View "Bierman v. Dayton" on Justia Law

Hospitals challenged the methodology that the Department used to calculate the "outlier payment" component of their Medicare reimbursements for 2008, 2009, 2010, and 2011. At issue was whether the Department's decision to continue with its methodology after the 2007 fiscal year was arbitrary in light of accumulating data about the methodology's generally sub-par performance. The DC Circuit held in Banner Health v. Price, 867 F.3d 1323 (D.C. Cir. 2017) (per curiam), that the Department's decision to wait a bit longer before reevaluating its complex predictive model was reasonable, because the Department had, at best, only limited additional data for 2008 and 2009 and because the 2009 data suggested that hospitals were paid more than expected.In this appeal, the court held that Banner Health foreclosed the hospitals' challenges to the Department's failure to publish a proposed draft rule during the 2003 rulemaking process and the Department's failure to account for the possibility of reconciliation claw-backs in setting the 2008, 2009, 2010, and 2011 thresholds. Finally, the court held that, while the hospitals' frustration with the Department's frequently off-target calculations was understandable, the methodology had not sunk to the level of arbitrary or capricious agency action. View "Billings Clinic v. Azar" on Justia Law

This matter stemmed from a lawsuit filed by the State of Mississippi against the defendant pharmacies. The State alleged deceptive trade practices and fraudulent reporting of inflated “usual and customary” prices in the defendant’s reimbursement requests to the Mississippi Department of Medicaid. The State argued that Walgreens, CVS, and Fred’s pharmacies purposefully misrepresented these prices to obtain higher prescription drug reimbursements from the State. Finding that the circuit court was better equipped to preside over this action, the DeSoto County Chancery Court transferred the matter to the DeSoto County Circuit Court in response to the defendants’ request. Aggrieved, the State timely filed an interlocutory appeal disputing the chancellor’s decision to transfer the case. After a thorough review of the parties’ positions, the Mississippi Supreme Court found that though the chancery court properly could have retained the action, the chancellor correctly used his discretion to transfer the case, allowing the issues to proceed in front of a circuit-court jury. As a result, the Supreme Court affirmed the chancellor’s decision. View "Mississippi v. Walgreen Co." on Justia Law

Harvey Cohoon was diagnosed with a treatable form of cancer and was residing at Victoria Healthcare Center while he underwent treatment and recovered from various injuries he had suffered. For 19 days, Cohoon did well at Victoria Center. On the 20th day, he was observed to have difficulty swallowing thin liquids, and after evaluation, his diet was changed. Plaintiff contended that change was not properly communicated to the kitchen, and that night he was served a dinner that did not comport with his new diet. Less than 20 minutes after being served dinner, a nurse found him in respiratory arrest. The paramedics had to remove large pieces of chicken from his throat before intubating him. More pieces of chicken were removed from his airway at the hospital. He died the following day due to complications from oxygen deprivation to his brain. Donna Cochrum, Cohoon’s niece, filed suit against Victoria Center, asserting causes of action for elder abuse and negligence. As personal representative of Cohoon’s estate, Cochrum asserted a wrongful death cause of action. A jury returned a verdict in favor of Cochrum on all causes of action. Subsequently, the trial court granted a motion for judgment notwithstanding the verdict (JNOV), finding insufficient evidence of recklessness to support the elder abuse cause of action. It also adjusted the remaining damages pursuant to Civil Code section 3333.2. Cochrum appealed the amended judgment, contending the evidence supported the elder abuse cause of action. Two of the defendants cross-appealed, contending the court improperly applied the Medical Injury Compensation Reform Act of 1975 cap. Finding no reversible error, the Court of Appeal affirmed the amended judgment. View "Cochrum v. Costa Victoria Healthcare, LLC" on Justia Law

The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

The Court of Appeals affirmed the judgments of the circuit court and Court of Special Appeals that there were no errors of procedure or substantive law on the part of Respondents - the University of Maryland Baltimore Washington Medical Center (Hospital) and the Maryland Department of Health - and the administrative law judge (ALJ) in determining that Petitioner met the requirements for involuntary admission to the psychiatric unit of the Hospital.The Court held (1) the ALJ did not err in finding that Petitioner’s hearing on involuntary admission complied with the ten-day deadline for an involuntary admission hearing set forth in Md. Code Ann. Health-Gen. 10-632(b); and (2) there was substantial support in the record for the ALJ’s finding that Petitioner presented a danger to the life or safety of herself or of others at the time of the hearing. View "In re J.C.N." on Justia Law