Justia Health Law Opinion Summaries

Plaintiffs purchased Illinois nursing homes and obtained new state licenses and federal Medicare provider numbers. Most of the residents in the 10 homes qualify for Medicaid assistance. The Illinois Department of Healthcare and Family Services (IDHFS) administers Medicaid funds under 42 U.S.C. 1396-1396w-5, reimbursing nursing homes for Medicaid-eligible expenses on a per diem basis. The rate must be calculated annually based on the facility's costs. When ownership of a home changes, state law requires IDHFS to calculate a new rate based on the new owner’s report of costs during at least the first six months of operation. The Medicaid Act requires states to use a public process, with notice and an opportunity to comment, in determining payment rates. The owners allege that IDHFS failed to: recalculate their reimbursement rates; provide an adequate notice-and-comment process; and comply with the state plan, costing them $12 million in unreimbursed costs. The Seventh Circuit affirmed denial of a motion to dismiss. Section 1396a(a)(13)(A) confers a right that is presumably enforceable under 42 U.S.C. 1983; it benefits the owners and is not so amorphous that its enforcement would strain judicial competence. While the Eleventh Amendment may bar some of the requested relief, if it appears that owners have been underpaid, that does not deprive the court of jurisdiction over the case as a whole. View "BT Bourbonnais Care, LLC v. Norwood" on Justia Law

The Ninth Circuit held that the Secretary erred in approving a state plan amendment (SPA) pursuant to 42 U.S.C. 1396(a)(30)(A), without requiring any evidence regarding the extent that such care and services were available to the general population in the geographic area. In this case, the Secretary's approval of the SPA absent considerations of some form of comparative-access data was arbitrary and capricious. Accordingly, the court reversed the district court's grant of summary judgment in favor of the Secretary and remanded. View "Hoag Memorial Hospital Presbyterian v. Price" on Justia Law

The Supreme Court reversed the district court’s order granting a writ mandating disclosure of public records. The public records sought were copies of the business licenses of persons operating medical marijuana establishments (MME) in the City of Sparks. The City produced the business licenses but redacted the licensees’ identifies from the documents. Respondent filed a petition for a writ of mandamus to compel the City to disclose the redacted information. The district court granted the petition, concluding that the City’s duty under the Nevada Public Records Act to disclose the identities of the business was not exempted by Nev. Admin. Code 453A.714’s confidentiality provision. The City appealed, arguing that a petition for a writ of mandamus was not the appropriate means of seeking judicial relief when challenging an administrative code and that section 453A.714 rendered confidential the identifying information of MME business license holders. The Supreme Court affirmed in part and reversed in part, holding (1) Respondent’s petition for a writ of mandamus was a procedurally proper means for seeking the disclosure of public records; but (2) the identifying information of MME business license holders was confidential under section 453A.714 and thus was exempt from disclosure. View "City of Sparks v. Reno Newspapers, Inc." on Justia Law

Petitioner Dao Nguyen appealed a New Hampshire Board of Barbering, Cosmetology, and Esthetics (Board) decision, suspending her personal license as a manicurist and revoking the shop license for Nail Care. In 2013, Board inspector Beulah Green conducted a routine inspection of Nail Care, finding numerous violations of the Board Administrative Rules (Rules), including two foot spas that were not disinfected properly, no record of cleaning for two foot spas, five tables that were not sanitized, numerous implements that were either not sanitized and disinfected properly or not discarded or disposed of properly, multiple “credo” blades, and the use of nail drills that are not manufactured for use on the natural nail (improper nail drills). For these violations, Green imposed a fine of $4,158. In the next few years, Green conducted additional inspections, and again found multiple, repeat violations of the Rules. Noting the repeated violations and the “blatant disregard” that the petitioner demonstrated towards the Rules, the Board suspended petitioner’s personal license for five years, revoked her shop license for Nail Care, and ordered her to pay all outstanding fines owed to the Board within 90 days. The Board also ruled that, if the petitioner’s license is reinstated, it will be subject to a three-year probationary period. Finding the Board’s decision was supported by substantial, credible evidence, the New Hampshire Supreme Court affirmed the Board’s decision. View "Appeal of Dao Nguyen" on Justia Law

Marlene Baker LaBerge, a 73-year-old woman, was a resident and patient of a 24- hour skilled nursing facility owned by Italian Maple Holdings, LLC dba La Paloma Healthcare Center (La Paloma). LaBerge's heirs, Paul LaBerge, Suzanne Marx, and Talmadge Baker (collectively Plaintiffs) sued La Paloma and Plum Healthcare, LLC (together Defendants) for elder abuse, violations of the Patient's Bill of Rights as codified at Health and Safety Code section 1430, negligence, and wrongful death. In response, Defendants filed a petition to compel arbitration based on the two arbitration agreements that LaBerge had executed. The two arbitration agreements included language required by Code of Civil Procedure section 1295, subdivision (c), requiring such agreements to include a 30-day "cooling off" period, during which the parties to the agreement may rescind it. Ten days after LaBerge signed the agreements (and therefore, prior to the expiration of the statutorily-required 30- day rescission period), LaBerge passed away. The superior court denied the petition to compel arbitration, relying on Rodriguez v. Superior Court, 176 Cal.App.4th 1461 (2009) to conclude that the agreements were not effective until the 30-day rescission period passed without either party rescinding the agreements; because LaBerge died before the expiration of the 30-day rescission period, the agreements could not be given effect. On appeal, Defendants contended the trial court’s interpretation was wrong, and the Court of Appeal should decline to follow Rodriguez because that case was factually distinguishable from this case. The Court of Appeal concluded the trial court erred in interpreting section 1295, subdivision (c), and that the arbitration agreements were valid and enforceable. Pursuant to the plain language of section 1295, subdivision (c), the terms of those agreements governed the parties' relationship upon their execution; the fact that one signatory died before the expiration of the statutory 30-day rescission period does not render the terms of the parties' agreements unenforceable in the absence of other grounds for not enforcing them. View "Baker v. Italian Maple Holdings" on Justia Law

In this action brought by two individuals (Relators) under the False Claims Act (FCA) and various state analogues, the First Circuit affirmed in part and reversed in part the district court’s dismissal of the complaint. The district court concluded that Relators failed to plead false claims under either the FCA or the state-law versions of the FCA with the particularity required by Fed. R. Civ. P. 9(b). The First Circuit held (1) the complaint was correctly dismissed to the extent it relied on the alleged falsity of statements made by the product manufacturer in securing approval from the FDA to market a hip-replacement device; but (2) the district court erred in dismissing the complaint to the extent to rested on allegations that the manufacturer sold latently defective versions of its FDA-approved product on unsuspecting doctors who sought government reimbursement for defective products, as Relators’ complaint was sufficient to survive a Rule 9(b) motion to dismiss. View "Nargol v. DePuy Orthopaedics, Inc." on Justia Law

Hospitals filed suit challenging the formula used by the HHS for calculating certain Medicare reimbursement adjustments for fiscal year 2012. The D.C. Circuit held that HHS violated the Medicare Act when it changed its reimbursement adjustment formula without providing notice and opportunity for comment. Accordingly, the court reversed the district court's grant of summary judgment to HHS and remanded for further proceedings. View "Allina Health Services v. Price" on Justia Law

Federal Medicaid funds are not available for state medical expenditures made on behalf of “any individual who is an inmate of a public institution (except as a patient in a medical institution),” 42 U.S.C. 1396d(a)(29)(A). "Inmate of a public institution" means a person who is living in a public institution. However, an individual living in a public institution is not an “inmate of a public institution” if he resides in the public institution “for a temporary period pending other arrangements appropriate to his needs.” Ohio submitted a proposed plan amendment aimed at exploiting this distinction: it sought to classify pretrial detainees under age 19 as noninmates, living in a public institution for only “a temporary period pending other arrangements appropriate to [their] needs,” for whom the state could claim Medicaid reimbursement. The Centers for Medicare and Medicaid Services rejected the amendment, finding that the inmate exclusion recognizes “no difference” between adults and juveniles, or convicted detainees and those awaiting trial. The Sixth Circuit denied a petition for review, agreeing that the involuntary nature of the stay is the determinative factor. The exception does not apply when the individual is involuntarily residing in a public institution awaiting adjudication of a criminal matter. View "Ohio Department of Medicaid v. Price" on Justia Law

The Medical Board of California did not violate patients’ right to privacy under Cal. Const. art. I, 1 when it obtained data from the Controlled Substance Utilization Review and Evaluation System (CURES), California’s prescription drug monitoring program, without a warrant or subpoena supported by good cause during the course of investigating the patients’ physician, Dr. Alwin Carl Lewis. The Supreme Court affirmed the judgment of the court of appeal, which determined that the Board’s actions did not involve a significant intrusion on a privacy interest protected by the state Constitution’s privacy provision and, even if there was an invasion of privacy, it was justified. The Supreme Court held that even assuming the Board’s actions constituted a serious intrusion on a legally protected privacy interest, its review of Lewis’s patients’ CURES records was justified by the state’s dual interest in protecting the public from the unlawful use and diversion of a particularly dangerous class of prescription drugs and protecting patients from negligent or incompetent physicians. View "Lewis v. Superior Court of Los Angeles County" on Justia Law

A patient who qualifies for the medical use of marijuana and has been terminated from her employment because she tested positive for marijuana as a result of her lawful medical use of marijuana may seek a civil remedy against her employer through claims of handicap discrimination in violation of Mass. Gen. Laws ch. 151B. The Supreme Judicial Court thus reversed the dismissal of Plaintiff’s claim for handicap discrimination and related claims under chapter 151B but affirmed the allowance of the motion to dismiss as to the counts claiming an implied private cause of action under the medical marijuana act and wrongful termination in violation of public policy, holding that there is no implied statutory private cause of action under the medical marijuana act and that Plaintiff failed to state a claim for wrongful termination in violation of public policy. View "Barbuto v. Advantage Sales & Marketing, LLC" on Justia Law