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Blue Valley Hospital, Inc., (“BVH”) appealed a district court’s dismissal of its action for lack of subject matter jurisdiction. The Department of Health and Human Services (“HHS”) and the Centers for Medicare and Medicaid Services (“CMS”) terminated BVH’s Medicare certification. The next day, BVH sought an administrative appeal before the HHS Departmental Appeals Board and brought this action. In this action, BVH sought an injunction to stay the termination of its Medicare certification and provider contracts pending its administrative appeal. The district court dismissed, holding the Medicare Act required BVH exhaust its administrative appeals before subject matter jurisdiction vested in the district court. BVH acknowledged that it did not exhaust administrative appeals with the Secretary of HHS prior to bringing this action, but argued: (1) the district court had federal question jurisdiction arising from BVH’s constitutional due process claim; (2) BVH’s due process claim presents a colorable and collateral constitutional claim for which jurisdictional exhaustion requirements are waived under Mathews v. Eldridge, 424 U.S. 319 (1976); and (3) the exhaustion requirements foreclosed the possibility of any judicial review and thus cannot deny jurisdiction under Bowen v. Michigan Academy of Family Physicians, 476 U.S. 667 (1986). The Tenth Circuit disagreed and affirmed dismissal. View "Blue Valley Hospital v. Azar" on Justia Law

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This case arose out of an allegedly negligent surgery performed on real party in interest Jamie Harper at the Modoc Medical Center. Harper did not present a claim to petitioner Last Frontier Healthcare District, doing business as the Modoc Medical Center (Last Frontier), within a year of her surgery. Respondent superior court originally granted Harper’s petition for relief from the claim presentation requirement based in part on its erroneous conclusion that Harper’s giving notice of her intent to sue extended the time to file her application for leave to present a late claim with Last Frontier. Last Frontier filed a petition for writ of mandate and/or prohibition with the Court of Appeal to challenge the superior court's order. The Court of Appeal issued an alternative writ and the trial court responded by issuing a new order properly denying Harper’s petition for relief from the claim presentation requirement: "Giving notice of an intent to file a medical malpractice action under Code of Civil Procedure section 364 does not alter the jurisdictional deadlines underlying an application for relief from the Government Claims Act requirement of presenting a timely claim to a public entity before bringing an action for damages against it." The Court of Appeal denied Last Frontier's petition for mandamus relief because the relief requested was no longer needed. View "Last Frontier Healthcare Dist. v. Superior Ct." on Justia Law

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The district court found that a woman, "Linda M.," charged with several misdemeanors was incompetent to stand trial and committed her to a state hospital. The hospital later brought petitions in the superior court for civil commitment and involuntary medication. Linda moved to dismiss or stay the proceedings, contending that the superior court was an improper forum because of the criminal case pending in the district court. The superior court denied the motion, asserted its jurisdiction to hear the case, and granted the hospital’s petition for authority to administer medication. Linda appealed. The Alaska Supreme Court held the superior court properly asserted its jurisdiction over the civil commitment and involuntary medication petitions and that the superior court did not err in finding that involuntary medication was in Linda's best interests. View "In Re Hospitalization of Linda M." on Justia Law

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Connor J. was living at a shelter for homeless youth, when his psychiatric condition allegedly began to deteriorate. A social worker filed a petition in superior court seeking authority to hospitalize Connor for evaluation. The petition noted Connor had a history of suicidal thoughts; that he had been diagnosed at various times with depression, anxiety, post-traumatic stress disorder, and oppositional defiant disorder; and that he had been treated for mental illness in the past at a hospital and several counseling centers. Connor was transported to Alaska Psychiatric Institute (API) for an evaluation. A few days later API filed a petition for 30-day commitment and a proceedings were initiated that lead to his commitment. The superior court issued a 30-day involuntary commitment order after finding that Connor was "gravely disabled" and there were no less restrictive alternatives to hospitalization. The respondent appealed, arguing that it was plain error to find he waived his statutory right to be present at the commitment hearing, that it was clear error to find there were no less restrictive alternatives, and that the commitment order should be amended to omit a finding that he posed a danger to others, a finding the superior court meant to reject. The Alaska Supreme Court concluded it was not plain error to find that the respondent waived his presence at the hearing. We further conclude that it was not clear error to find that there were no less restrictive alternatives to a 30-day hospital commitment. However, because there was no dispute that the “danger to others” finding should not have been included in the commitment order, the case was remanded for issuance of a corrected order. View "In Re Hospitalization of Connor J." on Justia Law

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The Supreme Court affirmed the order of the district court extending B.A.F.’s commitment to the Montana Mental Health Nursing Care Center, holding that the requirements of Mont. Code Ann. 53-21-119(1) did not apply when B.A.F. requested a hearing to stipulate to the extension of his involuntary commitment. On appeal, B.A.F. argued that the district court’s recommitment should be reversed because the record lacked evidence demonstrating that B.A.F. understood his statutory rights, the nature of the proceeding, and intentionally and knowingly waived those rights. The Supreme Court affirmed, holding that section 53-21-119(1) did not apply because B.A.F. did not seek a hearing on the petition to extend his commitment and that B.A.F. made it clear to the court that he understood his circumstances and intentionally agreed to the extension of care. View "In re B.A.F." on Justia Law

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The Ninth Circuit affirmed the district court's dismissal of plaintiffs' claim that their insurer, Blue Shield, violated the Medical Loss Ratio (MLR) provision of the Patient Protection and Affordable Care Act (ACA). The MLR is the ratio between what an insurer pays out in claims for medical services and the revenue it takes in. The panel held that there was no basis in the language, history, intent or spirit of the ACA to narrow the MLR by excluding payments for services rendered by out-of-network physicians. In this case, the MLR was properly calculated under federal law by including the settlement reimbursements for medical services by nonnetwork providers. Therefore, the district court correctly recognized the services were covered by the plan and the payments were made. View "Morris v. California Physicians' Service" on Justia Law

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The Supreme Court affirmed Defendant’s convictions and sentences, holding that the Arizona Health Care Cost Containment System (AHCCCS) statutory scheme, Ariz. Rev. Stat. 36-2901 to -2999.57, abrogates and creates an exception to Arizona’s statutory physician-patient privilege, Ariz. Rev. Stat. 13-4062(4), in cases of suspected AHCCCS fraud. Defendant was convicted of defrauding AHCCCS for lying about having cancer so her abortion would fall within the exception to the rule that AHCCCS does not cover abortions except when necessary to save a woman’s life or to protect her health. On appeal, Defendant argued that the superior court erred by admitting her medical records and by allowing her physicians to testify against her. The court of appeals affirmed, holding that the AHCCCS statutes abrogated the physician-patient privilege in cases of suspected AHCCCS fraud. The Supreme Court affirmed, holding (1) the legislature’s grant of brand authority to AHCCCS to investigate suspected fraud necessarily implies an exception to the privilege for internal AHCCCS investigations and proceedings; and (2) the AHCCCS statutes implicitly abrogate the privilege in the criminal investigation and prosecution of suspected AHCCCS fraud because the provisions at issue exhibit an intent to provide law enforcement access to patient information when investigating and prosecuting AHCCCS fraud. View "State v. Zeitner" on Justia Law

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MSPA, a firm that obtains Medicare Secondary Payer Act (MSP Act) claims and brings them on behalf of Medicare Advantage Organizations (MAOs), filed suit against Tenet over a delayed reimbursement of $286. The Eleventh Circuit affirmed the district court's grant of Tenet's motion to dismiss. The court held that MSPA had standing to invoke a federal court's jurisdiction because it suffered an injury in fact when it had to wait seven months for appropriate reimbursement and it validly assigned the right to vindicate that injury to La Ley Recovery Systems, who in turn validly assigned it to MSPA. On the merits, the court held that the MSP Act's private cause of action was only available in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement). In this case, MSPA did not sue a primary plan, but instead, it sued two medical services providers. Because private MSP Act plaintiffs could only sue primary plans, and MSPA had not done so, its claim was not plausible on its face. Therefore, the district court correctly dismissed MSPA's complaint for failure to state a claim. View "MSPA Claims 1, LLC v. Tenet Florida, Inc." on Justia Law

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Nita and her husband, Kirtish, pled guilty to defrauding Medicare (18 U.S.C. 1347), based on having forged physicians’ signatures on diagnostic reports and having conducted diagnostic testing without the required physician supervision. The government then brought this civil action for the same fraudulent schemes against Nita, Nita’s healthcare company (Heart Solution), Kirtish, and Kirtish’s healthcare company (Biosound). The district court granted the government summary judgment, relying on the convictions and plea colloquies in the criminal case, essentially concluding that Nita had admitted to all elements and issues relevant to her civil liability. Nita and Heart Solution appealed. The Third Circuit affirmed Nita’s liability under the False Claims Act, 31 U.S.C. 3729(a)(1)(A) and for common law fraud but vacated findings that Heart Solution is estopped from contesting liability and damages for all claims and Nita is estopped from contesting liability and damages for the remaining common law claims. The district court failed to dissect the issues that were determined in the criminal case from those that were not, lumping together Nita and Heart Solution, even though Heart Solution was not involved in the criminal case. It also failed to disaggregate claims Medicare paid to Nita and Heart Solution from those paid to Kirtish and Biosound. The plea colloquy did not clarify ownership interests in the companies; who, specifically, made certain misrepresentations; nor whether one company was paid the entire amount or whether the payments were divided between the companies. View "Doe v. Heart Solution PC" on Justia Law

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The Second Circuit certified the following question to the New York Court of Appeals: Does New York Public Health Law Section 230(11)(b) create a private right of action for bad faith and malicious reporting to the Office of Professional Medical Conduct? View "Haar v. Nationwide Mutual Fire Insurance Co." on Justia Law