Justia Health Law Opinion Summaries

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Zelda Sheppard appealed a superior court’s affirmance of an Industrial Accident Board (“IAB” or “Board”) decision granting Allen Family Foods’ (“Employer”) Petition for Review (“Petition”). The IAB determined that Sheppard’s prescribed narcotic pain medications were no longer compensable. Sheppard sought to dismiss the Petition at the conclusion of Employer’s case-in-chief during the IAB hearing, arguing that the matter should have been considered under the utilization review process. After hearing the case on the merits, the IAB disagreed, holding that Employer no longer needed to compensate Sheppard for her medical expenses after a two-month weaning period from the narcotic pain medications. On appeal, Sheppard argued the IAB erred as a matter of law when it denied Sheppard’s Motion to Dismiss Employer’s Petition because Employer failed to articulate a good faith change in condition or circumstance relating to the causal relationship of Sheppard’s treatment to the work injury. Accordingly, Sheppard argued that the Employer was required to proceed with the utilization review process before seeking termination of her benefits. The Delaware Supreme Court determined the IAB’s decision was supported by substantial evidence, therefore the superior court’s decision was affirmed. View "Sheppard v. Allen Family Foods" on Justia Law

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The Supreme Court reversed the judgment of the court of appeals dismissing as moot S.A.M.'s appeal of the order extending his voluntary commitment (recommitment) and affirmed the recommitment order, holding that the appeal of the expired recommitment order was not moot and that S.A.M.'s due process and insufficiency of the evidence claims were without merit.Sauk County successfully petitioned to have S.A.M. involuntary committed to its care for compelled treatment. Before the initial commitment order expired, the County petitioned to extend S.A.M.'s commitment. After a trial, the circuit court found grounds for a recommitment order. S.A.M. appealed, but the court of appeals dismissed the appeal because the recommitment order expired before the court could decide the merits of the appeal. The Supreme Court reversed, holding (1) two collateral consequences raised here rendered the appeal of the expired recommitment order not moot; but (2) on the merits, S.A.M.'s arguments were unavailing. View "Sauk County v. S.A.M." on Justia Law

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Defendant and several others were indicted on various healthcare fraud offenses stemming from a scheme in which Defendant and others would pay TRICARE beneficiaries to order certain creams and vitamins. At a jury trial, Defendant was convicted of one count of conspiracy to commit health care fraud, one count of receiving an illegal kickback payment, and six counts of making illegal kickback payments. The District Court sentenced Defendant to 240 months imprisonment.On appeal, Defendant challenged, among other things, the sufficiency of the evidence pertaining to his convictions for paying illegal kickbacks. The Fifth Circuit agreed with Defendant's reasoning that he did not "induce" TRICARE beneficiaries to order the substances by paying them because the substances were for their own use. Thus, the court reversed Defendant's convictions for paying illegal kickback payments. The court affirmed Defendant's other convictions and remanded for resentencing. View "USA v. Cooper" on Justia Law

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Lash, a 60-year-old, obese man with a remote history of smoking and high blood pressure, was traveling when he experienced shortness of breath and chest discomfort. He went to Sparta hospital. An EKG, blood work, and a chest x-ray revealed no signs of a previous heart attack, but his white blood cells and blood sugar were slightly elevated, suggesting a cardiac event. Dr. Panico identified mild congestive failure and an enlarged right hilum, a part of the lung. He recommended a CT scan to rule out a mass. Dr. Motwani, the main physician responsible for treating Lash, diagnosed an “anxiety reaction” and prescribed medications. Lash was not informed of his congestive heart failure nor that an enlarged right hilum could mean heart failure or cancer. One nurse mentioned only that Lash was seen for an “anxiety reaction.” The next evening, Lash went into cardiac arrest. He was taken to the emergency room, where he was pronounced dead.In a malpractice suit by Lash’s estate, the district court granted Sparta hospital summary judgment. Motwani settled the case and was dismissed from the lawsuit. The Seventh Circuit affirmed. . The Illinois Tort Immunity Act provides that “a local public entity,” such as Sparta, is not liable for an employee’s negligent “diagnosis.” Lash never received any treatment, so no doctor could have failed to disclose information that might have changed his decisions. View "Lash v. Sparta Community Hospital" on Justia Law

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The employer-sponsored group health plan offers all of its participants the same limited coverage for outpatient dialysis. A dialysis provider sued the plan, citing the Medicare Secondary Payer statute, which makes Medicare a “secondary” payer to an individual’s existing insurance plan for certain medical services, including dialysis, when that plan already covers the same services, 42 U.S.C. 1395y(b)(1)(C), (2), (4). To prevent plans from circumventing their primary-payer obligation for end-stage renal disease treatment, a plan may not differentiate in the benefits it provides between individuals having end-stage renal disease and other individuals based on the existence of end-stage renal disease, the need for renal dialysis, “or in any other manner” and may not take into account that an individual is entitled to or eligible for Medicare due to end-stage renal disease. The Sixth Circuit ruled that the limited payments for dialysis treatment had a disparate impact on individuals with end-stage renal disease.The Supreme Court reversed. The plan's coverage terms for outpatient dialysis do not violate section 1395y(b)(1)(C) because those terms apply uniformly to all covered individuals. The statute prohibits a plan from differentiating in benefits between individuals with and without end-stage renal disease; it cannot be read to encompass a disparate-impact theory. The statute simply coordinates payments between group health plans and Medicare without dictating any particular level of dialysis coverage. The plan does not “take into account” whether its participants are entitled to or eligible for Medicare. View "Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc." on Justia Law

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The Supreme Judicial Court affirmed the judgment entered by the district court extending a weapons restriction placed on J because J presented a likelihood of foreseeable harm, holding that there was no error in the proceedings below.While J was in protective custody for threatening behavior a doctor concluded that J was a mentally ill person within the meaning of Me. Rev. Stat. 34-B, 3801(5) and that he posed a likelihood of foreseeable harm within the meaning of Me. Rev. Stat. 34-B, 3862-A. The court subsequently prohibited J from possessing dangerous weapons pending a judicial hearing. After a hearing, the court entered a written order extending the restriction for one year. The Supreme Judicial Court affirmed, holding (1) section 3862-A neither violates Me. Const. art. I, 16, nor is it unconstitutionally vague; (2) the extension of the weapons restriction was supported by competent evidence; and (3) the prosecutor did not commit misconduct during closing arguments. View "In re Weapons Restriction of J." on Justia Law

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Tinimbang invested $811,400, founding Donnarich Home Health in 2005 with his then-wife Josephine and their children. In 2006-2007, the others forced him out of management; Tinimbang maintained his equity position. Josephine and their son, Richard, later incorporated two healthcare businesses: Josdan and Patient Home; some of the funding came from Donnarich’s assets. Tinimbang later asserted that he was not compensated for those asset transfers or for his removal as Donnarich’s president.Josephine and others were charged with conspiracy to commit healthcare fraud (18 U.S.C. 1349) and conspiracy to launder the proceeds of healthcare fraud and unlawful payments for patient referrals (18 U.S.C. 1956(h)) by using Donnarich and Josdan to fraudulently bill Medicare and creating shell companies to deposit checks. The government sought the forfeiture of assets involved in or traceable to the conspiracies. Josephine fled. Guerrero, an employee, pled guilty and agreed to forfeit assets. The district court entered a preliminary order of forfeiture.Tinimbang asserted a claim to the assets by instituting ancillary proceedings, citing his investment in Donnarich, his removal without compensation, and the allegedly improper transfers from Donnarich to Josdan and Patient. Tinimbang did not provide any financial tracing. The government “reviewed the movement of funds” and did not trace any of Tinimbang’s investment to the forfeiture assets. The Seventh Circuit affirmed summary judgment in favor of the government. Tinimbang had not carried his burden to show a vested or superior interest in the forfeited assets at the time of the criminal acts. View "United States v. Tinimbang" on Justia Law

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The Supreme Court held that the Iowa Constitution is not the source of a fundamental right to an abortion necessitating a strict scrutiny standard of review for regulations affecting that right.In Planned Parenthood of the Heartland, Inc. v. Iowa Board of Medicine (PPH I), 865 N.W.2d 252 (Iowa 2015), the Supreme Court applied the federal undue burden test established in Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992), under the Iowa Constitution. In Planned Parenthood of the Heartland v. Reynolds (PPH II), 915 N.W.2d 206, (Iowa 2018), the Supreme Court rejected the undue burden test and found that the due process clause of the Iowa Constitution protected abortion as a fundamental right. In 2020, the general assembly added a mandatory 24-hour waiting period for abortion to pending legislation limiting courts' ability to withdraw life-sustaining procedures. Planned Parenthood successfully sued in district court to block the statute from taking effect. The district court granted summary judgment for Planned Parenthood. The Supreme Court reversed, holding (1) PPH II is overruled; and (2) therefore, the Casey undue burden test applied in PPH I remains the governing standard. View "Planned Parenthood of the Heartland, Inc. v. Reynolds ex rel. State" on Justia Law

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In this case concerning the medical marijuana licensing and regulatory process the Supreme Court affirmed in part and dismissed in part this interlocutory appeal from the circuit court's denial of Defendants' motion to dismiss this action on the basis of sovereign immunity, holding that the circuit court erred in its ruling.Plaintiff brought this complaint seeking a writ of mandamus and declaratory relief to compel Defendants - the Arkansas Department of Finance and Administration, the Arkansas Alcoholic Beverage Control Division, and the Arkansas Medical Marijuana Commission - to revoke a cultivation facility license granted to another company and instead award it to Plaintiff. The circuit court denied Defendants' motion to dismiss on the doctrine of sovereign immunity. The Supreme Court remanded the action, holding (1) the circuit court did not err in denying the motion to dismiss the writ of mandamus on the basis of sovereign immunity; (2) the circuit court erred in denying gate State's motion to dismiss Plaintiff's claim of declaratory relief; and (3) to the extent that Appellants were seeking relief under the APA the case must be dismissed for lack of subject matter jurisdiction. View "Arkansas Department of Finance & Administration v. 2600 Holdings, LLC" on Justia Law

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The Supreme Court affirmed the order of the circuit court applying this Court's decision in State ex rel. AMFM, LLC v. King, 740 S.E.2d 66 (W. Va. 2013), to conclude that Respondent lacked authority to bind her mother to an arbitration agreement, holding that there was no error.Respondent admitted her mother to The Villages at Greystone, an assisted living residence, when Respondent was not her mother's attorney-in-fact. In her capacity as her mother's medical surrogate Respondent completed on her mother's behalf a residency agreement and an arbitration agreement. Respondent later sued Petitioners, alleging that her mother had suffered injuries while a resident of Greystone due to Petitioners' negligence. Petitioners filed a motion to arbitrate the claim, but the circuit court denied the motion, concluding that no valid arbitration agreement existed. The Supreme Court affirmed, holding that Petitioners failed to establish a valid agreement to arbitrate on the facts of this case. View "Beckley Health Partners, Ltd. v. Hoover" on Justia Law