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The Supreme Court vacated the district court’s order granting Respondent’s petition for judicial review filed under Nev. Rev. Stat. 233B, the Nevada Administrative Procedure Act (APA), holding that the application process provided by Nev. Rev. Stat. 453A.322 does not constitute a contested case as defined by Nev. Rev. Stat. 233B.032, and therefore, the district court did not have authority to grant APA-based relief. Respondent petitioned for judicial review of the Nevada Department of Health and Human Service’s decision not to issue it a Las Vegas registration certificate authorizing it to operate a medical marijuana dispensary. Respondent’s petition was based exclusively on the Nevada APA. The Department moved to dismiss, arguing that the APA only affords judicial review in contested cases, which the marijuana dispensary application process does not involve. The district court granted judicial review and directed the Department to reevaluate Respondent’s application. The Supreme Court vacated the judgment of the district court, holding that the APA did not afford Respondent the right of review it sought. View "State, Department of Health & Human Services v. Samantha Inc." on Justia Law

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Community, the nation’s largest for-profit hospital system, obtained about 30 percent of its revenue from Medicare reimbursement. Instead of using one of the systems commonly in use for determining whether Medicare patients need in-patient care, Community used its own system, Blue Book, which directed doctors to provide inpatient services for many conditions that other hospitals would treat as outpatient cases. Community paid higher bonuses to doctors who admitted more inpatients and fired doctors who did not meet quotas. Community’s internal audits found that its hospitals were improperly classifying many patients; its Medicare consultant told management that the Blue Book put the company at risk of a fraud suit. Community attempted a hostile takeover of a competitor, Tenet. Tenet publicly disclosed to the SEC, expert analyses and other information suggesting that Community’s profits depended largely on Medicare fraud. Community issued press releases, denying Tenet’s allegations, but ultimately corroborated many of Tenet’s claims. Community’s shareholders sued Community and its CFO and CEO, alleging that the disclosure caused a decline in stock prices. The district court rejected the claim. The Sixth Circuit reversed. The Tenet complaint at least plausibly presents an exception to the general rule that a disclosure in the form of a complaint would be regarded, by the market, as comprising mere allegations rather than truth. The plaintiffs plausibly alleged that the value of Community’s shares fell because of revelations about practices that Community had previously concealed. View "Norfolk County Retirement System v. Community Health Systems, Inc." on Justia Law

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Defendant was found incompetent to stand trial and was involuntarily committed for three years. Defendant was never made the subject of a conservatorship. Shortly after his release, the district court obtained a superseding indictment with identical charges under a new case number, as permitted by Cal. Penal Code 1387. When Defendant was rearrested under the new indictment, he argued that because he had already been committed for the three years authorized by Cal. Penal Code 1370(c), the trial court lacked the authority to order his rearrest. The Supreme Court held (1) defendants in Defendant’s position can be rearrested on charges that are refiled under 1387; but (2) if the trial court again determines that a defendant is not competent to stand trial, the defendant may be recommitted only for a period not exceeding the remaining balance, if any, of the three years authorized by section 1370(c). View "Jackson v. Superior Court" on Justia Law

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Nevada’s medical marijuana registry does not violate the Due Process, Equal Protection, or Self-Incrimination Clauses of the United States or Nevada Constitutions. Appellant in this case applied for and received a registry identification card. Thereafter, Appellant filed suit against the Nevada Legislature, the Governor, and the Department of Health and Human Services (collectively, Respondents) arguing that the medical marijuana registry and its associated fees violated his due process and equal protection rights and his right against self-incrimination. The district court granted summary judgment for Respondents. The Supreme Court affirmed, holding (1) Nevada’s medical marijuana registry does not impinge upon a fundamental right; (2) the registry is rationally related to the legitimate state interest of protecting the health, safety, and welfare of the public; and (3) the registry does not violate a registrant’s right against self-incrimination. View "Doe v. State ex rel. Legislature of 77th Session" on Justia Law

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This case turned on whether an attorney-in-fact made a “health care decision” by admitting her principal to a residential care facility for the elderly and, in the process, agreeing to an arbitration clause. The trial court found she acted outside the scope of her authority under the power of attorney, and the arbitration clause this appeal seeks to enforce was void. The issue this case presented for the Court of Appeal’s review centered on the scope of two statutes, the Power of Attorney Law (Prob. Code, sec. 4000 et seq. (PAL)), and the Health Care Decisions Law (Prob. Code, sec. 4600 et seq. (HCDL)), in light of the care a residential care facility for the elderly agreed to provide, and actually provided, in this instance (Health & Saf. Code, sec. 1569 et seq.). For resolution, the Court had to parse the authority of two of the principal’s relatives, one holding a power of attorney under the PAL and one holding a power of attorney under the HCDL. The Court concluded admission of decedent to the residential care facility for the elderly in this instance was a health care decision, and the attorney-in-fact who admitted her, acting under the PAL, was not authorized to make health care decisions on behalf of the principal. As a result of this conclusion, the Court affirmed the trial court’s denial of a motion by the residential care facility to compel arbitration. Because the attorney-in-fact acting under the PAL did not have authority to make health care decisions for her principal, her execution of the admission agreement and its arbitration clause are void. View "Hutcheson v. Eskaton Fountainwood Lodge" on Justia Law

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In an appeal by allowance, the issue presented to the Pennsylvania Supreme Court was whether the Superior Court applied the correct statute of limitations for a survival action in a medical professional liability case. In 2005, Elise Dubose was admitted to Albert Einstein Medical Center (Einstein) after she fell in her home and sustained severe head injuries, including anoxia and a brain injury. She was transferred to Willowcrest Nursing Home where Mrs. Dubose suffered malnourishment, dehydration, conscious pain from bedsores, a bone infection, and a sepsis systemic infection. An ulcers located at the sacral region of the spine which Mrs. Dubose developed during her initial hospitalization, gradually increased in size. The sacral ulcer became infected with bacteria from contact with feces. This infection caused sepsis in Mrs. Dubose in September 2007, and she was admitted to Einstein with sepsis. On October 18, 2007, Mrs. Dubose died from sepsis and multiple pressure sores. On August 13, 2009, Robert Dubose, as administrator for Mrs. Dubose's estate, filed a complaint against Willowcrest and Albert Einstein Healthcare Network (collectively Appellants) sounding in negligence and alleged wrongful death. The Supreme Court concluded the statute of limitations for medical professional liability cases in the form of wrongful death or survival actions was two years from the time of the decedent’s death. View "Dubose v. Willowcrest Nur. Home" on Justia Law

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The DC Circuit affirmed the district court's judgment interpreting the preclusion-of-review provision in Section 1877 of the Social Security Act (the Stark Law), 42 U.S.C. 1395nn(a)(1)–(2), to deprive it of subject matter jurisdiction. The court held that "the process under this paragraph" encompasses all of section 1395nn(i)(3), including the granting or denial of expansion applications. Therefore, section 1395nn(i)(3)(I) precludes judicial review of plaintiff's claims. View "Knapp Medical Center v. Hargan" on Justia Law

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Artur Hefczyc appealed an order denying his motion for class certification in his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed class, Hefczyc sought declaratory relief to establish that Rady's form contract, signed by patients or guarantors of patients who receive emergency room care, authorized Rady to charge only for the reasonable value of its services, and that Rady therefore was not authorized to bill self-pay patients based on its master list of itemized charge rates, commonly referred to as the "Chargemaster" schedule of rates, which Hefczyc alleged was "artificial" and "grossly inflated." The trial court denied Hefczyc's motion for class certification, concluding that the class was not ascertainable, that common issues did not predominate, and that class action litigation was not a superior means of proceeding. Hefczyc contends that the trial court erred in denying class certification because, as the complaint sought only declaratory relief, the motion for class certification was brought under the equivalent of Federal Rules of Civil Procedure, rule 23(b)(1)(A) or (b)(2) (28 U.S.C.), for which he was not required to establish the ascertainability of the class, that common issues predominated and that class action litigation was a superior means of proceeding. Hefczyc also contended that even if the trial court properly imposed those three requirements in this action, the trial court abused its discretion in concluding that those requirements were not met. After review, the Court of Appeal concluded that Hefczyc's arguments lacked merit, and accordingly affirmed the order denying class certification. View "Hefczyz v. Rady Children's Hosp." on Justia Law

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The Supreme Court rejected a constitutional challenge to the provision in Ariz. Rev. Stat. 36-2901.08(A) that the director of Arizona’s indigent health care program, Arizona Health Care Cost Containment System (AHCCCS), “shall establish, administer and collect an assessment” from Arizona hospitals (the hospital assessment). The legislature added this provision to fund the costs remaining after federal monies to expand coverage under AHCCCS, as provided for in H.B. 2010, which the legislature enacted in 2013 by a simple majority vote. The Supreme Court held that the hospital assessment is not subject to Ariz. Const. art. IX, 22, which generally requires that acts providing for a net increase in state revenues be approved by a two-thirds vote in each house of the legislature, because the exception set forth in Ariz. Const. art. IX, 22(C)(2) that the above requirement does not apply to statutorily authorized assessments that “are not prescribed by formula, amount or limit, and are set by a state officer or agency” applied in this case. View "Biggs v. Betlach" on Justia Law

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Caremark is a pharmacy benefit manager. In 2006, Caremark employees identified approximately 4,500 Prescription Drug Events (PPDEs) under Medicare Part D that had been authorized for payment by Caremark, but not yet submitted to the Centers for Medicare and Medicaid Services (CMS), due to the lack of a compatible Prescriber ID. Caremark then used a dummy Prescriber ID for those PDEs and programmed that dummy Prescriber ID into its system. Thereafter, when any claim with a missing or incorrectly formatted Prescriber ID was processed, the system would default to the dummy, which allowed Caremark to submit for payment PDEs without trigging CMS error codes. Spay, a pharmacy auditor, discovered the use of “dummy” Prescriber IDs while auditing a Caremark client. That client dropped all issues identified in the audit, collected no recovery from Caremark, and did not pay Spay. Spay filed a qui tam lawsuit, asserting violations of the False Claims Act because the inaccurate PDEs were used to support reimbursement requests. The government declined to intervene. The court granted Caremark summary judgment, finding that Caremark had established sufficient government knowledge to preclude finding the required element of scienter, noting that several courts have adopted the government knowledge inference doctrine. The Third Circuit affirmed, declining to adopt that doctrine but stating that the misrepresentations were not material to the government’s decision to pay the underlying claims. View "Spay v. CVS Caremark Corp" on Justia Law