Justia Health Law Opinion Summaries

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After three former AseraCare employees alleged that AseraCare had a practice of knowingly submitting unsubstantiated Medicare claims in violation of the False Claims Act, the Government intervened and filed the operative complaint. The Eleventh Circuit held that a clinical judgment of terminal illness warranting hospice benefits under Medicare cannot be deemed false, for purposes of the False Claims Act, when there is only a reasonable disagreement between medical experts as to the accuracy of that conclusion, with no other evidence to prove the falsity of the assessment. However, the court held that the Government should have been allowed to rely on the entire record, not just the trial record, in making its case that disputed issues of fact, beyond just the difference of opinion between experts, existed sufficient to warrant denial of the district court’s post-verdict sua sponte reconsideration of summary judgment on the falsity question. Accordingly, the court affirmed in part and remanded in part. View "United States v. Aseracare, Inc." on Justia Law

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Plaintiff-relator Matthew Omlansky, by virtue of knowledge gleaned as a state employee involved with the Medi-Cal program, brought this qui tam action in the name of the State of California alleging that defendant Save Mart Supermarkets (Save Mart) had violated the False Claims Act in its billings to Medi-Cal for prescription and nonprescription medications, charging a higher price than cash customers paid in violation of 2009 statutory provisions capping Medi-Cal charges at a provider’s usual and customary price (“statutory cap”). Per the trial court, the gist of the alleged fraud upon Medi-Cal, Save Mart generally offered a lower price for medications to cash customers, and would also match a lower price that a competitor was offering (although it appears from an exhibit to the complaint that the latter applied only to prescriptions), but did not apply these discounts from its list prices in the billings it submitted to Medi-Cal. The State declined to intervene. The trial court sustained a demurrer to the original complaint because all of the alleged violations occurred during a period when the 2009 statutory cap was subject to a federal injunction. Plaintiff then filed an essentially identical amended complaint. The only significant change was an allegation in paragraph 45 that Save Mart’s billing practices favoring cash customers continued from December 2016 to March 2017 after the expiration of the injunction, specifying six examples of “illegal pricing.” The court sustained Save Mart’s demurrer to this pleading as to two of the six grounds raised, and denied leave to amend. It entered a judgment of dismissal. Plaintiff timely appealed, but the Court of Appeal concurred with the grounds for the trial court’s ruling, thereby affirming dismissal of Plaintiff’s complaint. View "Omlansky v. Save Mart Supermarkets" on Justia Law

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Defendant, a 24-hour skilled nursing facility, appealed an order denying its petition to compel arbitration of claims asserting negligent or willful misconduct, elder abuse, and wrongful death filed against it by decedent’s daughter as successor in interest and individually. The trial court found the successor claims were not arbitrable because no arbitration agreement existed between decedent and defendant, given defendant’s failure to prove daughter had authority to sign the agreement on decedent’s behalf. The court further found the arbitration agreement was unenforceable against daughter individually on grounds of unconscionability. Finding no reversible error, the Court of Appeal affirmed the trial court order. View "Lopez v. Bartlett Care Center, LLC" on Justia Law

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Cameo Williams, Sr. was a veteran of the United States Army, who spent his entire service stateside - never overseas or in combat. But for years, based on false statements about combat service, he obtained VA benefits for combat-related PTSD. The issue presented for the Tenth Circuit Court of Appeals in this case was whether it mattered about Williams’ lies about overseas service to obtain his PTSD benefits. The Court rejected Williams’s argument that his lie was not material under 18 U.S.C. 1001(a)(2), as well as his two challenges to evidentiary rulings. View "United States v. Williams" on Justia Law

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Appellees Augustus Feleccia and Justin Resch were student athletes who played football at Lackawanna Junior College (Lackawanna), a nonprofit junior college. Lackawanna had customarily employed two athletic trainers to support the football program. The Athletic Director, Kim Mecca, had to fill two trainer vacancies in the summer of 2009. She received applications from Kaitlin Coyne, and Alexis Bonisese. At the time she applied and interviewed for the Lackawanna position, Coyne had not yet passed the athletic trainer certification exam, and was therefore not licensed by the Board. Bonisese was also not licensed, having failed the exam on her first attempt, and still awaiting the results of her second attempt when she applied and interviewed for the Lackawanna position. Nevertheless, Lackawanna hired both Coyne and Bonisese in August 2009 with the expectation they would serve as athletic trainers, pending receipt of their exam results, and both women signed “athletic trainer” job descriptions. After starting their employment at Lackawanna, Coyne and Bonisese both learned they did not pass the athletic trainer certification exam. Mecca retitled the positions held by Coyne and Bonisese from “athletic trainers” to “first responders.” However, neither Coyne nor Bonisese executed new job descriptions, despite never achieving the credentials included in the athletic trainer job descriptions they did sign. Appellants were also aware the qualifications of their new hires was called into question by their college professors and clinic supervisors. In 2010, appellees participated in the first day of spring contact football practice, engaging in a variation of the tackling drill known as the “Oklahoma Drill.” While participating in the drill, both Resch and Feleccia suffered injuries. Resch attempted to make a tackle and suffered a T-7 vertebral fracture. Resch was unable to get up off the ground and Coyne attended to him before he was transported to the hospital in an ambulance. Later that same day, Feleccia was injured while attempting to make his first tackle, experiencing a “stinger” in his right shoulder, i.e., experiencing numbness, tingling and a loss of mobility in his right shoulder. Bonisese attended Feleccia and cleared him to continue practice “if he was feeling better.” In this discretionary appeal arising from the dismissal of appellees’ personal injury claims on summary judgment, the Pennsylvania Supreme Court considered whether the superior court erred in: (1) finding a duty of care; and (2) holding a pre-injury waiver signed by student athletes injured while playing football was not enforceable against claims of negligence, gross negligence, and recklessness. After careful review, the Court affirmed the superior court’s order only to the extent it reversed the trial court’s entry of summary judgment on the claims of gross negligence and recklessness. The Case was remanded back to the trial court for further proceedings. View "Feleccia v. Lackawanna College, et al." on Justia Law

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Sarah DeMichele, M.D., was a board-certified psychiatrist licensed to practice medicine in Pennsylvania. From August 2011 through February 2013, Dr. DeMichele provided psychiatric care to M.R. M.R. struggled with suicidal ideations and engaged in a pattern of self-harming behavior, which she discussed regularly with Dr. DeMichele. In December 2012, M.R.’s self-inflicted injuries necessitated emergency medical treatment. M.R. ultimately was transferred to a Trauma Disorders Program in Maryland. In the program, M.R. was treated by psychiatrist Richard Loewenstein, M.D., and psychologist Catherine Fine, Ph.D. During the course of his treatment of M.R., Dr. Loewenstein obtained M.R.’s medical records from Dr. DeMichele. In 2014, Dr. Loewenstein submitted a complaint to the Professional Compliance Office of Pennsylvania’s State Board of Medicine (“Board”), in which he alleged that Dr. DeMichele’s care of M.R. was professionally deficient. Dr. Loewenstein’s complaint prompted an investigation and, ultimately, the initiation of disciplinary proceedings against Dr. DeMichele. In 2015, the Pennsylvania Department of State’s Bureau of Professional and Occupational Affairs (“Bureau”) filed an order directing Dr. DeMichele to show cause as to why the Board should not suspend, revoke, or restrict her medical license, or impose a civil penalty or the costs of investigation. In advance of the hearing, Dr. DeMichele requested that the hearing examiner issue subpoenas for the testimony of M.R. and the medical records of Dr. Loewenstein, Dr. Fine, the program, and M.R.’s former treating psychologist, April Westfall, Ph.D. Relying upon the authority provided under 63 P.S. 2203(c), the hearing examiner issued the requested subpoenas. However, when served with the subpoenas, all of M.R.’s treatment providers refused to release their records absent a court order or M.R.’s authorization. M.R. subsequently refused to authorize the release of her records. In this direct appeal, the Pennsylvania Supreme Court was asked to consider the enforceability of the subpoenas, as well as related questions regarding the scope and applicability of numerous statutes that protect a patient’s medical information. The Commonwealth Court granted the physician’s petition to enforce the subpoenas. Because the Supreme Court concluded the Commonwealth Court lacked subject matter jurisdiction to decide the issue, it vacated that court’s order. View "In Re: Enforcement of Subpoenas b/f the Bd of Med." on Justia Law

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The Supreme Court reversed the decision of the court of appeal affirming the finding of the City of San Diego that adoption of an ordinance authorizing the establishment of medical marijuana dispensaries and regulating their location and operation did not constitute a project, holding that the court of appeal misapplied the test for determining whether a proposed activity has the potential to cause environmental change under Cal. Pub. Res. Code 21065. The City did not conduct any environmental review when adopting the ordinance, finding that adoption of the ordinance did not constitute a project for purposes of the California Environmental Quality Act, Cal. Pub. Res. Code 21000 et seq. (CEQA). Petitioner filed a petition for writ of mandate challenging the City's failure to conduct CEQA review. The trial court denied the petition. The court of appeal affirmed, concluding that the City correctly concluded that the ordinance was not a project because it did not have the potential to cause a physical change in the environment. The Supreme Court reversed and remanded the case for further findings, holding that the City erred in determining that the adoption of the Ordinance was not a project. View "Union of Medical Marijuana Patients, Inc. v. City of San Diego" on Justia Law

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Kearney sought judicial review of the Board's decision denying its application to participate in the Medicare program. Although the facility later received approval, the initial denial prevented Kearney from participating in Medicare and receiving reimbursements for 87 days during 2014. The Eighth Circuit held that the Board failed adequately to explain the legal standard that it applied in resolving Kearney's administrative appeal. In this case, the court was unable to discern what meaning the Board attributed to 42 U.S.C. 1395x(e)(1) and the definition of "hospital." Furthermore, without an adequate explanation for what time period the agency considered in determining whether Kearney was primarily engaged in providing care to inpatients, the court was unable to resolve whether the Board's decision correctly applied the relevant legal standards. Therefore, the court reversed the district court's grant of summary judgment to the Department and remanded with directions. View "Kearney Regional Medical Center, LLC v. US Department of Health and Human Services" on Justia Law

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The Court of Appeals reversed the judgments of the Court of Special Appeals and circuit court dismissing D.L.'s petition for judicial review challenging her involuntary admission to a facility operated by Sheppard Pratt Health Systems, Inc. as moot based on her release from Sheppard Pratt, holding that D.L. faced collateral consequences as a result of her involuntary admission, and therefore, her appeal was not moot. An ALJ involuntarily admitted D.L. to Sheppard Pratt. After she was released, D.L. petitioned for judicial review. The circuit court granted Sheppard Pratt's motion to dismiss on grounds of mootness because D.L. had already been released from the facility. The Court of Special Appeals affirmed. The Court of Appeals reversed, holding that D.L. was subject to collateral consequences stemming from her involuntary admission, and therefore, the circuit court erred in dismissing the case as moot. View "D.L. v. Sheppard Pratt Health System Inc." on Justia Law

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A group of children's hospitals that receive Disproportionate Share Hospital (DSH) payments under the Medicaid Act filed suit challenging the Secretary's promulgation of a regulation defining "costs incurred" in furnishing hospital services to low income patients (the 2017 Rule). The DC Circuit reversed the district court's decision vacating the 2017 Rule and reinstated it, holding that the rule did not exceed the Secretary's statutory authority under the Medicaid Act and rejecting plaintiffs' reasons for why the statute did not grant the Secretary authority to require that payments by Medicare and private insurers be considered in calculating a hospital's "costs incurred;" the 2017 Rule is consistent with the statute's context and purpose, both of which suggest DSH payments are meant to assist those hospitals that need them most by covering only those costs for which DSH hospitals are in fact uncompensated; and the 2017 Rule was not a product of arbitrary and capricious reasoning. View "Children's Hospital Association of Texas v. Azar" on Justia Law