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Goodman served in the U.S. Army, 1972-1992, with service in Southwest Asia during the Persian Gulf War. During his service and at his discharge, Goodman underwent medical examinations that returned negative for rheumatoid arthritis; he denied having pain in his joints or arthritis. In 2007, Goodman sought treatment at a VA medical center for hand stiffness and knee pain, which he said had begun during service. He sought VA benefits for rheumatoid arthritis. The Board sought an independent medical advisory opinion from the Veterans Health Administration, which was conducted by a VA medical center Director of Rheumatology in 2014 and concluded that “it is less likely than not” that Goodman’s rheumatoid arthritis can be characterized as a medically unexplained chronic multi-symptom illness (MUCMI) under 38 C.F.R. 3.317, and that it “is less likely than not that his rheumatoid arthritis is related to a specific exposure event experienced … during service. The Board concluded that Goodman was not entitled to a presumptive service connection for a MUCMI; the Federal Circuit affirmed. The VA adjudicator may consider evidence of medical expert opinions and all other facts of record to make the final determination of whether a claimant has proven, based on the claimant’s unique symptoms, the existence of a MUCMI. View "Goodman v. Shulkin" on Justia Law

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Home health referral sources can be a protected legitimate business interest under Fla. Stat. 542.335. In these two cases consolidated for review before the Supreme Court, both Employees were former employees of licensed home health care companies. Both Employees engaged in conduct in violation of their non-compete compliment contracts by working for direct competitors of their prior employers within the non-compete territories during the relevant periods. Because a contract providing restrictions on competition must involve a legitimate business interest as defined by statute to be enforceable, at issue was whether home health service referral sources can be a protected legitimate business interest under section 542.335 sufficient to support a restriction on competition in a contract. The Supreme Court held that home health service referrals may be a protected legitimate business interest depending on the context and proof adduced. View "White v. Mederi Caretenders Visiting Services of Southeast Florida, LLC" on Justia Law

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The Supreme Judicial Court vacated the judgment of the superior court concluding that a provider’s participation in MaineCare constitutes a “license,” the revocation of which invokes the district court jurisdiction. The superior court declared that the district court, and not the Department of Health and Human Services, had exclusive original jurisdiction over the decision to terminate a doctor’s participation in, and reimbursement from, MaineCare and any other medical assistance programs in the state of Maine. The Supreme Judicial Court vacated the judgment entered in favor of the doctor and remanded the matter, holding that the Department’s decision to terminate the doctor’s participation in the MaineCare program did not fall within the licensing decisions over which the legislature gave the district court original and exclusive jurisdiction. View "Doane v. Department of Health & Human Services" on Justia Law

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Altapointe Health Systems, Inc., and Altapointe Healthcare Management, LLC (collectively referred to as "Altapointe"), petitioned for a writ of mandamus to direct the Mobile Circuit Court to vacate its order compelling Altapointe to respond to certain discovery requests and to enter a protective order in its favor in an action pending against it. Jim Avnet, as father and next friend of Hunter Avnet, sued Altapointe. Altapointe operated group homes for adults suffering from mental illness. Avnet asserted that Hunter, a resident at one of Altapointe's group homes, was assaulted by another resident with a blunt object, and was stabbed multiple times with a kitchen knife. Avnet asserted various claims of negligence and wantonness against Altapointe, including claims that Altapointe failed to comply with various unspecified regulations and guidelines designed to protect Hunter's safety and that Altapointe was negligent or wanton in hiring, training, and supervising its employees. Along with his complaint, Avnet served Altapointe with written discovery requests. Avnet's discovery requests sought the total amount of Altapointe's liability-insurance coverage limits; information regarding prior claims or lawsuits against Altapointe alleging personal injury or assault at the home; information concerning whether Altapointe was aware of any previous "aggressive acts" by the resident; and information and documents regarding Altapointe's own investigation of the incident. Altapointe objected to Avnet's discovery requests, contending that the information and documents requested were protected by certain discovery privileges. The Alabama Supreme Court concluded Altapointe offered sufficient evidence demonstrating that it was entitled to the quality-assurance privilege provided in 22-21-8, Ala. Code 1975 as to Avnet's request for information and documents relating to Altapointe's own investigation of the incident. Accordingly, the petition for writ of mandamus was granted as to that request. As to the remaining requests, however, Altapointe did not sufficiently establish that the discovery protections of the AMLA or the psychotherapist-patient privilege applied. Thus, as to those requests, the petition was denied. View "Ex parte Altapointe Health Systems, Inc." on Justia Law

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The Court of Appeals rejected Plaintiffs’ argument that an individual has a fundamental constitutional right to aid-in-dying as defined by Plaintiffs and also rejected Plaintiffs’ assertion that the State’s prohibition on assisted suicide is not rationally related to legitimate state interests. Plaintiffs filed this action requesting declaratory and injunctive relief to permit “aid-in-dying,” which would allow a mentally competent, terminally ill patient to obtain a prescription from a physician to cause death. The Attorney General filed a motion to dismiss on the grounds that Plaintiffs failed to state a cause of action and did not present a justiciable controversy. Supreme Court granted the motion. The Appellate Division affirmed as modified, declaring that the assisted suicide statutes provide a valid statutory basis to prosecute physicians who provide aid-in-dying and that the statutes do not violate the New York Constitution. The Court of Appeals affirmed, holding (1) the State Constitution’s Due Process Clause does not encompass a fundamental right to physician-assisted suicide; and (2) the State’s prohibition is rationally related to a number of legitimate state interests, and heightened scrutiny is unwarranted. View "Myers v. Schneiderman" on Justia Law

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Defendant Horizon Healthcare Services, Inc., New Jersey’s largest health insurer, maintained a two-tiered provider-hospital system. Plaintiff Saint Peter’s University Hospital, Inc., and plaintiff Capital Health System, Inc. and others, commenced separate lawsuits claiming Horizon treated them unfairly and in a manner that contravened their agreements when they were placed in the less advantageous Tier 2. Plaintiffs assert Horizon’s tiering procedures were pre-fitted or wrongfully adjusted to guarantee selection of certain larger hospitals for the preferential Tier 1. The New Jersey Supreme Court was asked, by way of interlocutory appeal, to settle multiple discovery disputes that arose in the course of the litigation. The Supreme Court concluded the Appellate Division exceeded the limits imposed by the standard of appellate review both by assessing the disputed information’s relevance against the panel’s own disapproving view of the merits and by giving no apparent weight or consideration to the protections afforded by confidentiality orders. Having closely examined the record, the Supreme Court rejected the Appellate Division’s determination that the chancery judges encharged with these matters abused their discretion. It was not an abuse of discretion for the chancery judges to find the information sought was relevant to plaintiffs’ claims that Horizon violated either the network hospital agreements’ contractual terms, or the overarching implied covenant of good faith and fair dealing, when they were relegated to the less desirable Tier 2. View "Capital Health System, Inc. v. Horizon Healthcare Services, Inc." on Justia Law

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Plaintiffs Managed Health Care Administration, Inc. ("MHCA"), and Alabama Psychiatric Services, P.C. ("APS") appealed the denial of their motion to compel Blue Cross and Blue Shield of Alabama ("Blue Cross") to arbitrate their claims. In 1986, Blue Cross contracted with APS, a subsidiary of MHCA, to provide mental-health services to Blue Cross's insureds. In 1991, Blue Cross's contract with APS was transferred to MHCA. In 1995, Blue Cross and MHCA entered into a new contract in which MHCA agreed to provide or arrange for mental-health services to Blue Cross's insureds. In 2006, Blue Cross and MHCA entered into yet another contract in which MHCA agreed to provide or arrange for mental-health services to Blue Cross's insureds. In late 2012, Blue Cross decided to replace MHCA, as its behavioral health benefits management vendor, with New Directions Behavioral Health, L.L.C. In 2013, Blue Cross and New Directions Behavioral Health, L.L.C. ("New Directions"), entered into a contract in which New Directions agreed to "arrange for the provision of all Covered Services to Members in accordance with the terms and conditions set forth in this Agreement," which gave New Directions authority to delegate certain services to third parties. pursuant to the authority granted it under the Blue Cross-New Directions 2013 contract and at the request of Blue Cross, New Directions entered into a contract which MHCA in which New Directions sub-delegated to MHCA certain of New Directions' obligations under the Blue Cross-New Directions 2013 contract. A disagreement arose concerning the amount of compensation MHCA was to receive for its services. In 2015, the plaintiffs sued Blue Cross and several fictitiously named defendants alleging fraudulent misrepresentation, fraudulent suppression, breach of an implied contract, and promissory estoppel, claims pertaining to plaintiffs' 2006 contract and for payments of delegated duties. After review, the Alabama Supreme Court concluded plaintiffs demonstrated they had a right to arbitration. The circuit court erred in denying the plaintiffs' motion to compel arbitration, and the Court reversed the circuit court's judgment denying the plaintiffs' motion to compel arbitration in its entirety. View "Managed Health Care Administration, Inc. v. Blue Cross & Blue Shield of Alabama" on Justia Law

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Alternative Medicine Maryland, LLC (AMM) sued the Natalie M. LaPrade Medical Cannabis Commission, its members, and the Department of Health and Mental Hygiene after AMM applied for, but did not receive, pre-approval for a medical cannabis grower license. AMM sought a declaratory judgment and preliminary and permanent injunctive relief, arguing that the Commission failed to follow applicable law with respect to the requirement to consider racial and ethnic diversity of potential medical cannabis grower licensees and requested that the Commission be required to reconnect the pre-approval process. Relevant to this appeal, the circuit court denied a motion to intervene filed by medical cannabis growers that had received pre-approvals for medical cannabis grower licenses, a coalition and trade association that advocate for the use of medical cannabis, and patients who would potentially receive medical cannabis as treatment for illnesses. The Supreme Court held (1) the growers were entitled to intervention as of right and permissive intervention; but (2) the circuit court did not err in denying intervention as of right or permissive intervention as to the patients and the trade association petitioners. View "Doe v. Alternative Medicine Maryland, LLC" on Justia Law

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KESA, the Kentucky Workers’ Compensation Fund, on behalf of its insureds, filed five separate medical fee disputes against the Injured Workers’ Pharmacy (IWP) and the insureds’ employees and former employees, all of whom had their prescriptions filled by IWP. The chief administrative law judge (CALJ) found (1) a pharmacy/pharmacist is a medical provider, which entitles an injured worker to choose where to have his or her prescriptions filled; (2) the pharmacy fee schedule is based on the amount a pharmacist pays a wholesaler for medication, and IWP is entitled to interest on any underpayment by KESA; and (3) because KESA brought its medical fee disputes without reasonable ground and without reasonable medical or factual foundation, KESA was required to pay the cost of the proceedings. The Workers’ Compensation Board reversed the award of costs but otherwise affirmed. The court of appeals affirmed. The Supreme Court affirmed in part, vacated in part, and remanded, holding (1) the court of appeals did not err regarding the assessment of interest and sanctions or in concluding that a pharmacy is a medical provider; but (2) the remainder of the court of appeals opinion is vacated and remanded because the CALJ did not make a determination regarding the actual average wholesale price paid by IWP. View "Steel Creations by and through KESA, the Kentucky Workers’ Compensation Fund v. Injured Workers’ Pharmacy" on Justia Law

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St. Vincent Health group acquired Randolph County Hospital and decided to replace the 80-year-old building. In 2002 the Hospital financed the project by borrowing $15.3 million from a fraternal corporation. Within a year, St. Vincent Health group was acquired by Ascension, the nation’s largest Roman Catholic health-care system. Ascension loaned the Hospital $15.6 million to refinance the loan. The Hospital sought reimbursement under 42 U.S.C. 1395f(b)(1), 1395x(v)(1)(A), and 42 C.F.R. 413.153, for “the necessary and proper costs of financing medical facilities.” Recognizing its problems with poor documentation, the Hospital withdrew its request that Medicare cover any expense before 2004 but requested compensation for 2004-2008, after Ascension had refinanced the loan in compliance with section 413.153(c)(2). The Provider Reimbursement Review Board ordered the 2004-2008 claims paid, finding that problems with the 2002 loan did not taint the refinancing. The Centers for Medicare and Medicaid Services reversed. The district court rejected reasoning concerning the initial loan but granted summary judgment, finding that the Hospital had not established that the Ascension loan refinanced that loan. The Seventh Circuit vacated, stating the “taint” theory is legally untenable and cannot be reasserted on remand, but the agency is free to request more or better documentation and to explore the significance of the difference in the principal amounts of the loans. View "St. Vincent Randolph Hospital, v. Price" on Justia Law