Justia Health Law Opinion Summaries

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After her claim for coverage under the Public Education Employees' Health Insurance Plan ("PEEHIP") was denied, Marilyn Player sued Blue Cross and Blue Shield of Alabama ("BCBS") at the Macon Circuit Court ("the trial court") asserting claims of breach of contract and bad faith. BCBS sought a writ of mandamus to direct the trial court to transfer Player's case to the Montgomery Circuit Court pursuant to section 16-25A-7(e), Ala. Code 1975. A complaint seeking judicial review of a decision of a PEEHIP claims administrator could be heard only by the Montgomery Circuit Court. Player argued that 16-25A-7(e) did not apply to her complaint because her claims, she contended, did not constitute an action for a dispute over the denial of benefits and her complaint could not be characterized as an appeal of any administrative action. Rather, the breach-of-contract and bad-faith claims, Player argued, were regular tort claims recognized by the common law of Alabama and therefore did not fall within the purview of 16-25A-7(e). The Alabama Supreme Court was not persuaded: "Player cannot avoid the legislature's exclusive-venue provision by recasting her claims using artful labels." The trial court exceeded its discretion in denying BCBS's motion for a change of venue from Macon County to Montgomery County. Despite Player's attempt to cast the issues in her complaint as regular tort claims, Player's breach-of-contract and bad-faith claims are, in essence, disputes over a final decision allegedly made by BCBS regarding Player's insulin medication. Section 16-25A-7(e) controlled in this action; therefore, venue was proper in Montgomery County. The Supreme Court granted the petition and issued the writ. The trial court was ordered to transfer the action to the Montgomery Circuit Court. View "Ex parte Blue Cross & Blue Shield of Alabama." on Justia Law

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Deborah Faison ("Deborah") died from cardiac arrest while she was a patient at Thomas Hospital in Fairhope, Alabama. Her husband Larry Faison ("Faison") then sued Gulf Health Hospitals, Inc. ("Gulf Health"), which owned and operated the hospital. Over a year after filing suit, Faison was allowed to amend his complaint by making additional factual allegations to support his claims. Gulf Health petitioned the Alabama Supreme Court for a writ of mandamus to direct the trial court to strike the amended complaint. Gulf Health argued the the amendment was untimely and without good cause. The Supreme Court determined Gulf Health did not meet its burden of showing that a postjudgment appeal was an inadequate remedy. Therefore, petition was denied. View "Ex parte Gulf Health Hospitals, Inc., d/b/a Thomas Hospital." on Justia Law

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Plaintiffs, collection agencies, appealed the district court's dismissals with prejudice of their claims against defendants, seeking double damages against defendants under the Medicare Secondary Payer Act and alleging that actors within the Medicare Advantage system, including Medicare Advantage Organizations (MAOs) and various "downstream actors" that contracted with MAOs, had assigned their Medicare Secondary Payer Act claims to plaintiffs for collection.The Eleventh Circuit vacated the dismissals of plaintiffs' claims based on assignments from downstream actors, holding that the district court erred by narrowly construing 42 U.S.C. 1395y(b)(3)(A) to categorically exclude claims by downstream actors. The court explained that both the text and the objective of section 1395y(b)(3)(A) support allowing downstream actors to bring suit, or assign their right to bring suit, against primary payers. Therefore, the court remanded these claims for further proceedings.The court found that the district court erred insofar as it dismissed MSPRC's HFAP claims with prejudice, and ordered that the district court's dismissal be without prejudice. The court also found that the district court erred in dismissing MSPA's FHCP and IMC claims based on the purported cancellation and validity of MSPA's assignments. Finally, defendants' alternative claims are without merit. The court vacated the dismissal of plaintiffs' remaining claims in case number 18-12149. In case number 18-13049, the court affirmed the dismissal of plaintiffs' claims but modified the dismissal of these claims to be without prejudice. View "MSP Recovery Claims, Series LLC v. Ace American Insurance Co." on Justia Law

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Baltimore filed suit against the Government, alleging that HHS's Final Rule, prohibiting physicians and other providers in Title X programs from referring patients for an abortion, even if that is the patient's wish, violates the Administrative Procedure Act (APA). The Final Rule, instead, requires them to refer the patient for prenatal care. Furthermore, the Final Rule requires entities receiving Title X funds, but offering abortion-related services pursuant to another source of funds, to physically separate their abortion-related services from the Title X services. After the district court issued a preliminary injunction enjoining the Government from implementing or enforcing the Final Rule because the Final Rule is likely not in accordance with law, the Government appealed. While the appeal of the preliminary injunction was pending and after discovery, the district court issued a permanent injunction on different grounds.The Fourth Circuit consolidated the appeals and a majority of the full court voted to hear both cases en banc. The court upheld the district court's grant of the permanent injunction on two grounds: first, the Final Rule was promulgated in an arbitrary and capricious manner because it failed to recognize and address the ethical concerns of literally every major medical organization in the country, and it arbitrarily estimated the cost of the physical separation of abortion services; and second, the Final Rule contravenes statutory provisions requiring nondirective counseling in Title X programs and prohibiting interference with physician/patient communications. Accordingly, because the court affirmed the permanent injunction in Case No. 20-1215, the appeal of the preliminary injunction in Case No. 19-1614 is moot and the court dismissed it. View "Mayor and City Council of Baltimore v. Azar" on Justia Law

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A jury convicted Sandra, Calvin, and their son Bryan Bailey of conspiring to commit healthcare fraud and other related crimes (18 U.S.C. 371, 1343, 1347; 42 U.S.C. 1320a-7b). The three, working for medical equipment companies, used fraud, forgery, and bribery to sell power wheelchairs and other equipment that was not medically necessary. The district court sentenced Sandra to 120 months’, Calvin to 45 months, and Bryan to 84 months’ imprisonment.The Sixth Circuit affirmed the convictions and the sentence imposed on Bryan. The court rejected challenges to the sufficiency of the evidence and to various evidentiary rulings and upheld the admission of certain out of court statements made in furtherance of the conspiracy. The district court miscalculated Sandra’s Guidelines-range sentence when it erroneously imposed a two-level increase in her offense level for using “mass marketing” in her scheme and incorrectly calculated the loss amount for which Calvin was responsible—and by extension, his Guidelines-range sentence—by holding him responsible for losses beyond those he agreed to jointly undertake. View "United States v. Bailey" on Justia Law

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Hepatitis C (HCV) is a bloodborne virus. Only about 1% of the general population suffers from HCV; its prevalence among prison inmates is much higher. HCV primarily attacks the liver, causing scarring, or “fibrosis,” which is measured from F0 (no fibrosis) to F4 (cirrhosis). Many people “spontaneously clear” HCV without treatment. HCV patients were previously prescribed weekly injections of Interferon, which caused unpleasant side effects, and succeeded in eradicating HCV only about 30% of the time. In 2013, a new HCV treatment became available—direct-acting antiviral (DAA) pills, with few side effects and a 95% cure rate. DAAs are very expensive.Chronic-HCV inmates incarcerated in Florida prisons filed a class action under 42 U.S.C. 1983, alleging deliberate indifference to inmates’ serious medical needs. Florida then hired Dr. Dewsnup, who had developed and implemented an HCV-treatment plan for the Oregon prison system. Florida adopted Dewsnup's proposal of providing DAAs for all inmates at level F2 and above and monitoring F0- and F1-level inmates and treating them with DAAs under certain circumstances. Ultimately, the court ordered DAA treatment of all F0s and F1s within two years of their initial staging. The Eleventh Circuit reversed. The state’s plan to monitor all HCV-positive inmates, including those who have not exhibited serious symptoms, and provide DAAs to anyone with an exacerbating condition, showing signs of rapid progression, or developing even moderate fibrosis, satisfies constitutional requirements. View "Hoffer v. Secretary, Florida Department Corrections" on Justia Law

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Hepatitis C is a contagious, progressive virus that can lead to cirrhosis of the liver, liver cancer, and ultimately death. There is no vaccine for hepatitis C. Doctors previously treated the virus using interferons; that treatment brought little success and severe side effects. In 2011, the FDA approved new direct-acting antivirals that halt the progress of hepatitis C and eventually cause the virus to disappear. In 2015, the cost of a single course of treatment using direct-acting antivirals was $80,000-$189,000. By the time of trial, those prices was $13,000-$32,000.A 2016 policy specified that the Tennessee Department of Corrections would provide the antivirals only to infected inmates with severe liver scarring. By 2019, approximately 4,740 of Tennessee's 21,000 inmates had hepatitis. Under a 2019 guidance, every new inmate is tested for hepatitis C. Inmates who test positive undergo a baseline evaluation; an advisory committee of healthcare professionals evaluates each infected inmate and determines his course of treatment. The guidance establishes criteria that make antivirals available to “individuals [who] are at higher risk for complications or disease progression," includes a series of procedural steps for local providers, and provides for continuous care and monitoring of infected inmates, regardless of their treatment plan.The Sixth Circuit affirmed the rejection of inmates' claims under 42 U.S.C. 1983, alleging deliberate indifference to their serious medical needs. The 2019 guidance showed reasonable medical judgment to care for the class of infected inmates. While the best course of action might be to treat all infected inmates with antivirals, the defendant could not spend more than was allocated and had repeatedly sought budget increases. View "Atkins v. Parker" on Justia Law

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The Court of Appeals affirmed the judgment of circuit court judge upholding the order of the administrative law judge (ALJ) ordering Gregory Johnson's involuntary medication, holding that there was no error in the order authorizing Johnson's involuntary medication.Johnson was charged with attempted first-degree murder and related offenses. The circuit court found Johnson incompetent to stand trial and dangerous and committed him for treatment to a state-run forensic psychiatric hospital. After Johnson repeatedly refused to take prescribed antipsychotic medication the Maryland Department of Health began the process to administer the medication to Johnson involuntarily. An ALJ ordered Johnson's involuntary medication to restore him to competency, and the circuit court upheld the order. The Court of Appeals affirmed, holding (1) Maryland law authorizes involuntary medication to restore an individual's competence to stand trial and does not violate separation of powers by entrusting an ALJ with the power to order such medication subject to judicial review; and (2) because the Department and the ALJ met due process requirements, there was no error in the order authorizing Johnson's involuntary medication. View "Johnson v. Department of Health" on Justia Law

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Almost three years after a federal district court declared that Texas Senate Bill 8 placed an undue burden on a woman's right to access a previability abortion and enjoined its enforcement, the State seeks to stay the judgment.The Fifth Circuit denied the state's motion for a stay and held that June Medical Servs. LLC v. Russo, 140 S. Ct. 2103 (2020), has not disturbed the undue-burden test, and Whole Woman's Health v. Hellerstedt, 136 S. Ct. 2292 (2016), remains binding law in this circuit. Under this circuit's reading of the Marks principle, that the challenged Louisiana law posed an undue burden on women seeking an abortion is the full extent of June Medical's ratio decidendi. The court stated that the decision does not furnish a new controlling rule as to how to perform the undue-burden test. Therefore, the court held that Hellerstedt's formulation of the test continues to govern this case, and because the district court correctly applied Hellerstedt's balancing test, remand is not warranted.The court also held that the state's law is patently procedurally defective where the state's failure to show the impracticability of moving first in the district court under Federal Rule of Appellate Procedure 8(2) is sufficient grounds to deny its motion. View "Whole Woman's Health v. Paxton" on Justia Law

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The Supreme Court held that the Arizona Department of Health Services' (ADHS) interpretation of Arizona Administrative Code R9-17-303, which governs ADHS's allocation of marijuana dispensary registration certificates, violated Ariz. Rev. Stat. 36-2804(C).On June 16, 2016, ADHS announced that, because every county had at least one dispensary, it would allocate new registration certificates based on other factors set forth in R9-17-303. Saguaro Healing LLC timely applied for a certificate for its dispensary in La Paz County. During the application period, the only dispensary in La Paz County relocated out of the county. ADHS, however, did not consider the vacancy when prioritizing registration certificates and did not issue a certificate to Saguaro, leaving La Paz County without a dispensary. Saguaro filed a complaint for special action. The trial court dismissed the complaint because R9-17-303(B) "does not say when, during the process of issuing new certificates, [ADHS] must determine how certificates will be allocated." The Supreme Court reversed, holding (1) Ariz. Rev. Stat. 36-2804(C) requires ADHS to issue at least one medical marijuana dispensary registration certificate in each county with a qualified applicant; and (2) ADHS's interpretation of R9-17-303 contrary to this statutory mandate violates section 36-2804(C). View "Saguaro Healing LLC v. State" on Justia Law