Justia Health Law Opinion Summaries

Sardar Ashrafkhan owned and operated a fraudulent medical practice where doctors wrote and billed Medicare for fake prescriptions. These prescriptions were filled at specific pharmacies, which paid Ashrafkhan kickbacks. The scheme resulted in millions of dollars in fraudulent Medicare claims and the illegal sale of opioid-based drugs. Ashrafkhan was indicted in 2013 and tried in 2015, where the government presented evidence that he masterminded the scheme. The jury convicted him of drug conspiracy, health care fraud conspiracy, and money laundering. At sentencing, he received an adjustment for being an organizer or leader of a criminal activity involving five or more participants.The United States District Court for the Eastern District of Michigan sentenced Ashrafkhan to 276 months of imprisonment, varying downward from the guidelines range of 600 months. Ashrafkhan appealed, and the United States Court of Appeals for the Sixth Circuit affirmed his conviction and sentence. After his sentencing, the United States Sentencing Commission promulgated a new guideline, USSG § 4C1.1, which provides a two-point reduction in the offense level for defendants with no criminal history points, known as "zero-point offenders." Ashrafkhan moved for a sentence reduction under this new guideline, but the district court denied his motion, reasoning that his aggravating role adjustment rendered him ineligible for the reduction.The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's decision. The court held that to be eligible for the zero-point offender reduction under USSG § 4C1.1, a defendant must not have received an aggravating role adjustment and must not have engaged in a continuing criminal enterprise. Since Ashrafkhan received an aggravating role adjustment, he was ineligible for the reduction, regardless of whether he engaged in a continuing criminal enterprise. The court's interpretation was based on the plain text and context of the guideline, as well as precedent from similar cases. View "United States v. Ashrafkhan" on Justia Law

A hospital in Siskiyou County, California, filed a lawsuit against the County of Siskiyou and other defendants, challenging the practice of bringing individuals with psychiatric emergencies to its emergency department under the Lanterman-Petris-Short (LPS) Act. The hospital argued that it was not equipped or licensed to provide the necessary psychiatric care and sought to prevent the county from bringing such patients to its facility unless they had a physical emergency condition. The hospital also sought reimbursement for the costs associated with holding these patients.The Siskiyou County Superior Court denied the hospital's motion for a preliminary injunction, which sought to stop the county from bringing psychiatric patients to its emergency department. The court found that the hospital had not demonstrated a likelihood of success on the merits and that the burden on the county and the potential harm to the patients outweighed the hospital's concerns.The hospital's complaint included several causes of action, including violations of Medicaid laws, disability discrimination laws, mental health parity laws, and section 17000 of the Welfare and Institutions Code. The hospital also alleged breach of an implied-in-fact contract for the costs incurred in providing post-stabilization services to psychiatric patients. The trial court sustained demurrers to the complaint without leave to amend, finding that the hospital failed to identify any clear legal mandate that the county or the Department of Health Care Services had violated.The California Court of Appeal, Third Appellate District, affirmed the trial court's judgment of dismissal. The appellate court concluded that the hospital had not identified any mandatory and ministerial duty that the county or the department had violated, which is necessary to obtain a writ of mandate. The court also found that the hospital's breach of contract claim failed because there were no allegations of mutual consent to an implied contract. Consequently, the hospital's appeal from the denial of its motion for a preliminary injunction was dismissed as moot. View "Siskiyou Hospital v. County of Siskiyou" on Justia Law

Michael Chapman, an Alabama inmate, sued prison officials and staff for deliberate indifference to his medical needs, violating the Eighth Amendment. Chapman alleged that an untreated ear infection led to severe injuries, including mastoiditis, a ruptured eardrum, and a brain abscess. He also claimed that the prison's refusal to perform cataract surgery on his right eye constituted deliberate indifference. The district court granted summary judgment for all defendants except the prison’s medical contractor, which had filed for bankruptcy.The United States District Court for the Middle District of Alabama found Chapman’s claim against nurse Charlie Waugh time-barred and ruled against Chapman on other claims, including his request for injunctive relief against Commissioner John Hamm, citing sovereign immunity. The court also concluded that Chapman’s claims against other defendants failed on the merits and dismissed his state-law claims without prejudice.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court reversed the district court’s determination that Chapman’s claim against Waugh was time-barred, finding that Chapman’s cause of action accrued within the limitations period. The court vacated the district court’s judgment for Waugh and remanded for reconsideration in light of the recent en banc decision in Wade, which clarified the standard for deliberate indifference claims. The court also vacated the judgment for Hamm on Chapman’s cataract-related claim for injunctive relief, as sovereign immunity does not bar such claims. Additionally, the court vacated the summary judgment for all other defendants due to procedural errors, including inadequate notice and time for Chapman to respond, and remanded for further consideration. View "Chapman v. Dunn" on Justia Law

Ricky Koel sought emergency care at Citizens Medical Center in Colby, Kansas, after sustaining serious injuries to his right eye. He was evaluated by a triage nurse, a physician assistant, and Dr. Daniel Kuhlman, who suspected a possible globe rupture. Dr. Sam Funk, an optometrist, also examined Koel but did not confirm an open globe rupture. A CT scan indicated a possible globe rupture, but Dr. Kuhlman did not share these results with the specialists. Koel was discharged with instructions to see an ophthalmologist the next morning. Despite undergoing emergency surgery the following day, Koel ultimately lost vision in his injured eye.The United States District Court for the District of Kansas dismissed Koel's EMTALA claim, concluding that Citizens Medical Center did not violate the Act's requirements. The court granted summary judgment in favor of Citizens and declined to exercise supplemental jurisdiction over Koel's state-law claims.The United States Court of Appeals for the Tenth Circuit reviewed the case. The court held that Citizens Medical Center provided an appropriate medical screening examination within its capabilities and adhered to its own standard procedures, as required by EMTALA. The court also found that Citizens did not have actual knowledge of Koel's specific emergency medical condition (an occult globe rupture) and therefore was not obligated to stabilize him for that condition before discharge. The court affirmed the district court's summary judgment in favor of Citizens Medical Center. View "Koel v. Citizens Medical Center" on Justia Law

Elizabeth Holmes and Ramesh "Sunny" Balwani, founders of Theranos, were convicted of defrauding investors about the capabilities of their company's blood-testing technology. Theranos claimed it could run accurate tests with just a drop of blood, attracting significant investments. However, the technology was unreliable, and the company misled investors about its financial health, partnerships, and the validation of its technology by pharmaceutical companies.The United States District Court for the Northern District of California severed their trials due to Holmes's allegations of abuse by Balwani. Holmes was convicted on four counts related to investor fraud, while Balwani was convicted on all counts, including conspiracy to commit wire fraud against investors and patients. Holmes was sentenced to 135 months, and Balwani to 155 months in prison. The district court also ordered them to pay $452 million in restitution.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the convictions, sentences, and restitution order. It held that the district court did not abuse its discretion in admitting testimony from former Theranos employees, even if some of it veered into expert territory. The court found any errors in admitting this testimony to be harmless due to the weight of other evidence against the defendants.The Ninth Circuit also upheld the district court's decision to admit a report from the Center for Medicare and Medicaid Services, finding it relevant to Holmes's knowledge and intent. The court rejected Holmes's argument that the district court violated her Confrontation Clause rights by limiting cross-examination of a former Theranos lab director. Additionally, the court found no merit in Balwani's claims of constructive amendment of the indictment and Napue violations. The court concluded that the district court's factual findings on loss causation and the number of victims were not clearly erroneous and affirmed the restitution order. View "USA V. HOLMES" on Justia Law

A medical doctor, employed by San Bernardino Medical Group and working for OptumCare Medical Group, faced a summary suspension of his clinical privileges by PrimeCare Medical Network, Inc. after a patient complaint. The patient alleged that the doctor hit her hand during an office visit, which the doctor admitted to in his notes, explaining it was to stop her from arguing. The next day, PrimeCare’s Chief Medical Officer (CMO) summarily suspended the doctor’s privileges, citing imminent danger to patient health.The Corporate Quality Improvement Committee (CQIC) upheld the suspension pending the doctor’s completion of an anger management course. The doctor requested a formal hearing, and PrimeCare’s Judicial Hearing Committee (JHC) found that the summary suspension was not warranted, as the incident was isolated and did not demonstrate imminent danger. The JHC recommended anger management and a chaperone for the doctor but did not find the suspension justified.PrimeCare’s Board of Directors reviewed the JHC’s decision, arguing it was inconsistent with the applicable burden of proof. The Board conducted an independent review, disagreed with the JHC’s findings, and reinstated the suspension, concluding that the doctor’s actions and subsequent comments posed an imminent threat to patients.The doctor filed a petition for writ of administrative mandamus, which the Superior Court of San Bernardino County granted. The court ruled that the Board exceeded its jurisdiction and committed a prejudicial abuse of discretion by independently reviewing and reversing the JHC’s decision. The court ordered the Board to adopt the JHC’s decision, reinstate the doctor’s privileges, and report the reinstatement to relevant entities.The California Court of Appeal, Fourth Appellate District, affirmed the trial court’s judgment, agreeing that the Board’s actions were unauthorized and inconsistent with the statutory requirement that peer review be performed by licentiates. View "Lin v. Board of Directors of PrimeCare Medical Network" on Justia Law

The case involves the United States government alleging that Regeneron Pharmaceuticals violated the Anti-Kickback Statute (AKS) by covering copayments for patients prescribed Eylea, a drug used to treat wet age-related macular degeneration. The government contends that this action induced doctors to prescribe Eylea, leading to Medicare claims that were "false or fraudulent" under the False Claims Act (FCA) because they "resulted from" the AKS violation.The United States District Court for the District of Massachusetts reviewed the case and agreed with Regeneron's interpretation that the phrase "resulting from" in the 2010 amendment to the AKS requires a but-for causation standard. This means that the government must prove that the AKS violation was the actual cause of the Medicare claims. The district court noted the conflict in case law and sought interlocutory review, which was granted.The United States Court of Appeals for the First Circuit affirmed the district court's ruling. The court held that the phrase "resulting from" in the 2010 amendment to the AKS imposes a but-for causation requirement. The court reasoned that the ordinary meaning of "resulting from" requires actual causality, typically in the form of but-for causation, unless there are textual or contextual indications to the contrary. The court found no such indications in the 2010 amendment or its legislative history. Therefore, to establish falsity under the FCA based on an AKS violation, the government must prove that the kickback was a but-for cause of the submitted claim. View "United States v. Regeneron Pharmaceuticals, Inc." on Justia Law

A medical institute and its co-director sought to provide patients with psilocybin, a schedule I controlled substance, for therapeutic use. They requested the Drug Enforcement Administration (DEA) to exempt the co-director from registration under the Controlled Substances Act (CSA) or to waive the registration requirement. The DEA declined both requests, leading the petitioners to seek judicial review.Previously, the petitioners had asked the DEA for guidance on accommodating the Right to Try Act (RTT Act) for psilocybin use. The DEA responded that the RTT Act did not waive CSA requirements, and the petitioners' initial judicial review was dismissed for lack of jurisdiction. The petitioners then made a concrete request to the DEA for exemption or waiver, which the DEA again denied, prompting the current appeal.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that it had jurisdiction under 21 U.S.C. § 877 to review the DEA's final decision. The court found that the DEA's denial was not arbitrary and capricious. The DEA provided a reasonable explanation, stating that the RTT Act did not exempt the CSA's requirements and that the proposed use of psilocybin was inconsistent with public health and safety. The DEA also noted that the petitioners did not provide sufficient details for the proposed regulation. The court denied the petition for review, affirming the DEA's decision. View "ADVANCED INTEGRATIVE MEDICAL SCIENCE INSTITUTE, PLLC V. UNITED STATES DRUG ENFORCEMENT ADMIN" on Justia Law

In this case, inmates at the Louisiana State Penitentiary (LSP) filed a class action lawsuit in 2015 against the warden, the Louisiana Department of Public Safety and Corrections, and other officials. The plaintiffs alleged that the defendants were deliberately indifferent to their serious medical needs, violating the Eighth Amendment, the Rehabilitation Act of 1973, and the Americans with Disabilities Act (ADA). The district court bifurcated the case into liability and remedy phases. After an eleven-day bench trial, the court found in favor of the plaintiffs on all claims. Subsequently, a ten-day trial on remedies concluded that the plaintiffs were entitled to permanent injunctive relief, but the court did not specify the relief in its judgment.The United States District Court for the Middle District of Louisiana entered a "Judgment" in favor of the plaintiffs and a "Remedial Order" outlining the appointment of special masters to develop remedial plans. The defendants appealed, arguing that the district court's judgment and remedial order were final and appealable under 28 U.S.C. § 1291 or, alternatively, under 28 U.S.C. § 1292(a)(1).The United States Court of Appeals for the Fifth Circuit reviewed the case and concluded that the district court had not entered a final decision appealable under 28 U.S.C. § 1291, nor had it entered an injunction appealable under 28 U.S.C. § 1292(a)(1). The appellate court determined that the district court's actions were not final because they contemplated further proceedings, including the appointment of special masters and the development of remedial plans. Consequently, the Fifth Circuit dismissed the appeal for lack of jurisdiction and vacated the stay of the remedial order. View "Parker v. Hooper" on Justia Law

Dr. Thomas C. Weiner, an oncologist, had his medical staff membership and clinical privileges revoked by St. Peter’s Health (SPH) in 2020. Concerns about his patient care practices, including manipulation of DNR status, substandard care, and inappropriate chemotherapy treatments, led to an investigation by SPH’s Peer Review Committee (PRC) and Medical Executive Committee (MEC). External reviews from the University of Utah and the Greeley Company supported these concerns, prompting SPH to take corrective actions.The First Judicial District Court, Lewis and Clark County, denied Weiner’s motion for summary judgment and granted summary judgment to SPH, concluding that SPH was entitled to immunity under the Health Care Quality Improvement Act (HCQIA). The court found that SPH’s actions were taken in the reasonable belief that they were in furtherance of quality health care, after a reasonable effort to obtain the facts, and with adequate notice and hearing procedures.The Supreme Court of the State of Montana reviewed the case and affirmed the lower court’s decision. The court held that SPH’s actions met the standards specified in the HCQIA, granting them immunity from damages. The court found that SPH acted reasonably in suspending and ultimately revoking Weiner’s privileges based on substantial evidence of substandard care and potential harm to patients. The court also determined that the imminent harm exception applied, justifying the lack of pre-suspension process for the initial actions. The court concluded that Weiner failed to rebut the presumption of immunity under the HCQIA, and SPH was entitled to immunity from damages for the claims addressed. View "Weiner v. St. Peter's" on Justia Law