Justia Health Law Opinion Summaries

The case involves three sets of plaintiffs who filed class-action lawsuits against their healthcare provider, Cedars-Sinai Health System and Cedars-Sinai Medical Center. The plaintiffs alleged that Cedars-Sinai unlawfully disclosed their private medical information to third parties through tracking software on its website. Cedars-Sinai removed the suits to federal court, arguing that it developed its website while acting under a federal officer and at the direction of the federal government.The district court disagreed with Cedars-Sinai's argument. It held that Cedars-Sinai developed its website in compliance with a generally applicable and comprehensive regulatory scheme and that there is therefore no federal jurisdiction under § 1442(a)(1). The court found that although Cedars-Sinai’s website furthers the government’s broad goal of promoting access to digital health records, Cedars-Sinai’s relationship with the federal government does not establish that it acted pursuant to congressionally delegated authority to help accomplish a basic governmental task.The United States Court of Appeals for the Ninth Circuit affirmed the district court’s orders remanding the removed actions to state court. The court agreed with the district court that Cedars-Sinai developed its website in compliance with a generally applicable and comprehensive regulatory scheme under the Health Information Technology for Economic and Clinical Health Act, and that there was therefore no federal jurisdiction under § 1442(a)(1). The court concluded that Cedars-Sinai did not meet § 1442(a)(1)’s “causal nexus” requirement. View "Doe v. Cedars-Sinai Health System" on Justia Law

This case involves a qui tam action under the False Claims Act (FCA) and the Iowa False Claims Act (IFCA) brought by Stephen Grant, a sleep medicine practitioner, against Steven Zorn, Iowa Sleep Disorders Center, and Iowa CPAP. Grant alleged that the defendants had knowingly overbilled the government for initial and established patient visits and violated the Anti-Kickback Statute and the Stark Law by knowingly soliciting and directing referrals from Iowa Sleep to Iowa CPAP. The district court found the defendants liable for submitting 1,050 false claims to the United States and the State of Iowa and imposed a total award of $7,598,991.50.The district court had rejected the defendants' public disclosure defense and awarded summary judgment to the defendants on the Anti-Kickback Statute and Stark Law claim. After a bench trial, the district court found the defendants liable on several claims, including that Iowa Sleep had violated the anti-retaliation provisions of the FCA and IFCA by firing Grant. The district court also concluded that the defendants had overbilled on initial patient visits but not on established patient visits.On appeal, the United States Court of Appeals for the Eighth Circuit affirmed in part, vacated in part, and remanded for further proceedings. The court held that the public disclosure bar was inapplicable because Grant’s complaint did not allege “substantially the same allegations” contained in the AdvanceMed letters. The court also held that the district court did not abuse its discretion in admitting expert testimony on extrapolation and overbilling. However, the court found that the district court erred in its determination of damages and civil penalties, violating the Eighth Amendment’s Excessive Fines Clause. The court vacated the punitive sanction and remanded the case for further proceedings. View "Grant v. Zorn" on Justia Law

This case involves two consolidated appeals from Northwestern Medical Center and Rutland Regional Medical Center against the Green Mountain Care Board (GMCB). The GMCB had approved the proposed budgets of both medical centers for the fiscal year 2024, but with certain conditions. The medical centers challenged the GMCB's imposition of budgetary conditions that capped increases to rates charged to commercial payers. However, the medical centers had not properly raised their claims with the GMCB, leaving them unpreserved for review.The GMCB is an independent board that regulates the health care industry in Vermont. It reviews and establishes hospital budgets annually, with the aim of reducing the per-capita rate of growth in expenditures for health services in Vermont across all payers. The GMCB had released its established benchmarks for the 2024 fiscal year budget submissions, which included a benchmark that limited a hospital’s growth of net patient revenue/fixed prospective payment (NPR/FPP) to 8.6%, effectively capping increases to NPR/FPP growth by that amount. It also included a benchmark for commercial rate increases which provided that the GMCB would “also review and may adjust requested hospital commercial rate increases.”The GMCB approved the budgets of Northwestern and Rutland Regional, subject to certain conditions. These conditions included a cap on increases to commercial rates. However, neither Northwestern nor Rutland Regional had raised their claims with the GMCB, leaving them unpreserved for review.On appeal, Northwestern and Rutland Regional argued that the GMCB deprived them of due process by failing to provide adequate notice that it would impose the Commercial Rate Cap Conditions on their proposed budgets. They also claimed that the GMCB had no authority to impose the Commercial Rate Cap Conditions because the conditions lacked a factual basis and contradicted the GMCB’s initial approval of their proposed budgets. However, the Vermont Supreme Court declined to reach the merits of these claims because they were not preserved for review. The court noted that Northwestern and Rutland Regional had several opportunities to raise their claims with the GMCB before the GMCB issued its final budget decisions, but they failed to do so. Therefore, the court affirmed the decisions of the GMCB. View "In re Northwestern Medical Center Fiscal Year 2024" on Justia Law

The case involves a challenge to a series of statutes and implementing regulations ("Challenged Laws") relating to the licensure of abortion provider facilities in Kansas. The plaintiffs, an abortion care facility and its doctors, argued that the Challenged Laws infringed on a woman's fundamental right to personal autonomy, which includes the right to abortion, as protected under section 1 of the Kansas Constitution Bill of Rights. The district court agreed and issued a permanent injunction restraining the State from enforcing the Challenged Laws.The State appealed the decision, arguing that the Challenged Laws did not infringe on the right to abortion and that they survived strict scrutiny because they furthered the State's compelling interest in protecting maternal health and regulating the medical profession. The State also argued that the district court erred in striking down the Challenged Laws in their entirety, ignoring the statute's severability clause.The Supreme Court of the State of Kansas affirmed the district court's decision. The court held that the Challenged Laws did infringe on a woman's right to abortion and that the State failed to meet its burden to show that the laws furthered its stated compelling interests. The court also found it improper to sever the unconstitutional substantive licensure requirements from the statute. The court declined to address the equal protection issues raised by the State. View "Hodes v. Stanek" on Justia Law

The case involves M.A.C., a homeless individual with mental health disorders, who was involuntarily committed in Waukesha County in 2020. In 2022, the County sought to extend M.A.C.'s commitment. However, M.A.C. was not present at the recommitment hearing, and her appointed counsel had been unable to contact her. The circuit court found M.A.C. in default and ordered her to be recommitted and involuntarily medicated. M.A.C. appealed, challenging the recommitment and involuntary medication orders on three grounds: lack of individual notice of the hearings, the unavailability of default judgment in such hearings, and insufficient evidence for her involuntary medication.The case was initially reviewed by the Court of Appeals, which affirmed the circuit court's orders. The Court of Appeals relied heavily on a previous case, Waukesha County v. S.L.L., to uphold the circuit court's decisions. M.A.C. then appealed to the Supreme Court of Wisconsin.The Supreme Court of Wisconsin reversed the decision of the Court of Appeals. The court held that under Wisconsin statutes, a subject individual is entitled to notice of recommitment and involuntary medication hearings, and providing notice to counsel only is not sufficient. The court also held that default judgment is not available for recommitment or involuntary medication hearings under Wisconsin statutes. Finally, the court found that the County failed to provide sufficient evidence for M.A.C.'s involuntary medication. The court overruled the contrary holdings of the S.L.L. case. View "Waukesha County v. M.A.C." on Justia Law

Rodney Clemons, an inmate at Stateville Correctional Center, filed a lawsuit against Wexford Health Sources, Inc., and two of its physicians, alleging that they were deliberately indifferent to his serious foot condition. Clemons had injured his right ankle before his incarceration and suffered from pain in his right ankle and foot for several years while incarcerated. He claimed that the defendants prioritized cost concerns over reasoned medical judgment.The case was initially heard in the United States District Court for the Northern District of Illinois, Eastern Division. The district court granted summary judgment to the defendants, concluding that the treatment plan adopted by the physicians was reasonable and that there was no evidence of a widespread pattern of indifference that could infer a constitutional violation by Wexford.Clemons appealed to the United States Court of Appeals for the Seventh Circuit. The appellate court affirmed the district court's decision. The court found that the prison doctor's treatment decisions were not so unacceptable that no minimally competent professional would have responded in the same way. The court also found that the alleged policy of limiting referrals to trim costs was not facially unconstitutional. Furthermore, Clemons failed to show a pattern of violations that would infer that Wexford was aware of and condoned the misconduct of their employees. Therefore, the court concluded that Clemons failed to show that the defendants were deliberately indifferent to his serious medical needs. View "Clemons v. Wexford Health Sources, Inc." on Justia Law

The Supreme Court of Texas reviewed a case involving a new law that prohibits certain medical treatments for children if administered for the purpose of transitioning a child's biological sex or affirming the child's perception of their sex if it is inconsistent with their biological sex. Several parents of children with gender dysphoria, along with physicians and groups that would be affected by the law, sued to enjoin its enforcement, alleging that it is facially unconstitutional. The trial court concluded that the law likely violates the Texas Constitution and temporarily enjoined the law's enforcement.The Supreme Court of Texas disagreed with the trial court's decision. The court held that the plaintiffs failed to establish a probable right to relief on their claims that the prohibition of certain treatments for children suffering from gender dysphoria violates the Texas Constitution. The court emphasized that while parents have a fundamental interest in directing the care, custody, and control of their children, this interest is not absolute. The court concluded that the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment. The court also concluded that the law does not unconstitutionally deprive parents of their rights or physicians or health care providers of an alleged property right in their medical licenses or claimed right to occupational freedom. The court further concluded that the law does not unconstitutionally deny or abridge equality under the law because of sex or any other characteristic asserted by plaintiffs. The court therefore reversed and vacated the trial court's order. View "STATE OF TEXAS v. LOE" on Justia Law

Joel Phillip McNinch, Jr., a dementia patient with other serious health issues, was admitted to Brandon Nursing and Rehabilitation Center, LLC in June 2019. He was later admitted to Merit Health Rankin due to combative behaviors related to his dementia. He developed a decubitus ulcer and was admitted to St. Dominic Hospital, where he died the next day. His widow, Cheryl McNinch, requested her husband's medical records from Brandon Nursing and Merit Health soon after his death and received them in mid-December 2019. She filed a complaint in January 2022, alleging negligence, medical malpractice, gross negligence, and reckless disregard, claiming that substandard care had accelerated her husband's health deterioration and led to his death.The defendants moved to dismiss the case, arguing that the action was barred by the two-year statute of limitations. Mrs. McNinch argued that the discovery rule operated to toll the statute of limitations until she received the medical records. The trial court converted the defendant’s motion to dismiss into a motion for summary judgment and granted the motion without holding a hearing.The Supreme Court of Mississippi reversed the trial court's decision, finding that the trial court erred by granting summary judgment to the defendants. The Supreme Court held that there were genuine issues of material fact regarding whether Mrs. McNinch had knowledge of negligent conduct through personal observation or other means prior to or at the time of Mr. McNinch’s death. The court found that the discovery rule could operate to toll the statute of limitations when the medical records are necessary to discover the negligence. The court concluded that Mrs. McNinch exercised reasonable diligence in requesting the medical records promptly, and therefore, the complaint was filed within the statute of limitations. The case was remanded to the circuit court for further proceedings. View "McNINCH v. BRANDON NURSING & REHABILITATION CENTER" on Justia Law

The case involves the United States of America, et al. ex rel. Michael Angelo and MSP WB, LLC (Relators-Appellants) against Allstate Insurance Company, et al. (Defendants-Appellees). The relators alleged that Allstate Insurance violated the False Claims Act by avoiding its obligations under the Medicare Secondary Payer Act. They claimed that Allstate failed to report or inaccurately reported to the Centers for Medicare & Medicaid Services (CMS) information regarding its beneficiaries, which led to Allstate failing to reimburse Medicare for auto-accident-related medical costs incurred by beneficiaries insured by Allstate.The United States District Court for the Eastern District of Michigan dismissed the case with prejudice, deeming the relators' second amended complaint deficient in numerous respects. The relators then moved for reconsideration, which the district court denied. They also filed a motion to amend or correct under Rule 59(e), asking the district court to amend its judgment to dismiss the case without prejudice to allow them to file another amended complaint. The district court denied the motion on all grounds.The United States Court of Appeals for the Sixth Circuit affirmed the district court's decision. The court found that the relators failed to state a claim for a violation of the False Claims Act. The court noted that the relators did not provide sufficient facts demonstrating that Allstate had an "established duty" to pay money or property owed to the government. The court also found that the relators did not demonstrate Allstate's understanding that its conduct violated its obligations under federal law. Furthermore, the court found that the relators' claim for conspiracy also failed as they did not provide any specific details regarding the alleged plan or an agreement to execute the plan. The court also affirmed the district court's decision to deny the relators leave to amend their complaint again. View "United States ex rel. Angelo v. Allstate Insurance Co." on Justia Law

A nurse practitioner, Lisa Hofschulz, and her ex-husband, Robert Hofschulz, were convicted of conspiracy and multiple counts of distributing drugs in an unauthorized manner, including one count resulting in a patient's death. The charges stemmed from their operation of a "pain clinic" that functioned as a front for an opioid mill, dispensing opioid prescriptions for cash-only payments. Robert Hofschulz was also convicted for his role in assisting Lisa Hofschulz in running the opioid mill.The Hofschulzes were initially tried in the United States District Court for the Eastern District of Wisconsin. They were found guilty on all counts, with Lisa Hofschulz receiving a minimum 20-year prison term for the count of unlawful distribution resulting in death, and Robert Hofschulz receiving concurrent terms of 36 months in prison on each of his five convictions. The Hofschulzes appealed their convictions on three grounds: they claimed the jury instructions were inconsistent with a Supreme Court decision, that the judge wrongly permitted the government’s medical expert to testify about the standard of care, and that the evidence was insufficient to support their convictions.The case was then reviewed by the United States Court of Appeals for the Seventh Circuit. The court found no instructional error, stating that the district judge had correctly instructed the jury that the government must prove beyond a reasonable doubt that the Hofschulzes intended to distribute controlled substances and intended to do so in an unauthorized manner. The court also found that the judge had correctly permitted the government’s medical expert to testify about the standard of care in the usual course of professional pain management. Lastly, the court dismissed the Hofschulzes' challenge to the sufficiency of the evidence, deeming it frivolous. The court affirmed the convictions of the Hofschulzes. View "United States v. Hofschulz" on Justia Law