Justia Health Law Opinion Summaries

Plaintiff was placed on unpaid administrative leave and then terminated from her employment with defendant Sequoia Union Elementary School District (the School District) after refusing to either provide verification of her COVID-19 vaccination status or undergo weekly testing as required by a then-operative order of the State Public Health Officer.Plaintiff brought suit under the Confidentiality of Medical Information Act against defendants the School District; Sequoia Union Elementary School (the School); and the School principal and superintendent, alleging (1) discrimination due to her refusal to authorize release of her medical information and (2) unauthorized use of her medical information.The trial court sustained defendants’ demurrer without leave to amend, finding each claim failed as a matter of law due to certain statutory exceptions.Without any factual allegations that defendants received any “medical information,” such as medical records, a medical certification, or other information in “electronic or physical form... derived from a provider of health care” (section 56.05, subd.(i)), the Fifth Appellate District found that the complaint fails to state a cause of action for unauthorized use of such information under section 56.20(c). View "Rossi v. Sequoia Union Elementary School" on Justia Law

Former employees of Alternatives, a for-profit hospice provider, sued under the False Claims Act, 31 U.S.C. 3729, alleging that Alternatives submitted claims for Medicare reimbursement despite inadequate documentation in the patients’ medical records supporting hospice eligibility, under 42 C.F.R. 418.22(b)(2). For a patient to be eligible for Medicare hospice benefits, and for a hospice provider to be entitled to reimbursement, a patient must be certified as “terminally ill.” The district court granted Alternatives summary judgment based on lack of materiality, finding “no evidence” that Alternatives’ insufficiently documented certifications "were material to the Government’s decision to pay.” The court reasoned that “[t]he Government could see what was or was not submitted” yet never refused any of Alternatives’ claims, despite the inadequacy or missing supporting documentation or where compliance was otherwise lacking.The Third Circuit vacated. When a government contractor submits a claim for payment but fails to disclose a statutory, regulatory, or contractual violation, that claim does not automatically trigger liability. The Act requires that the alleged violation be “material” to the government’s decision to pay. The Supreme Court has identified factors to assist courts in evaluating materiality. In this case, the court based its decision principally on the government’s continued payments after being made aware of its deficient documentation, overlooking factors that could have weighed in favor of materiality— and despite an open dispute over the government’s “actual knowledge.” View "Druding v. Care Alternatives" on Justia Law

Defendant ended up at a Twin Cities chiropractic clinic after an automobile accident. The visit resulted in a job: the clinic hired him to recruit patients. And then another one did too. Defendant’s role was to bring in as many accident victims as possible. Each new patient could undergo treatment up to $20,000, the limit of basic economic benefits available under most Minnesota automobile insurance policies. After a jury trial, the district court ordered Defendant to pay $187,277 in restitution to the insurance companies he defrauded. On remand, the amount of restitution decreased. This time, the district court concluded that Defendant qualified as a runner for only 53 of the 65 victims, which dropped the award to $155,864. Defendant, for his part, has adopted an all-or-nothing strategy: he does not believe he owes a single penny of restitution.   The Eighth Circuit affirmed. The court explained that Defendant received up to $1,500 per patient he recruited, which satisfies the pecuniary-gain requirement. A series of text messages establishes the remaining elements. When the clinic owner later said she was “praying for some ice and snow” to bring in more clients, Defendant replied that he had “been praying for [the] last four weeks.” It was reasonable to conclude from these messages that Hussein “directly procure[d]” these patients with at least a “reason to know,” if not actual knowledge, that the provider’s purpose was to obtain benefits under an automobile-insurance contract. View "United States v. Abdisalan Hussein" on Justia Law

In 2023, a majority of the South Carolina Supreme Court found unconstitutional the 2021 version of the Fetal Heartbeat and Protection from Abortion Act (the 2021 Act). In response to its decision, the South Carolina General Assembly (the legislature) revised the 2021 Act, especially in terms of its legislative findings and purposes, and passed a new version of the Fetal Heartbeat and Protection from Abortion Act (the 2023 Act). Immediately after the Governor signed the 2023 Act into law, Planned Parenthood South Atlantic and three other medical providers (collectively, Planned Parenthood) filed an action in the circuit court seeking a declaration that the new law was unconstitutional. Upon Planned Parenthood's motion, the circuit court enjoined enforcement of the 2023 Act pending resolution of the constitutional challenge. Numerous state officials (collectively, the State) promptly filed an emergency petition to the South Carolina Supreme Court for supersedeas or, alternatively, a request that it accept the matter in its original jurisdiction and expedite briefing. The Court denied the petition for supersedeas but granted the alternative request to accept the matter in its original jurisdiction and expedite resolution of the case. The Court vacated the preliminary injunction issued by the circuit court and declared the 2023 Act constitutional. View "Planned Parenthood South Atlantic, et al. v. State of South Carolina, et al." on Justia Law

The United States District Court for the Northern District of Ohio certified two questions to the Georgia Supreme Court regarding whether a state entity could continue asserting claims against opioid manufacturers and distributors after the State of Georgia entered into a settlement with the pharmaceutical companies, and as part of the settlement, the General Assembly enacted OCGA § 10-13B-1, et seq. (the “Settlement Act”) in 2022, which included a litigation preemption provision that “bar[s] any and all past, present or future claims on behalf of any governmental entity seeking to recover against any business or person that is a released entity under the terms of the relevant settlement.” OCGA § 10-13B-3 (a) (the “preemption provision”). In April 2019, before Georgia entered into the state-wide settlement with the pharmaceutical companies, the Hospital Authority of Wayne County, Georgia (“HAWC”) filed suit against a number of such entities, seeking to recover unreimbursed amounts it claims to have expended in treating opioid-dependent patients. HAWC subsequently chose not to participate in the state-wide settlement and did not individually release any of its claims. At some point, HAWC’s litigation was consolidated, along with over 3,000 other cases, into a federal multidistrict litigation in the District Court. See In re Natl. Prescription Opiate Litigation, (MDL No. 2804). Seven defendants named in HAWC’s complaint filed a motion to dismiss HAWC’s claims against them (the “Motion”), contending that the suit was barred by the preemption provision. The Georgia Supreme Court concluded that the Georgia General Assembly's passage of the preemption provision took away any power HAWC otherwise might have had under OCGA § 31-7-75 to pursue claims that the preemption provision and the Settlement Act were unconstitutional, and the answer to the first question certified by the District Court was no. In light of this answer, the Supreme Court did not need to answer the second certified question. View "Hospital Authority of Wayne County v. AmeriSourceBergen Drug Corp, et al." on Justia Law

In this case determining the scope of immunity afforded by Executive Order No. 7V, as it related to acts or omissions undertaken in good faith by health care professionals and health care facilities because of an alleged lack of resources attributable to the COVID-19 pandemic the Supreme Court upheld the judgment of the trial court concluding that Defendants failed to establish that the immunity afforded by the order applied in this case.Governor Ned Lamont issued Executive Order No. 7V providing immunity from suit and liability to health care providers under certain circumstances relating to COVID-19. Plaintiff in this case filed wrongful death claims against Defendants, Regency House of Walling ford, Inc. and National Health Care Associates, Inc., alleging twelve counts of wrongful death based on medical negligence and medical recklessness. Defendants moved to dismiss the complaint, claiming immunity under Executive Order No. 7V. The trial court denied the motion to dismiss. The Supreme Court affirmed, holding that the trial court too narrowly construed the language of the order but nevertheless did not err in denying Defendants' motion to dismiss. View "Manginelli v. Regency House of Wallingford, Inc." on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the trial court in his wrongful death action filed by the daughter of the decedent and the executor of her estate, holding that the trial court erred in dismissing counts five, six, and seven of the complaint.At issue was Executive Order No. 7V, which conferred immunity on health care providers in connection with the governor's March, 2020 declaration of a public health emergency caused by the COVID-19 pandemic. Plaintiff brought this action against several physicians and a hospital, but Defendants moved to dismiss the complaint on the ground that they were immune under the federal Public Readiness and Emergency Preparedness Act (PREP Act) for allegedly grossly negligent acts and omissions undertaken before the receipt of the decedent's negative COVID-19 test result. The court granted the motions to dismiss as to certain physicians. The Supreme Court affirmed in part and reversed in part and remanded the case for further proceedings, holding that the trial court erred in concluding that Defendants were entitled to immunity under the PREP Act. View "Mills v. Hartford HealthCare Corp." on Justia Law

Plaintiff and appellant Rhonda S. is the conservator, appointed pursuant to section 5350 of the Lanterman-Petris Short Act (LPS), of her adult son David S. Plaintiff sued Defendants and respondents Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals for a declaration of their obligations, under LPS and the terms of David’s health plan, to transport and accept for “assessment and evaluation” (each as defined in LPS) conservatees like David upon their conservators’ demand. The trial court sustained Kaiser’s demurrer.
The Second Appellate District affirmed. The court explained that it rejects Plaintiff’s implication that an LPS conservatee is per se suffering from an “Emergency Medical Condition” at all times following the judicial determination of grave disability. The purposes of LPS conservatorship include providing treatment to the conservatee. (Section 5350.1.) To assume a conservatee’s condition remains static following the conservatorship order is to assume treatment is always ineffectual. We are offered no basis for such an assumption. For a mental health condition to be an “Emergency Medical Condition” under the plan, “acute symptoms of sufficient severity” must result in an “immediate” specified danger or mental health disorder-induced disability. Second, even if conservatees were in a state of perpetual “Emergency Medical Condition” within the meaning of the plan, Plaintiff’s requested declaration would eliminate the coverage requirement that a “reasonable person would have believed that the medical condition was an Emergency Medical Condition which required ambulance services.” View "Rhonda S. v. Kaiser Foundation Health Plan" on Justia Law

Defendants Gladden and Linton were convicted of conspiracy to commit health care fraud and mail fraud, and the substantive offenses of health care fraud, mail fraud, and aggravated identity theft, for their roles in a multi-year scheme to defraud insurance companies. The government alleged Defendants received inflated reimbursement payments by billing for medically unnecessary and fraudulent prescriptions.The Eleventh Circuit found that the evidence presented at trial was sufficient to support the jury’s verdict as to all of Linton’s convictions and as to Gladden’s convictions for conspiracy, health care fraud, and mail fraud. In addition, the Eleventh Circuit found that the district court did not clearly err in calculating Gladden’s restitution and forfeiture amounts. The Court also vacated Galdden's conviction for aggravated identity theft and remanded for further proceedings consistent with this opinion. View "USA v. John Gladden, et al" on Justia Law

The United States Food and Drug Administration approved mifepristone for use in 2000 under the brand name Mifeprex. FDA approved a generic version in 2019, and in 2021, FDA announced that it would not enforce an agency regulation requiring mifepristone to be prescribed and dispensed in person. The agency moved that requirement from mifepristone’s conditions for use. The subject of this appeal is those four actions: the 2000 Approval, the 2016 Amendments, the 2019 Generic Approval, and the 2021 Non-Enforcement Decision. Plaintiffs, Medical Organizations and Doctors contend that FDA overlooked important safety risks in approving mifepristone and amending its restrictions. The Medical Organizations and Doctors moved for preliminary injunctive relief. The district court granted the motion but stayed the effective date of each of the challenged actions under 5 U.S.C. Section 705. FDA appealed, as did Intervenor Danco Laboratories, LLC.     The Fifth Circuit vacated in part and affirmed in part. The court vacated in part and concluded that the Medical Organizations and Doctors’ claim as to the 2000 Approval is likely barred by the statute of limitations. Thus, until final judgment, Mifeprex will remain available to the public under the conditions for use that existed in 2016. The court also vacated the portion of the order relating to the 2019 Generic Approval because Plaintiffs have not shown that they are injured by that particular action. The generic version of mifepristone will also be available under the same conditions as Mifeprex. The court affirmed the components of the stay order that concern the 2016 Amendments and the 2021 Non-Enforcement Decision. View "Alliance Hippocratic Medicine v. FDA" on Justia Law