Justia Health Law Opinion Summaries

This case presented the questions of whether and how Alaska Statute 09.55.548(b) applied when the claimant’s losses were compensated by an employer’s self-funded health benefit plan governed by the federal Employee Retirement Income Security Act (ERISA). The Alaska Supreme Court concluded that an ERISA plan did not fall within the statute’s “federal program” exception. Therefore AS 09.55.548(b) required a claimant’s damages award to be reduced by the amount of compensation received from an ERISA plan. But the Supreme Court also concluded that the distinction the statute draws between different types of medical malpractice claimants was not fairly and substantially related to the statute’s purpose of ensuring claimants do not receive a double recovery — an award of damages predicated on losses that were already compensated by a collateral source. "Because insurance contracts commonly require the insured to repay the insurer using the proceeds of any tort recovery, claimants with health insurance are scarcely more likely to receive a double recovery than other malpractice claimants. The statute therefore violates the equal protection guarantee of the Alaska Constitution." View "Knolmayer, et al. v. McCollum" on Justia Law

The Supreme Court affirmed in part and remanded in part the order of the district court denying Plaintiffs' application to preliminarily enjoin the State from enforcing House Bill 702, a "vaccination discrimination law," as enacted by the Legislature and signed by the Governor, holding that the district court did not abuse its discretion in declining to issue the preliminary injunction.HB 702, codified as Mont. Code Ann. 49-2-312, was an act "prohibition discrimination based on a person's vaccination status." Plaintiffs sought to preserve their ability to enforce a vaccine mandate on current and prospective employees by bringing this action. The lower court dismissed the complaint, ruling that Plaintiffs failed to satisfy their burden of establishing a prima facie case that they would suffer irreparable harm caused by implantation of the law prior to the final resolution of the case. The Supreme Court remanded in part, holding (1) the court's decision to deny preliminary injunctive relief did not constitute a manifest abuse of discretion; and (2) the court did not manifestly abuse its discretion in denying preliminary injunctive relief prior to final resolution on the merits. View "Netzer v. State" on Justia Law

Plaintiffs brought various claims against Rockland County ("Rockland County Defendants") officials including a violation of the Free Exercise Clause of the First Amendment, based on orders which excluded children who were not vaccinated against measles from attending school and an emergency declaration which barred unvaccinated children, other than those with medical exemptions, from places of public assembly. The district court granted summary judgment for Rockland County Defendants.The Second Circuit reversed, finding that Plainitffs' claim raises numerous disputes—including whether there is evidence of religious animus, to whom the emergency declaration applied, and what the County’s purpose was in enacting the declaration—that prevent Defendants from prevailing on summary judgment. View "M.A. v. Rockland County Department of Health" on Justia Law

Pro se plaintiff Gary Wisner, M.D. filed a complaint alleging that defendants Dignity Health and the Dignity Health St. Joseph’s Medical Center (collectively, SJMC) falsely reported to the National Practitioner Data Bank (NPDB) that Wisner surrendered his clinical privileges while under criminal investigation for insurance fraud. The trial court granted a special motion to strike the complaint after concluding that Wisner’s claims arose from a protected activity and that Wisner failed to establish a probability of prevailing on the merits. Wisner contested both aspects of the trial court’s order, and he also argued the court erred by denying his motion to conduct limited discovery prior to the hearing on the anti-SLAPP motion. Finding no error, the Court of Appeal affirmed. View "Wisner v. Dignity Health" on Justia Law

In this case arising out of the Department of Human Services' attempt to recover payments made to Dr. Frederick Nitta from its Medicaid Primary Care Physician Program the Supreme Court vacated the judgment of the intermediate court of appeals (ICA) to the extent it remanded the case and otherwise affirmed, holding that DHS's claims largely lacked merit.The Program at issue was established by 42 U.S.C. 1396a(a)(13)(C) of the Affordable Care Act (ACA) and enabled certain physicians to temporarily receive increased payments for primary care services provided in 2013 and 2014 to Medicaid patients. In this case, DHS demanded repayment of more than $200,000 in enhanced payments received by Nitta through the program after it determined that Nitta was ineligible for participation in the Program because he did not meet specialty requirements as set forth in a federal administrative rule. While Nitta's appeal was pending, the Court of Appeals for the Sixth Circuit invalidated the rule and remanded the case. The ICA adopted the Sixth's Circuit's analysis. The Supreme Court largely affirmed, (1) the rule is invalid because it contravenes the statute; and (2) Nitta was entitled to enhanced payments under the statute. View "Nitta v. Department of Human Services" on Justia Law

Blue Cross Blue Shield of Vermont (Blue Cross) appealed the Green Mountain Care Board’s (GMCB) decision modifying its proposed health-insurance rates for 2022. The GMCB approved Blue Cross’s proposed rates with several exceptions, one of which was relevant here: its contribution to reserves (CTR). Blue Cross had sought a base CTR rate of 1.5%, but the GMCB ordered Blue Cross to lower it to 1.0%, thereby diminishing overall insurance rates by 0.5% and reducing health-insurance premiums. The GMCB found that a 1.5% base CTR was “excessive” because Blue Cross was expected to be above its target Risk Based Capital (RBC) range by the end of 2021, “individuals and small businesses are still struggling financially after a year-long economic slowdown,” and a 1.0% CTR would allow its “reserves to sit comfortably within the company’s RBC target range.” Blue Cross moved for reconsideration, arguing that the term “excessive” was strictly actuarial in nature, and that the GMCB misconstrued it by weighing non-actuarial evidence— testimony concerning affordability—as part of its examination of whether the proposed rate was excessive. On appeal to the Vermont Supreme Court, Blue Cross raised essentially the same issue. Because none of the actuarial experts who testified concluded that Blue Cross’s proposed CTR was excessive, Blue Cross argued, the GMCB could not properly conclude that it was. Blue Cross conceded that health-insurance rates for 2022 could not now be changed, but it urged the Supreme Court to rule on the merits, arguing that this matter was not moot because the CTR rate for this year will disadvantage Blue Cross in future rate-review proceedings. The Supreme Court determined Blue Cross did not demonstrate that this kind of case was capable of repetition yet evading review or subjected it to continuing negative collateral consequences. Therefore, Blue Cross failed to meet the exceptional thresholds necessary for the Court to reach the merits in a moot case. View "In re Blue Cross and Blue Shield 2022 Individual & Small Group Market Filing" on Justia Law

Amiodarone was developed in the 1960s for the treatment of angina and was released in other countries. Amiodarone is associated with side effects, including pulmonary fibrosis, blindness, thyroid cancer, and death. In the 1970s, U.S. physicians began obtaining amiodarone from other countries for use in patients with life-threatening ventricular fibrillation or ventricular tachycardia who did not respond to other drugs. In 1985, the FDA approved Wyeth’s formulation of amiodarone, Cordarone, as a drug of last resort for patients suffering from recurring life-threatening ventricular fibrillation and ventricular tachycardia. The FDA’s “special needs” approval issued without randomized clinical trials. In 1989, the FDA described Wyeth’s promotional activities as promoting an unapproved use of the drug. In 1992, the FDA objected to promotional labeling pieces for Cordarone. Other manufacturers developed generic amiodarone, which has been available since 1998.Consolidated lawsuits alleged that plaintiffs suffered unnecessary, serious side effects when they took amiodarone, as prescribed by their doctors, for off-label use to treat atrial fibrillation, a more common, less serious, condition than ventricular fibrillation. The FDA never approved amiodarone for the treatment of atrial fibrillation, even on a special-needs basis. The court of appeal affirmed the dismissal of the lawsuits. The claims are preempted as attempts to privately enforce the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 301, regulations governing medication guides and labeling and have no independent basis in state law. The court also rejected fraud claims under California’s unfair competition law and Consumers Legal Remedy Act. View "Amiodarone Cases" on Justia Law

This appeal arose from an Idaho district court decision affirming a declaratory ruling issued by Respondent Dave Jeppesen (the Director) in his capacity as Director of the Idaho Department of Health and Welfare (the Department). Appellant Grace at Twin Falls, LLC (Grace), a residential assisted living and memory care facility, partnered with a preferred pharmacy to offset costs associated with a software system that coordinated the tracking and delivery of residents’ prescription medications. Because residents who failed to choose the preferred pharmacy did not receive the offset, Grace sought to charge those residents an additional $10.00 each month to cover the difference. Grace brought a petition for declaratory ruling to the Department, asking the Director to declare that Idaho Code section 39-3316(12)(b) and IDAPA 16.03.22.550.12.b did not prohibit Grace from charging the $10.00 fee to those residents who did not choose the preferred pharmacy. The Director denied the petition, declaring that Grace would not “be permitted to assess a non-preferred-pharmacy fee as such fee violates residents’ right to choose their pharmacy or pharmacist . . . .” Grace sought judicial review before the district court, which affirmed the Director’s declaratory ruling. Grace then appealed to the Idaho Supreme Court. Finding no reversible error, the Supreme Court affirmed the district court. View "Grace at Twin Falls, LLC v. Jeppesen" on Justia Law

The First Circuit affirmed Defendant's sentence of twenty-four months' imprisonment imposed in connection with his plea of guilty to health care fraud, holding that the sentence was neither procedurally nor substantively unreasonable.Defendant pleaded guilty to health care fraud for his multiyear scheme to defraud MaineCare, a state-run program that administers Medicaid benefits in the state of Maine and reimburses Maine health care providers for MaineCare services. After a hearing, the court varied downward and imposed a sentence of twenty-four months' imprisonment. The First Circuit affirmed Defendant's sentence, holding (1) the district court did not err in its loss calculations or in imposing a four-level leader/organizer enhancement; and (2) Defendant's downward variant sentence satisfied the substantive reasonableness standard. View "United States v. Ahmed" on Justia Law

The First Circuit affirmed the judgment of the district court dismissing Calvary Chapel of Bangor's (Calvary) complaint against Maine Governor Janet Mills raising several facial and as-applied constitutional and statutory challenges to the Governor's executive orders seeking to slow the spread of the COVID-19 outbreak in early 2020, holding that the complaint was moot and that no mootness exception could save it.Calvary sued the Governor in federal court claiming that the Governor's orders at issue discriminated against Calvary by treating religious gatherings less favorably than other gatherings. Calvary requested a temporary restraining order, a preliminary injunction, a permanent injunction, and a declaratory judgment. The district court denied relief and dismissed the complaint. The First Circuit affirmed, holding that this case was moot and that no exception to mootness applied. View "Calvary Chapel of Bangor v. Mills" on Justia Law