Justia Health Law Opinion Summaries

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

Eight named inmates and two nonprofit organizations (collectively, plaintiffs) filed an amended complaint in district court seeking a mixture of a classwide writ of habeas corpus and classwide injunctive and declaratory relief. Plaintiffs alleged that the State’s management of COVID-19 in New Mexico prisons violated inmates’ rights under the New Mexico Constitution. The district court dismissed the amended complaint, concluding that it lacked subject-matter jurisdiction because the individual inmate-plaintiffs failed to exhaust the internal grievance procedures of the New Mexico Corrections Department (NMCD) before seeking relief, as required by NMSA 1978, Section 33-2-11(B) (1990). Agreeing with the result, but not all of its reasoning, the New Mexico Supreme Court affirmed the district court: "to satisfy the habeas corpus exhaustion requirement under Rule 5-802(C) for an entire plaintiff class, one or more named class members must exhaust administrative remedies for each claim. Because no Named Plaintiff exhausted or sought to exhaust NMCD’s internal grievance procedures, we affirm." View "Anderson, et al. v. New Mexico" on Justia Law

The Mississippi Division of Medicaid (DOM) and Yalobusha County Nursing Home (YNH) dispute four costs submitted for reimbursement by YNH in its fiscal year 2013 Medicaid cost report. The DOM appeals the Hinds County Chancery Court’s judgment ordering the DOM to reverse the four adjustments at issue. Because the DOM correctly interpreted the appropriate statutes and because its decisions were supported by substantial evidence, the Mississippi Supreme Court reversed the chancery court’s order and rendered judgment reinstating the decisions of the DOM. View "Mississippi Division of Medicaid v. Yalobusha County Nursing Home" on Justia Law

Neurosurgeon Donald Blaskiewicz, M.D. went to work for the Spine Institute of Idaho (the “Spine Institute” or the “Institute”) in 2018. The Spine Institute entered into a Professional Services Agreement (the PSA) with Blaskiewicz containing a non-compete clause, contractually proscribing Blaskiewicz from practicing medicine within fifty miles of the Spine Institute’s office (with an explicit exception for Caldwell) for a period of eighteen months, should his employment with the Spine Institute be terminated for any reason. Pursuant to the PSA, Blaskiewicz had two ways to avoid the non-compete clause: he could either get permission from the Spine Institute to practice medicine within the proscribed area, or he could pay the Spine Institute $350,000 in “liquidated damages.” The PSA also required any disputes to be resolved by arbitration. Less than a year and a half after hiring Blaskiewicz, the Spine Institute terminated his employment. Blaskiewicz filed suit in district court, seeking a declaratory judgment that the non-compete clause was unenforceable. The district court concluded that the non-compete clause was against public policy and void as a matter of law, and granted summary judgment in favor of Blaskiewicz. The Idaho Supreme Court reversed, finding the district court did not cite or analyze the statutes governing non-compete agreements in Idaho. The Court concluded there were genuine issues of material fact such that summary judgment was inappropriate as to whether the non-compete provision was void as a matter of public policy or otherwise enforceable. View "Blaskiewicz v. Spine Institute of Idaho" on Justia Law