Justia Health Law Opinion Summaries

The Supreme Court affirmed the order of the circuit court applying this Court's decision in State ex rel. AMFM, LLC v. King, 740 S.E.2d 66 (W. Va. 2013), to conclude that Respondent lacked authority to bind her mother to an arbitration agreement, holding that there was no error.Respondent admitted her mother to The Villages at Greystone, an assisted living residence, when Respondent was not her mother's attorney-in-fact. In her capacity as her mother's medical surrogate Respondent completed on her mother's behalf a residency agreement and an arbitration agreement. Respondent later sued Petitioners, alleging that her mother had suffered injuries while a resident of Greystone due to Petitioners' negligence. Petitioners filed a motion to arbitrate the claim, but the circuit court denied the motion, concluding that no valid arbitration agreement existed. The Supreme Court affirmed, holding that Petitioners failed to establish a valid agreement to arbitrate on the facts of this case. View "Beckley Health Partners, Ltd. v. Hoover" on Justia Law

Defendant was convicted of conspiracy to commit healthcare fraud, conspiracy to solicit and receive healthcare kickbacks, and two counts of false statements relating to healthcare matters. On appeal, Defendant challenged the sufficiency of evidence and her sentence.   The Fifth Circuit affirmed Defendant’s conviction and sentence. The court explained that the government was required to prove beyond a reasonable doubt “(1) an agreement between two or more persons to pursue an unlawful objective; (2) the defendant’s knowledge of the unlawful objective and voluntary agreement to join the conspiracy; and (3) an overt act by one or more of the members of the conspiracy in furtherance of the objective of the conspiracy.” The evidence was sufficient to prove that Defendant made an agreement to and did receive $60 kickbacks in exchange for home healthcare certifications. Thus, it was not unreasonable for the jury to conclude that the $60 payments were kickbacks, rather than legitimate co-pays, based on the evidence that patients rarely paid the fee, and that Defendant charged a uniform $60 fee regardless of the services rendered.   In Defendant’s challenge to the PSR’s calculation of the loss amount and its effect on her Sentencing Guidelines range, the court held that the district court did not err by overruling Defendant’s objection to the inclusion of Medicare Part A claims in the loss amount. However, the district court did err by overruling Defendant’s objection to the inclusion of the non-certification Medicare Part B claims in the loss amount because absent the fraud Medicare would have paid for these claims. Nonetheless, this error was harmless. View "USA v. Hamilton" on Justia Law

The formula that the Department of Health and Human Services must employ annually to set reimbursement rates for certain outpatient prescription drugs provided by hospitals to Medicare patients, 42 U.S.C. 1395l(t)(14)(A)(iii), provides two options. If HHS has conducted a survey of hospitals’ acquisition costs for each covered outpatient drug, it may set reimbursement rates based on the hospitals’ “average acquisition cost” for each drug, and may “vary” the reimbursement rates “by hospital group.” Absent a survey, HHS must set reimbursement rates based on “the average price” charged by manufacturers for the drug as calculated and adjusted by the Secretary. For 2018 and 2019, HHS did not conduct a survey but issued a final rule establishing separate reimbursement rates for hospitals that serve low-income or rural populations through the “340B program” and all other hospitals. The district court concluded that HHS had acted outside its statutory authority. The D.C. Circuit reversed. A unanimous Supreme Court reversed. The statute does not preclude judicial review of HHS’s reimbursement rates. Absent a survey of hospitals’ acquisition costs, HHS may not vary the reimbursement rates only for 340B hospitals; HHS’s 2018 and 2019 reimbursement rates for 340B hospitals were therefore unlawful. HHS’s power to increase or decrease the price is distinct from its power to set different rates for different groups of hospitals and HHS’s interpretation would make little sense given the statute’s overall structure. Congress, when enacting the statute, was aware that 340B hospitals paid less for covered prescription drugs and may have intended to offset the considerable costs of providing healthcare to the uninsured and underinsured in low-income and rural communities. View "American Hospital Association v. Becerra" on Justia Law

The Supreme Court affirmed the judgment of a panel of the court of appeals dismissing an appeal in this temporary commitment case on the grounds that the appeal was moot, holding that "public interest exception" to mootness applied.After a hearing, the trial court found E.F. was gravely disabled and entered a temporary commitment order allowing for her emergency detention. While E.F.'s appeal was pending, the commitment order expired. The court of appeals dismissed E.F.'s appeal as moot, interpreting T.W. v. St. Vincent Hospital & Healthcare Center, Inc., 121 N.E.3d 1039 (Ind. 2019), as disfavoring the practice of applying the public interest exception except in "rare circumstances." The Supreme Court reversed, holding that E.F. should have the opportunity to make certain arguments before the court of appeals. View "In re Commitment of E.F." on Justia Law

The Supreme Court affirmed the order of the circuit court granting summary judgment in favor of Defendant, Paramount Senior Living at Ona, LLC, and dismissing Plaintiff's complaint alleging that Paramount, which operated a senior care care, was responsible as a successor corporation for alleged wrongful conduct by Passage Midland Meadows Operations, an LLC that previously operated the home when Thelma Sturgeon was there, holding that there was no error.Specifically, the Supreme Court held that the circuit court (1) did not err by applying and expanding the general rule in Davis v. Celotex Corp., 420 S.E.2d 557 (W. Va. 1992) that "the purchaser of all the assets of a corporation is not liable for the debts or liabilities of the corporation purchased" in determining that Paramount was not liable as a successor corporation; and (2) did not err in concluding that the case was ripe for summary judgment. View "Milmoe v. Paramount Senior Living at Ona, LLC" on Justia Law

Plaintiff Sean Kelly appealed the grant of summary judgment to the University of Vermont Medical Center (UVMMC) on employment discrimination and breach-of-contract claims arising from UVMMC’s decision not to extend his one-year medical fellowship. UVMMC selected plaintiff for the 2017-18 fellowship. UVMMC was aware that plaintiff suffered from an adrenal deficiency that had delayed the completion of his residency. In the first five months of the fellowship, plaintiff missed nineteen full days and parts of nine more days for various reasons. By February 2018, after missing several more days and expressing that he felt “frustrated with [his] absences” and “overall inadequate as a fellow,” program personnel became concerned that plaintiff was falling behind in his training. In a March 30 meeting, the program director told plaintiff his performance had “deficiencies and these need[ed] to be addressed.” At some point during this period, the director also told plaintiff he “should plan on extending [his] fellowship due to [his] time out and some minor deficits through August.” Plaintiff emailed other program personnel expressing frustration at the prospect of staying through August to complete his training. On April 14, 2018, plaintiff suffered a stroke, and on April 19th he attempted suicide. He was hospitalized from April 14 through May 3 and was not cleared to return to work until June 1, 2018. In all, plaintiff missed approximately six more weeks of the fellowship. On or about May 31, the director called plaintiff and told him that while UVMMC had determined he needed six more months of training to finish the fellowship, it could not accommodate additional training for that length of time. UVMMC paid plaintiff his remaining salary. Plaintiff filed a grievance under the Graduate Medical Education rules; the grievance committee affirmed UVMMC's decision. Because the decision not to extend his fellowship was an academic decision, there was no employment action and consequently no adverse employment action. The Vermont Supreme Court did not find plaintiff's arguments on appeal persuasive, and affirmed the grant of summary judgment in UVMMC's favor. View "Kelly v. University of Vermont Medical Center" on Justia Law

The Supreme Court held that the public records law's general prohibition on pre-release judicial review of decisions to provide access to public records barred the claims brought by Wisconsin Manufacturers and Commerce and two other trade associations (WMC) seeking to stop the release of certain records.After the Milwaukee Journal Sentinel made public records requests to the Department of Health Services (DHS) for documents related to the COVID-19 pandemic WMC learned that DHS planned to respond by releasing a list of all Wisconsin businesses with more than twenty-five employees that have had at least two employees test positive for COVID-19 or that have had close case contacts. WMC brought this action seeking declaratory and injunctive relief to stop the release. The circuit court granted a temporary injunction. The court of appeals reversed. The Supreme Court affirmed, holding that WMC's complaint failed to state a claim upon which relief may be granted because its claim was barred by Wis. Stat. 19.356(1). View "Wisconsin Manufacturers & Commerce v. Evers" on Justia Law

The Supreme Court reversed in part and affirmed in part the order of the trial court finding that HEA-1123 is constitutional, holding that Governor Eric J. Holcomb was not procedurally barred from seeking declaratory relief on the constitutionality of House Enrolled Act 1123 (HEA-1123) and that the law is unconstitutional.HEA-1123, which was passed during the COVID-19 pandemic, authorizes the General Assembly to commence an "emergency session" under certain conditions through a simple resolution. The Governor vetoed the bill, finding it unconstitutional. The General Assembly overrode the Governor's veto, and the law went into effect. The Governor filed suit. The trial court found the HEA-1123 was constitutional. The Supreme Court reversed, holding (1) HEA-1123 violates Ind. Const. art. III, 1; and (2) by authorizing the Legislative Council to set an emergency session at a time when the General Assembly was not in session, HEA-1123 infringed on constitutional authority vested only in the Governor. View "Holcomb v. Bray" on Justia Law

The Ninth Circuit Court of Appeals certified a question of law to the Oregon Supreme Court. The question related to the applicability of Oregon’s anti- discrimination laws to a private contractor that provided healthcare services within a jail. Plaintiff filed a lawsuit against defendant, a private entity that contracted with the Clackamas County Jail to provide healthcare services to incarcerated persons, alleging that defendant had discriminated against him on the basis of disability, in violation of ORS 659A.142(4). The district court held that defendant was not a place of public accommodation, as defined by ORS 659A.400. The Ninth Circuit asked the Supreme Court to help it to resolve plaintiff’s appeal of the dismissal of his state law claim: “Is a private contractor providing healthcare services at a county jail a ‘place of public accommodation’ within the meaning of Oregon Revised Statutes § 659A.400 and subject to liability under § 659A.142?” The Supreme Court responded in the affirmative. View "Abraham v. Corizon Health, Inc." on Justia Law

In this appeal, the issue presented for the New Jersey Supreme Court in this case was whether a plaintiff had to submit an affidavit of merit (AOM) in support of a vicarious liability claim against a licensed health care facility based on the alleged negligent conduct of an employee who was not a “licensed person” under the AOM statute. Plaintiff Troy Haviland brought a claim against defendant Lourdes Medical Center of Burlington County, Inc., alleging, as relevant here, that an unnamed radiology technician employed by defendant negligently performed his radiological imaging examination, causing serious injuries. Defendant filed a motion to dismiss plaintiff’s complaint for failure to serve an AOM, which was granted. The Appellate Division reversed, determining that an AOM was not required when a plaintiff’s claim against a licensed person was limited solely to vicarious liability, based upon the alleged negligence of an employee who was not a licensed person under the AOM statute. To this the Supreme Court concurred: the AOM statute did not require submission of an AOM to support a vicarious liability claim against a licensed health care facility based only on the conduct of its non-licensed employee. View "Haviland v. Lourdes Medical Center of Burlington County, Inc." on Justia Law