Justia Health Law Opinion Summaries

Several skilled nursing facilities challenged the State Department of Health Care Services and its director, Michelle Baass, over the formula used to calculate Medi-Cal reimbursement overpayments. The plaintiffs argued that the Department's method, which was based on the amount Medicare paid for ancillary services rather than the amount Medi-Cal overpaid, violated a ministerial duty and constituted an underground regulation.The trial court sustained the Department's demurrer without leave to amend, concluding that the plaintiffs' claim was not cognizable in a traditional writ of mandate proceeding. The court also found that the plaintiffs failed to state a claim that the Department violated a ministerial duty or adopted an underground regulation. Additionally, the trial court denied the plaintiffs' motion to compel discovery of certain documents, deeming them privileged.The California Court of Appeal, Third Appellate District, reviewed the case. The court determined that some of the plaintiffs' claims were indeed cognizable in a traditional writ of mandate proceeding and that the petition stated a claim for relief regarding the Department's use of an underground regulation when calculating Medi-Cal reimbursement overpayments. However, the court found that the plaintiffs did not provide an adequate record to review whether the trial court erred in denying their motion to compel discovery.The appellate court reversed the judgment of dismissal and affirmed the trial court's order denying the plaintiffs' motion to compel. The case was remanded to the trial court with instructions to vacate its order sustaining the Department's demurrer without leave to amend and to enter a new order overruling the demurrer. The plaintiffs were awarded their costs on appeal. View "California Healthcare & Rehabilitation Center v. Baass" on Justia Law

Daniel R. Smith, who is currently blind, underwent medical examinations upon entering military service in August 1964 and upon leaving in June 1965. Both examinations noted poor night and color vision, with vision correctable in both eyes. After his discharge, Smith filed several claims with the U.S. Department of Veterans Affairs (VA) for benefits based on retinitis pigmentosa, an eye disease causing vision loss. An ophthalmologist opined that Smith's condition preexisted his service and did not worsen during service. The VA denied his claim, and the Board of Veterans’ Appeals agreed, finding clear and unmistakable evidence rebutting the presumption of sound health upon entry into service. The Court of Appeals for Veterans Claims affirmed this decision.The United States Court of Appeals for Veterans Claims reviewed the case and affirmed the Board's decision, finding that Dr. Wilson's opinion constituted clear and unmistakable evidence that Smith's retinitis pigmentosa did not increase in severity during service. Smith appealed, arguing that Dr. Wilson's opinion did not meet the clear and unmistakable evidence standard and that it improperly relied on the absence of evidence.The United States Court of Appeals for the Federal Circuit reviewed the case and dismissed Smith's appeal. The court held that it lacked jurisdiction to review the factual determination that Dr. Wilson's opinion met the clear and unmistakable evidence standard. The court also found that the Veterans Court did not rely on an absence of evidence but rather on affirmative evidence comparing Smith's vision tests at entry and separation from service. Therefore, the Federal Circuit concluded that it could not address Smith's legal contention regarding the sufficiency of the evidence. View "SMITH v. COLLINS " on Justia Law

The case involves the U.S. Centers for Medicare & Medicaid Services (CMS) approving the New York State Department of Health’s (NYSDOH) application to distribute $361.25 million to certain managed care organizations. These organizations were to direct the funds to the top one-third of revenue-generating licensed home care services agencies (LHCSAs) in New York’s four rate regions, provided they agreed to use the funding in a specified manner. The plaintiffs, who are LHCSAs that did not meet the revenue threshold, argued that the approval was unlawful under federal law and regulations because the class of eligible agencies was improperly defined and the application was not assessed for actuarial soundness before approval.The district court dismissed the amended complaint against the State Appellees for failing to adequately allege a cause of action under Ex parte Young and granted summary judgment to the Federal Appellees. The court concluded that the approval of the State’s application did not violate the Administrative Procedure Act (APA) and denied the plaintiffs’ motion to admit extra-record evidence.The United States Court of Appeals for the Second Circuit reviewed the case and agreed with the district court’s decision. The court held that CMS’s approval of NYSDOH’s application complied with federal law. It found that the provider class was properly defined under 42 C.F.R. § 438.6(c)(2)(ii)(B) and that CMS was not required to assess actuarial soundness during the pre-approval process. The court also concluded that CMS did not act arbitrarily or capriciously in approving the application and that the district court did not abuse its discretion in excluding the extra-record evidence. Consequently, the Second Circuit affirmed the judgment of the district court. View "Safe Haven Home Care, Inc. v. United States Department of Health and Human" on Justia Law

A father, Scott Williams, and his son, Taeyan Williams, were convicted by a federal jury of various drug-related offenses, including conspiracy to distribute and possess with intent to distribute marijuana and cocaine. The case stemmed from an investigation into the disappearance of a drug dealer, Noah Smothers, who supplied drugs to Scott and Taeyan. A search of Scott's home revealed large quantities of drugs, firearms, and cash. Both Scott and Taeyan were found guilty of conspiracy and possession with intent to distribute, while Scott was also convicted of additional charges related to methamphetamine and evidence destruction.The United States District Court for the District of Maryland denied Scott's motion to suppress evidence obtained from the search, despite his claim that law enforcement failed to knock and announce before entering. The court held that suppression was not the appropriate remedy. Scott and Taeyan were sentenced to 276 months and 150 months in prison, respectively, followed by five years of supervised release. Both appealed their convictions and sentences.The United States Court of Appeals for the Fourth Circuit reviewed the case. The court affirmed Taeyan's conviction, finding sufficient evidence to support his possession with intent to distribute charges, based on his connection to the drugs found in Scott's home. The court also upheld the district court's denial of Scott's motion to suppress, citing exigent circumstances that justified the no-knock entry. Additionally, the court rejected Scott's request for a sentence reduction under the newly promulgated U.S.S.G. § 4C1.1, advising him to seek relief through a motion under 18 U.S.C. § 3582. Finally, the court found no improper delegation of judicial authority in the conditions of Scott's supervised release, affirming the district court's judgments in their entirety. View "United States v. Williams" on Justia Law

In November 2021, Lincoln Medical administered a COVID-19 vaccine to the five-year-old child of Jeremiah Hogan and Siara Jean Harrington at a school clinic without obtaining parental consent. Hogan filed a notice of claim in the Superior Court against the doctor, Lincoln Medical Partners, and MaineHealth, Inc., alleging various torts including professional negligence, battery, and false imprisonment on behalf of the child, and emotional distress and tortious interference with parental rights on behalf of the parents.The Superior Court appointed a chair for the prelitigation screening panel, and Lincoln Medical moved to dismiss the notice of claim, citing immunity under the federal Public Readiness and Emergency Preparedness (PREP) Act. The court granted the motion to dismiss, interpreting the PREP Act to provide immunity to the defendants with no applicable exceptions. Hogan appealed the decision.The Maine Supreme Judicial Court reviewed the case and affirmed the Superior Court's judgment. The court held that the PREP Act provides broad immunity to covered persons, including individuals and corporations, from suits related to the administration of covered countermeasures, such as the COVID-19 vaccine. The court found that the federal statute preempts state law that would otherwise allow Hogan to sue, as the claims were directly related to the administration of the vaccine. The court concluded that the defendants were immune from Hogan’s claims under the PREP Act, and the state tort claims were preempted by federal law. View "Hogan v. Lincoln Medical Partners" on Justia Law

Sardar Ashrafkhan owned and operated a fraudulent medical practice where doctors wrote and billed Medicare for fake prescriptions. These prescriptions were filled at specific pharmacies, which paid Ashrafkhan kickbacks. The scheme resulted in millions of dollars in fraudulent Medicare claims and the illegal sale of opioid-based drugs. Ashrafkhan was indicted in 2013 and tried in 2015, where the government presented evidence that he masterminded the scheme. The jury convicted him of drug conspiracy, health care fraud conspiracy, and money laundering. At sentencing, he received an adjustment for being an organizer or leader of a criminal activity involving five or more participants.The United States District Court for the Eastern District of Michigan sentenced Ashrafkhan to 276 months of imprisonment, varying downward from the guidelines range of 600 months. Ashrafkhan appealed, and the United States Court of Appeals for the Sixth Circuit affirmed his conviction and sentence. After his sentencing, the United States Sentencing Commission promulgated a new guideline, USSG § 4C1.1, which provides a two-point reduction in the offense level for defendants with no criminal history points, known as "zero-point offenders." Ashrafkhan moved for a sentence reduction under this new guideline, but the district court denied his motion, reasoning that his aggravating role adjustment rendered him ineligible for the reduction.The United States Court of Appeals for the Sixth Circuit reviewed the case and affirmed the district court's decision. The court held that to be eligible for the zero-point offender reduction under USSG § 4C1.1, a defendant must not have received an aggravating role adjustment and must not have engaged in a continuing criminal enterprise. Since Ashrafkhan received an aggravating role adjustment, he was ineligible for the reduction, regardless of whether he engaged in a continuing criminal enterprise. The court's interpretation was based on the plain text and context of the guideline, as well as precedent from similar cases. View "United States v. Ashrafkhan" on Justia Law

A hospital in Siskiyou County, California, filed a lawsuit against the County of Siskiyou and other defendants, challenging the practice of bringing individuals with psychiatric emergencies to its emergency department under the Lanterman-Petris-Short (LPS) Act. The hospital argued that it was not equipped or licensed to provide the necessary psychiatric care and sought to prevent the county from bringing such patients to its facility unless they had a physical emergency condition. The hospital also sought reimbursement for the costs associated with holding these patients.The Siskiyou County Superior Court denied the hospital's motion for a preliminary injunction, which sought to stop the county from bringing psychiatric patients to its emergency department. The court found that the hospital had not demonstrated a likelihood of success on the merits and that the burden on the county and the potential harm to the patients outweighed the hospital's concerns.The hospital's complaint included several causes of action, including violations of Medicaid laws, disability discrimination laws, mental health parity laws, and section 17000 of the Welfare and Institutions Code. The hospital also alleged breach of an implied-in-fact contract for the costs incurred in providing post-stabilization services to psychiatric patients. The trial court sustained demurrers to the complaint without leave to amend, finding that the hospital failed to identify any clear legal mandate that the county or the Department of Health Care Services had violated.The California Court of Appeal, Third Appellate District, affirmed the trial court's judgment of dismissal. The appellate court concluded that the hospital had not identified any mandatory and ministerial duty that the county or the department had violated, which is necessary to obtain a writ of mandate. The court also found that the hospital's breach of contract claim failed because there were no allegations of mutual consent to an implied contract. Consequently, the hospital's appeal from the denial of its motion for a preliminary injunction was dismissed as moot. View "Siskiyou Hospital v. County of Siskiyou" on Justia Law

Michael Chapman, an Alabama inmate, sued prison officials and staff for deliberate indifference to his medical needs, violating the Eighth Amendment. Chapman alleged that an untreated ear infection led to severe injuries, including mastoiditis, a ruptured eardrum, and a brain abscess. He also claimed that the prison's refusal to perform cataract surgery on his right eye constituted deliberate indifference. The district court granted summary judgment for all defendants except the prison’s medical contractor, which had filed for bankruptcy.The United States District Court for the Middle District of Alabama found Chapman’s claim against nurse Charlie Waugh time-barred and ruled against Chapman on other claims, including his request for injunctive relief against Commissioner John Hamm, citing sovereign immunity. The court also concluded that Chapman’s claims against other defendants failed on the merits and dismissed his state-law claims without prejudice.The United States Court of Appeals for the Eleventh Circuit reviewed the case. The court reversed the district court’s determination that Chapman’s claim against Waugh was time-barred, finding that Chapman’s cause of action accrued within the limitations period. The court vacated the district court’s judgment for Waugh and remanded for reconsideration in light of the recent en banc decision in Wade, which clarified the standard for deliberate indifference claims. The court also vacated the judgment for Hamm on Chapman’s cataract-related claim for injunctive relief, as sovereign immunity does not bar such claims. Additionally, the court vacated the summary judgment for all other defendants due to procedural errors, including inadequate notice and time for Chapman to respond, and remanded for further consideration. View "Chapman v. Dunn" on Justia Law

Ricky Koel sought emergency care at Citizens Medical Center in Colby, Kansas, after sustaining serious injuries to his right eye. He was evaluated by a triage nurse, a physician assistant, and Dr. Daniel Kuhlman, who suspected a possible globe rupture. Dr. Sam Funk, an optometrist, also examined Koel but did not confirm an open globe rupture. A CT scan indicated a possible globe rupture, but Dr. Kuhlman did not share these results with the specialists. Koel was discharged with instructions to see an ophthalmologist the next morning. Despite undergoing emergency surgery the following day, Koel ultimately lost vision in his injured eye.The United States District Court for the District of Kansas dismissed Koel's EMTALA claim, concluding that Citizens Medical Center did not violate the Act's requirements. The court granted summary judgment in favor of Citizens and declined to exercise supplemental jurisdiction over Koel's state-law claims.The United States Court of Appeals for the Tenth Circuit reviewed the case. The court held that Citizens Medical Center provided an appropriate medical screening examination within its capabilities and adhered to its own standard procedures, as required by EMTALA. The court also found that Citizens did not have actual knowledge of Koel's specific emergency medical condition (an occult globe rupture) and therefore was not obligated to stabilize him for that condition before discharge. The court affirmed the district court's summary judgment in favor of Citizens Medical Center. View "Koel v. Citizens Medical Center" on Justia Law

Elizabeth Holmes and Ramesh "Sunny" Balwani, founders of Theranos, were convicted of defrauding investors about the capabilities of their company's blood-testing technology. Theranos claimed it could run accurate tests with just a drop of blood, attracting significant investments. However, the technology was unreliable, and the company misled investors about its financial health, partnerships, and the validation of its technology by pharmaceutical companies.The United States District Court for the Northern District of California severed their trials due to Holmes's allegations of abuse by Balwani. Holmes was convicted on four counts related to investor fraud, while Balwani was convicted on all counts, including conspiracy to commit wire fraud against investors and patients. Holmes was sentenced to 135 months, and Balwani to 155 months in prison. The district court also ordered them to pay $452 million in restitution.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court affirmed the convictions, sentences, and restitution order. It held that the district court did not abuse its discretion in admitting testimony from former Theranos employees, even if some of it veered into expert territory. The court found any errors in admitting this testimony to be harmless due to the weight of other evidence against the defendants.The Ninth Circuit also upheld the district court's decision to admit a report from the Center for Medicare and Medicaid Services, finding it relevant to Holmes's knowledge and intent. The court rejected Holmes's argument that the district court violated her Confrontation Clause rights by limiting cross-examination of a former Theranos lab director. Additionally, the court found no merit in Balwani's claims of constructive amendment of the indictment and Napue violations. The court concluded that the district court's factual findings on loss causation and the number of victims were not clearly erroneous and affirmed the restitution order. View "USA V. HOLMES" on Justia Law