Justia Health Law Opinion Summaries

Mamalakis, a Wisconsin anesthesiologist, filed a qui tam lawsuit (False Claims Act, 31 U.S.C. 3729), alleging that Anesthetix, his former employer, fraudulently billed Medicare and Medicaid for services performed by its anesthesiologists. His central allegation is that the anesthesiologists regularly billed the government using the code for “medically directed” services when their services qualified for payment only at the lower rate for services that are “medically supervised.” A magistrate judge held that the complaint did not provide enough factual particularity to satisfy the heightened pleading standard for fraud claims, FED. R. CIV. P. 9(b). Mamalakis filed an amended complaint that included 10 specific examples of inflated billing, each identifying a particular procedure and anesthesiologist and providing details about how the services did not qualify for payment at the medical-direction billing rate. Six examples included a specific allegation that the anesthesiologist billed the services using that code; the other four relied on general allegations regarding the group’s uniform policy of billing at the medical-direction rate. The judge dismissed the case with prejudice.The Seventh Circuit reversed. Although Rule 9(b) imposes a high pleading bar to protect defendants from baseless accusations of fraud, Mamalakis cleared it. The examples, read in context with the other allegations in the amended complaint, provide sufficient particularity about the alleged fraudulent billing to survive dismissal. View "Mamalakis v. Anesthetix Management LLC" on Justia Law

The Supreme Court accepted certification of two questions by the United States Court of Appeals for the Ninth Circuit regarding whether a charitable write-off of medical expenses may be recovered as damages or is subject to the collateral source rule.Specifically, the Supreme Court concluded (1) for a claim that accrued prior to the effective date of Mont. Code Ann. 27-1-308 a plaintiff in a survival action may not recover the reasonable value of medical care and related services when the costs of such services or care are wholly written off under the provider's charitable care program and the patient receives a zero-balance bill; and (2) for a claim that accrued prior to the effective date of Mont. Code Ann. 27-1-308, such a charitable care write-off is not a collateral source within the meaning of section 27-1-307. View "Gibson v. United States" on Justia Law

In November 2021, the Secretary of Health and Human Services issued an interim rule that requires facilities that provide health care to Medicare and Medicaid beneficiaries to ensure that their staff, unless exempt for medical or religious reasons, are fully vaccinated against COVID-19, 86 Fed. Reg. 61,555. Under the rule, covered staff must request an exemption or receive their first dose of a two-dose vaccine or a single-dose vaccine by December 6, 2021. Florida unsuccessfully sought a preliminary injunction to bar the interim rule’s enforcement.The Eleventh Circuit upheld the denial of the motion, first deciding not to apply the mootness doctrine and to exercise jurisdiction despite another district court’s issuance of a nationwide injunction. Florida failed to demonstrate a substantial likelihood that it will prevail on the merits, that it will suffer irreparable injury absent an injunction, or that the balance of the equities favors an injunction. The Secretary has express statutory authority to require facilities voluntarily participating in the Medicare or Medicaid programs to meet health and safety standards to protect patients. The Secretary provided a detailed explanation for why there was good cause for dispensing with the notice-and-comment requirement. Ample evidence supports the Secretary’s determination that facility staff vaccination will provide important protection for patients. View "State of Florida v. Department of Health and Human Services" on Justia Law

The Eighth Circuit affirmed the district court's dismissal of Regional's declaratory judgment claims alleging that defendants' procedures in suspending Regional's Medicare payments and forcing it out of business without notice, a hearing, or an opportunity to appeal violated its Fifth Amendment rights to procedural and substantive due process. The court concluded that no actual controversy exists between Regional and defendants within the meaning of the Declaratory Judgment Act. The court explained that, having abandoned any claim for damages, Regional seeks nothing more than a judicial pronouncement that its constitutional rights were violated. Therefore, the possibility of Regional re-establishing a business that is certified to receive Medicare reimbursements, again submitting documentation insufficient to meet Medicare requirements for billed services, and again having Medicare payments suspended is too conjectural or hypothetical to pose a real and immediate threat of injury sufficient to confer subject matter jurisdiction in federal court. View "Regional Home Health Care, Inc. v. Becerra" on Justia Law

A 16-year-old high school student and her parents filed an emergency motion for an injunction pending appeal, seeking to enjoin the school district from requiring compliance with a student vaccination mandate. The Ninth Circuit granted plaintiffs' motion in part. The court ordered that an injunction shall be in effect only while a "per se" deferral of vaccination is available to pregnant students under the school district's student vaccination mandate, and that the injunction shall terminate upon removal of the per se deferral option for pregnant students. Defendants then filed a letter and supporting declaration explaining that the deferral option for pregnant students has been removed from the mandate. Given the removal of the per se deferral option for pregnant students, the injunction issued in the November 28, 2021 order has terminated under its own terms.The Ninth Circuit issued an order providing its reasoning for why an injunction pending appeal is not warranted as to the now-modified student vaccination mandate. The court concluded that plaintiffs have not demonstrated a sufficient likelihood of success in showing that the district court erred in applying rational basis review, as opposed to strict scrutiny, to the student vaccination mandate. The court explained that plaintiffs' emergency motion fails to raise a serious question as to whether the vaccination mandate is not neutral and generally applicable; plaintiffs have not demonstrated a likelihood of success in showing that the district court erred by applying rational basis review; and plaintiffs do not argue that they are likely to succeed on the merits of their free exercise claim if rational basis review applies. The court also concluded that plaintiffs have not carried their burden of establishing that they will suffer irreparable harm if this court does not issue an injunction, or that the public interest weighs in their favor. View "Doe v. San Diego Unified School District" on Justia Law

The Fifth Circuit granted the Texas Attorney General a stay pending appeal of the permanent injunction that bars him from enforcing Texas Governor Greg Abbott's Executive Order GA-38, which prohibits local governmental entities from imposing mask mandates.After determining that plaintiffs have likely failed to demonstrate standing, the court concluded that the Attorney General has demonstrated a strong likelihood of success on the merits as a matter of law. In this case, the district court lacked jurisdiction over plaintiffs' claims where plaintiffs have not exhausted their administrative remedies under the Individuals with Disabilities Education Act (IDEA). Furthermore, even if a failure to exhaust remedies does not bar plaintiffs' claims, plaintiffs likely failed to make out a prima facie case under the Americans with Disabilities Act (ADA) or the Rehabilitation Act. The court explained that, given the availability of vaccines, voluntary masking, and other possible accommodations, the record before the court likely does not support the conclusion that a mask mandate would be both necessary and obvious under the ADA or the Rehabilitation Act. The court also held that it was likely erroneous for the district court to hold that GA-38 was preempted by either the ADA or the Rehabilitation Act. To the extent that it is even properly before the court, the court did not read the American Rescue Plan Act to preempt GA-38's prohibition of local mask mandates, as the district court did. The court further concluded that, assuming plaintiffs' claims are otherwise viable, at a minimum, the district court's blanket injunction prohibiting the enforcement of GA-38 in all public schools across the State of Texas is overbroad. Finally, the court concluded that the Attorney General has demonstrated the prospect of irreparable injury absent a stay; has shown that maintaining the status quo ante pending appeal will not risk substantial injury to plaintiffs; and that the public interest favors a stay. View "E.T. v. Paxton" on Justia Law

Teachers and school administrators challenge the denial of motions to preliminarily enjoin the enforcement of an order issued by the New York City Commissioner of Health and Mental Hygiene mandating that individuals who work in New York City schools be vaccinated against the COVID-19 virus.The Second Circuit concluded that the Vaccine Mandate does not violate the First Amendment on its face. However, the court concluded that plaintiffs have established their entitlement to preliminary relief on the narrow ground that the procedures employed to assess their religious accommodation claims were likely constitutionally infirm as applied to them. The court explained that the Accommodation Standards as applied here were neither neutral nor generally applicable to plaintiffs, and thus the court applied a strict scrutiny analysis at this stage of the proceeding. The court concluded that these procedures cannot survive strict scrutiny because denying religious accommodations based on the criteria outlined in the Accommodation Standards, such as whether an applicant can produce a letter from a religious official, is not narrowly tailored to serve the government's interest in preventing the spread of COVID-19. Accordingly, the court vacated the district court's orders denying preliminary relief and concurred with and continued the interim relief granted by the motions panel as to these fifteen individual plaintiffs. The court remanded for further proceedings. View "Kane v. De Blasio" on Justia Law

The Supreme Court reversed the decision of the court of appeals reversing the circuit court's dismissal of Plaintiff's claim against Defendant for unlawfully overcharging her for copies of her medical records, in violation of fee restrictions set forth in Wis. Stat. 146.83(3f), holding that the circuit court erred.On appeal, Defendant argued that the statutory fee restrictions did not apply to it because it was not a healthcare provider, as statutory defined, and because principles of agency law did not impose personal liability on it for the fees at issue. The Supreme Court agreed and reversed, holding (1) Defendant was not a healthcare provider under a plain meaning interpretation of Wis. Stat. 146.81(1) and was therefore not subject to the fee restrictions in section 146.83(3f)(b); and (2) neither common law principles nor Wis. Stat. 990.001(9) set forth that an agent is personally liable for charging more for healthcare records than statutory permitted by its principal. View "Townsend v. ChartSwap, LLC" on Justia Law

Several entities that owned or operated hospitals in Alabama ("plaintiffs") filed suit against manufacturers of prescription opioid medications, distributors of those medications, and retail pharmacies ("defendants"), alleging that defendants' marketing or selling of the medications resulted in an epidemic of opioid abuse in Alabama. Plaintiffs sought to recover unreimbursed medical expenses incurred in treating individuals with opioid-related medical conditions. Among other theories of liability, plaintiffs asserted that defendants had created a public nuisance in the form of the epidemic. The trial court entered a case-management order directing the parties to try each of plaintiffs' causes of action separately. The public-nuisance claim was to be tried first and is itself to be bifurcated into two separate trials. The first trial on the public-nuisance claim was to involve "liability," and the second trial was to involve "special damage." Defendants, asserting that the trial court had erred in bifurcating the public-nuisance claim, petitioned the Alabama Supreme Court for a writ of mandamus directing the trial court to vacate the relevant portion of the case-management order. The Supreme Court granted the writ: "conducting a trial on the issue of the defendants' 'liability' for a public nuisance and a second trial on 'special damage' neither avoids prejudice nor furthers convenience, expedition, or economy. We can only conclude that the trial court exceeded its discretion. We therefore grant the defendants' petition and issue a writ of mandamus." View "Ex parte Endo Health Solutions Inc. et al." on Justia Law

The Supreme Judicial Court affirmed the judgment of the superior court judge denying Plaintiffs' second request for a preliminary injunction, holding that there was no error.Plaintiffs, a class of inmates in Department of Correction (DOC) facilities, brought this complaint alleging that the conditions of their confinement during the COVID-19 pandemic constituted cruel and unusual punishment under the Eighth Amendment and seeking to enjoin the DOC to use various measures to reduce the incarcerated population. After the class was certified Plaintiffs filed a second emergency motion for a preliminary injunction seeking an immediate reduction in the incarcerated population. The motion judge denied Plaintiffs' second motion for preliminary relief. The Supreme Judicial Court affirmed, holding that Plaintiffs were unlikely to prevail on their Eighth Amendment claim, and therefore, the superior court did not err in denying their second motion for preliminary relief. View "Foster v. Commissioner of Correction" on Justia Law