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The Fifth Circuit affirmed the district court's denial of attorneys' fees for plaintiff under the Individuals with Disabilities Education Act (IDEA). The court held that the hearing officer's decision did not make plaintiff a prevailing party under the IDEA and thus she was not entitled to attorneys' fees. In this case, the officer's decision effected no change to plaintiff's educational plan, which the officer agreed was entirely appropriate despite lacking a prior autism diagnosis. Furthermore, the IDEA focuses, not on a student's diagnostic label, but on whether the student received appropriate education services, which the officer found plaintiff had received from the school district. View "Lauren C. v. Lewisville Independent School District" on Justia Law

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The Second Circuit granted a petition for review of the Commissioner's decision adopting the Department of Appeals Board's (DAB) decision and imposition of an assessment and penalty for petitioner's failure to report work activity while receiving Social Security disability insurance (SSDI) benefits. Although the court agreed that petitioner's failure to report work activity was "material" and thus authorized the Commissioner to impose an assessment and penalty, the court held that the DAB lacked substantial evidence to support the amounts of the assessment and penalty it imposed. In this case, petitioner's earnings from work activity did not amount to "substantial gainful activity," he remained disabled while failing to report work activity, and the findings of fact on which the DAB relied established only that petitioner's work was "sporadic." Therefore, the court vacated the DAB's decision and remanded for further proceedings. View "Cappetta v. Commissioner of Social Security Administration" on Justia Law

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In this challenge to an initiative petition seeking to expand Medicaid coverage the Supreme Court affirmed the judgment of the district court granting summary judgment in favor of Defendants, the named sponsors of the petition and the Secretary of State, holding that Appellants’ statutory and constitutional arguments were unavailing. Appellants sought to invalidate an initiative petition that received enough signatures to be placed on the November 2018 ballot. The district dismissed the complaint with prejudice. The Supreme Court affirmed, holding that the district court did not err by (1) dismissing as unripe and failing to find merit to Appellant’s claims that the ballot measure was an unconstitutional delegation of legislative authority and did not meet the statutory criteria for appropriations; (2) finding that the initiative did not violate the single subject rule; and (3) excluding a challenged exhibit from the evidence. View "Christensen v. Gale" on Justia Law

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The SSA determined that because plaintiff was also receiving civil service disability retirement payments, his Social Security benefits should be reduced under the windfall elimination provision. At issue was the boundaries of "payment based wholly on service as a member of a uniformed service" for the purpose of social security benefit calculations. The Eleventh Circuit, accounting for the unique nature of the dual status technician position and applying Skidmore deference, held that plaintiff did not perform his dual status technician employment wholly as a member of a uniformed service. Consequently, payments based on that employment did not qualify for the exception. The court did not think the requirements of the dual status technician position were sufficient to place dual status technicians within the sweep of the exception—especially given the provision's use of the word "wholly." Therefore, the uniformed services exception did not apply in plaintiff's case. View "Martin v. Social Security Administration" on Justia Law

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Silver’s qui tam action, filed under the False Claims Act (FCA), 31 U.S.C. 3729–33, alleged that PharMerica, which owns and operates institutional pharmacies serving nursing homes, unlawfully discounted prices for nursing homes’ Medicare Part A patients (reimbursed by the federal government to the nursing home on a flat per-diem basis) in order to secure contracts to supply services to patients covered by Medicare Part D and Medicaid (reimbursed directly to the pharmacy by the government on a cost basis) in the same nursing homes--a practice called swapping. The district court dismissed, based on the FCA’s public disclosure bar. The Third Circuit reversed. The district court improperly determined that documents publicly describing the generalized risk of swapping in the nursing home industry served to bar his specific claim, which depended on non-public information that PharMerica was actually engaging in swapping in specific contracts. The district court also erred in concluding, on the basis of Silver’s testimony, that he relied upon certain publicly available information to reach his conclusion and that the information itself disclosed the fraud, without independently determining that the relevant public document did, in fact, effectuate such a disclosure. View "Silver v. Omnicare Inc" on Justia Law

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The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act, 42 U.S.C. 1437f(t) (Section 8). Enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.”because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent. The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit initially affirmed. On rehearing, the Third Circuit reversed. The statute’s plain language and history indicate that enhanced voucher holders may not be evicted absent good cause, even at the end of a lease term. The court remanded so that the district court may consider whether Harvey has good cause to evict. View "Hayes v. Harvey" on Justia Law

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The Supreme Judicial Court dismissed the appeal brought by the Department of Health and Human Services (Department) from a partial judgment entered in the Business and Consumer Docket mandating the implementation of one provision of the citizen initiative expanding Medicaid coverage. The initiating petition in this case requested numerous forms of relief. The superior court addressed only one component of the requested relief due to ripeness issues. The Supreme Judicial Court decided that it must dismiss this appeal as interlocutory because the petition was not disposed of in its entirety and no exception to the final judgment rule existed. View "Maine Equal Justice Partners v. Commissioner, Department of Health & Human Services" on Justia Law

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Plessinger was born with congenital spinal stenosis. He began experiencing back pain in 2010, at age 23. He worked as a diesel mechanic, electric lineman, fast food worker, welder, and truck driver. A 2012 accident exacerbated a prior injury from falling at work. He had surgery for a disc rupture in 2013. Later in 2013, in connection with Plessinger’s application for Social Security disability benefits, non‐examining consultants assessed his residual functional; one determined that Plessinger had the residual functional capacity to perform light work, another determined he could perform only sedentary work. Plessinger was later diagnosed with failed back surgery syndrome. In 2014, a doctor determined that Plessinger could walk only 20-30 feet and could stand for only five minutes. An ALJ found that he was severely impaired by his lumbar degenerative disc disease and stenosis, thoracic degenerative disc disease, obesity, and systemic hypertension but found the impairments not disabling. The Seventh Circuit reversed. In the face of the great weight of medical evidence supporting Plessinger’s claims of disabling impairments, the ALJ gave undue weight to the opinion of a medical expert who did not examine Plessinger and hedged his opinion in a critical way that was never resolved. The ALJ’s decision to discount the credibility of Plessinger's complaints of pain was not supported by substantial evidence. View "Plessinger v. Berryhill" on Justia Law

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The Fifth Circuit affirmed the district court's judgment upholding a hearing officer's decision that the school district deprived plaintiff, a high school student with a disability, of a free and appropriate public education (FAPE) by failing to fulfill its Child Find duty in a timely manner. The court held that the district court did not reversibly err by concluding that taken together, the student's academic decline, hospitalization, and incidents of theft should have led the district to suspect her need for special education services by October 2014, at the latest. Therefore, the school district violated the Individuals with Disabilities Education Act's Child Find requirements by failing to identify, locate, and evaluate students with suspected disabilities within a reasonable time. The court also held that the student was a prevailing party entitled to attorneys' fees because she received a FAPE and thus achieved some of the benefit she sought in requesting the due process hearing. View "Krawietz v. Galveston Independent School District" on Justia Law

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The Social Security Administration (SSA) reduced the payment of a back-award that it owed Berg by the amount of an earlier overpayment that Berg owed to SSA. Berg contested this setoff because it was taken during the 90-day period before the filing of her bankruptcy petition. The bankruptcy court concluded that SSA permissibly recovered $17,385 of overpayment but impermissibly improved its position by $2,015. The Seventh Circuit affirmed. Under 11 U.S.C. 553(b)(2), a debtor (Berg) may recover from a creditor (SSA) an amount set off by the creditor in the 90 days preceding the filing of the bankruptcy petition only to the extent that the creditor improved its position during that 90-day period. The bankruptcy court correctly calculated the accrual of Berg’s benefits as occurring on the dates that she had a right to benefits--the last day of each month that she was eligible for benefits and survived to the end of the month. On May 9, 2014, 90 days before the filing of the petition, that amount was $17,385. Because Berg then owed SSA $19,400, the insufficiency on that date was $2,015. On July 30, the date the SSA took the setoff, Berg still owed SSA $19,400, but SSA owed her $20,307; SSA improved its position by $2,015 during the 90-day preference period. That is the amount that Berg may now recover. View "Berg v. Social Security Administration" on Justia Law