Justia Public Benefits Opinion Summaries

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In July 2010, L.M. was born at full-term and developed normally for six months. In February 2011, L.M. received childhood vaccines, including the diphtheria-tetanus-acellular pertussis vaccination. By that evening, L.M. had a fever, was lethargic, had poor muscle tone, and would not eat., Any disturbance caused L.M. to scream. L.M. began to have several seizures a day. At seven years of age, L.M. could crawl and walk with the assistance of a walker. She had a poorly coordinated grasp, suffered cortical visual impairments, and was nonverbal, though she could use a few signs to express ideas such as “yes,” and “no.” Testing revealed that L.M. had a genetic mutation. In a claim under the National Vaccine Injury Compensation Program, L.M. alleged that the vaccinations administered to L.M. in February 2011, significantly aggravated L.M.’s pre-existing condition under two alternative theories. The Special Master denied the petition, finding that L.M.’s genetic mutation was “the most compelling explanation for her predisposition to develop a seizure disorder.” The Federal Circuit affirmed the denial of an “on-table” claim, finding no support for an argument that most encephalopathies do not become acute until after vaccination. The court vacated and remanded the denial of an “off-table” claim, which requires determining whether the child’s receipt of vaccinations significantly aggravated her seizure disorder in the face of an underlying genetic mutation. View "Sharpe v. Secretary of Health and Human Services" on Justia Law

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The Eleventh Circuit affirmed the denial of social security disability benefits to plaintiff. The court rejected plaintiff's claim that the ALJ erred in finding that plaintiff was not disabled because the ALJ failed to appropriately consider the VA's determination that plaintiff was unable to work due to a disability and thus entitled to veterans' benefits. Rather, the court held that the ALJ's decisions demonstrates that he considered the VA's determination. The court also held that substantial evidence, including recent medical records that postdate the VA's decision, supported the ALJ's rejection of the VA's disability decision as determinative of whether plaintiff was disabled for Social Security purposes. View "Noble v. Commissioner of Social Security" on Justia Law

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In this class action, the Supreme Court reversed the judgment of the court of appeals affirming the common pleas court's decision to certify the class, holding that the common pleas court lacked subject matter jurisdiction over the class action for the named and prospective class plaintiffs whose claims for recovery fell within the express language of Ohio Rev. Code 5160.37. The class action sought a declaratory judgment that former Ohio Rev. Code 5101.58 relating to Medicaid reimbursements is unconstitutional. The action further sought to recover all sums paid to the Ohio Department of Medicaid (Department) under section 5101.58. Plaintiff moved to certify as a class all persons who paid any amount to the Department pursuant to the statute from April 6, 2007 to the present. The trial court certified the class. The court of appeals affirmed. The Supreme Court reversed, holding (1) section 5160.37 now provides the sole remedy for Medicaid program participants to recover excessive reimbursement payments made to the Department on or after September 29, 2007; and (2) therefore, the common pleas court lacked jurisdiction over the claims asserted by Plaintiffs. View "Pivonka v. Corcoran" on Justia Law

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Daugherty, an ALJ hearing disability-benefits applications for the Social Security Administration, took bribes. Conn, who represented many claimants, paid Daugherty $400 per favorable decision; Conn received $5,000 or more per case out of the benefits that Daugherty awarded. Four physicians, including Huffnagle, submitted evaluations to support Daugherty’s decisions, even if the applicant failed to appear for examination. Conn and Daugherty pleaded guilty to federal felonies. One of the physicians was convicted. Huffnagle died. The total cost of benefits granted by Daugherty exceeds $500 million. Following an investigation, a notice under 42 U.S.C. 1320a–8(l), set in motion a process for redetermination of the benefits awarded in connection with the scheme. In a suit under 42 U.S.C. 405(g), 1383(c)(3), Jaxson claimed that the ALJ who presided over his redetermination should have considered Huffnagle’s report but declined to do so only because an internal claims-processing manual and ruling say that an ALJ cannot accept evidence that the Inspector General found is likely a product of fraud. The Seventh Circuit affirmed a ruling in favor of Jaxson. Jaxson may have a hard time persuading an ALJ that there is not even “reason to believe” that Huffnagle’s report is fraudulent but he is entitled to try; 42 U.S.C. 405(b)(1), requires a “reasonable notice and opportunity for a hearing”, and “hearing” means a procedure at which both sides can present views on potentially dispositive matters. View "Jaxson v. Saul" on Justia Law

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Plaintiffs each brought an action asserting that the ALJ who denied their application for benefits was not properly appointed in accordance with the Appointments Clause of the Constitution. The Eighth Circuit held that the district court properly declined to consider the issue and affirmed the judgments. In these cases, none of the claimants raised the issue during the proceedings before the Social Security Administration and thus the district court properly concluded that they waived their argument. The court rejected plaintiffs' claims that their constitutional claims need not be exhausted and that exhaustion of this particular constitutional challenge would have been futile. The court further explained that this is not one of the rare situations in which a federal court should consider an issue that was not presented to the agency. View "Davis v. Saul" on Justia Law

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General’s clinicians perform services in long-term care facilities. General bills Medicare under 42 U.S.C. 1395. A Centers for Medicare and Medicaid Services (CMS) contractor, AdvanceMed, initiated audits in 2002 after the CMS fraud unit received complaints about General’s billing practices. In 2004 AdvanceMed initiated an audit of General’s physicians without providing any notice to General. AdvanceMed sent records requests to physicians at 12 General facilities, covering 382 claims involving 278 patients in 2002-2004. General was not notified of these requests. AdvanceMed did not request any records from General. AdvanceMed determined that 35 of the 382 claims were allowed as billed; 33 claims were allowed at different levels than billed. The remaining 314 claims were denied: 3 did not meet policy guidelines, 73 had no documentation to support the services, and 238 were medically unnecessary. General learned of this audit when it received a letter in 2007, indicating that General had been overpaid by $16,778.80; the overpayment was extrapolated to a universe of 41,818 claims. The total amount of overpayment demanded was $1,836,646.56. The Appeals Council determined and the Sixth Circuit affirmed that no remedy should be granted because the lack of notice was inconsequential and did not prevent General from ably and thoroughly arguing the principal issues resulting from the audit, the validity of the sampling methodology, and the coverage of the reviewed claims. The addition of more medical records would not have materially impacted its findings. View "General Medicine, P.C. v. Azar" on Justia Law

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At issue in this case was the correct interpretation of Ariz. Rev. Stat. 23-750(E)(5), which provides that income earned by any individual who performed certain services while employed by an entity that provides such services to or on behalf of an "educational institution" cannot be used to qualify for unemployment during breaks between academic terms if that person is guaranteed reemployment. Plaintiffs were employees of Chicanos For La Cause (CPLC), a nonprofit corporation that administered federally funded Early Head Start and Migrant Seasonal Head Start programs and provided services to help school districts comply with their obligations under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. When the summer break began, Plaintiffs applied for unemployment insurance benefits from Arizona Department of Economic Security (ADES), which granted benefits. The ADES Appeals Board reversed. The Supreme Court remanded the case to ADES to award unemployment benefits to two plaintiffs and for further proceedings to resolve the claims of the remaining plaintiffs, holding that section 23-750(E)(5) applies to plaintiffs only if they performed services for CPLC that CPLC supplied to the school districts. View "Rosas v. Arizona Department of Economic Security" on Justia Law

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In separate claims, appellees Willie Carr and Kim Minor sought disability benefits from the Social Security Administration (“SSA”). In each case, the administrative law judge (“ALJ”) denied the claim, and the agency’s Appeals Council declined to review. While his case was pending in district court, the U.S. Supreme Court held that Securities and Exchange Commission (“SEC”) ALJs were “inferior officers” under the Appointments Clause, and therefore must be appointed by the President, a court, or head of the agency. Shortly thereafter, Minor also sued in district court to challenge the denial of benefits in her case. In response to the Supreme Court case, Lucia v. S.E.C., 138 S. Ct. 2044 (2018), the SSA Commissioner appointed the SSA's ALJs to address any Appointments Clause questions Lucia posed. After the Commissioner’s action, Carr and Minor each filed a supplemental brief, asserting for the first time that the ALJs who had rejected their claims had not been properly appointed under the Appointments Clause. The district court upheld the ALJs’ denials of the claims, but it agreed with the Appointments Clause challenges. The court vacated the SSA decisions and remanded for new hearings before constitutionally appointed ALJs. It held that appellees did not waive their Appointments Clause challenges by failing to raise them in their SSA proceedings. On appeal, the Commissioner argued Appellees waived their Appointments Clause challenges by failing to exhaust them before the SSA. The Tenth Circuit agreed with the Commissioner and reversed. View "Carr v. Commissioner, SSA" on Justia Law

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The Orange County Department of Child Support Services (Department) has withdrawn money from Daniel Lak’s (Father) Social Security Disability Insurance benefits (SSDI) to pay for child/spousal support arrears since 2015. Father disputed the Department's authority to withdraw money, and at a hearing, sought reimbursement for overpayments and maintained the Department violated Family Code section 5246 (d)(3) by collecting more than five percent from his SSDI. The court denied Father’s requests and determined the Department could continue withdrawing money from SSDI for support arrears. On appeal, Father maintaned the court misinterpreted the law and failed to properly consider his motion for sanctions. Finding his contentions lack merit, the Court of Appeal affirmed the court’s order the Department did not overdraw money for arrears, Father failed to demonstrate he qualified for section 5246(d)(3)’s five percent rule, and sanctions were not warranted. View "Lak v. Lak" on Justia Law

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Carr served Air Force active duty, 1976-1980, earning 45 months of education benefits under Chapter 34 (Vietnam-era GI Bill), Carr used 41 months and 11 days of those benefits for his own education before the entire Chapter 34 program expired. After September 11, 2001, Carr returned to active duty and would have been eligible for 36 additional months of benefits under Chapter 33 (Post-9/11 GI Bill), but 38 U.S.C. 3695 limited him to a cumulative total of 48 months. Carr transferred those benefits to his daughter, 38 U.S.C. 3319, who used paid for two semesters. Due to a VA error, she initially did not receive payments to cover the final days of the Fall 2010 semester and was informed, incorrectly, that she had exhausted her benefits. Later, it was discovered that she had 19 days of benefits remaining; one day was applied to the Fall 2013 semester. Chapter 33 permits extensions of education benefits “in a roundabout way” to the end of the semester, 38 C.F.R. 21.9635(o)(1). The regional office, the Board of Veterans’ Appeals, and the Veterans Court rejected Carr's Chapter 33 claim. The Federal Circuit reversed and remanded for consideration of the unaddressed regulatory challenge. . The Veterans Court resolved the appeal through statutory interpretation and did not address the transferred benefits regulation; 38 U.S.C. 3695(a)’s aggregate multi-program benefits cap does not preclude end-of-term extensions of benefits authorized under individual benefits programs. View "Carr v. Wilkie" on Justia Law