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The Coalition filed suit on behalf of its foster parent members, alleging that the State pays foster parents members inadequate rates to cover the costs of caring for their foster children, in violation of the Adoption Assistance and Child Welfare Act of 1980. The Second Circuit affirmed the district court's finding that the Coalition has standing to sue on behalf of its members under Nnebe v. Daus, 644 10 F.3d 147 (2d Cir. 2011) and rejected the State's argument that the Coalition was barred by the third‐party standing rule. However, the court reversed the district court's dismissal of the Coalition's claims and joined the Sixth and Ninth Circuits in holding that the Act creates a specific entitlement for foster parents to receive foster care maintenance payments, and that this entitlement was enforceable through 42 U.S.C. 1983. Accordingly, the court vacated the order dismissing the case and remanded for further proceedings. View "New York State Citizens' Coalition for Children v. Poole" on Justia Law

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Genesis Hospice LLC provided outpatient hospice care to Medicaid beneficiaries in the Mississippi Delta. Claims Genesis submitted outside the norm, prompting a Mississippi Division of Medicaid audit. A statistical sample of 75 of the 808 billed claims were reviewed, and of that 75, 68 claims were not substantiated by the patients’ records and thus not eligible for payment. The auditing physicians specifically found that the patient records for the 68 rejected claims lacked sufficient documentation to support the given terminal-illness diagnosis and/or lacked documentation of disease progression. Medicaid’s statistician extrapolated that 68 of 75 unsupported claims represented a total overpayment of $1,941,285 for the 808 claims Genesis billed during the relevant time period. And Medicaid demanded Genesis repay this amount. Medicaid’s decision has been affirmed in an administrative appeal before Medicaid and by the Hinds County Chancery Court, sitting as an appellate court. On further appeal to the Mississippi Supreme Court, Genesis essentially argued Medicaid unfairly imposed documentation requirements not found in the federal or state Medicaid regulations. Genesis insisted the only requirement was a physician’s certification that in his or her subjective clinical judgment the patient was terminally ill, which Genesis provided. The Supreme Court found the regulations were clear: a physician’s certification of terminal illness is indeed required, but so is documentation that substantiates the physician’s certification. Because Genesis’ records failed to support 90 percent of its hospice claims, Medicaid had the administrative discretion to demand these unsupported claims be repaid. Therefore, the Supreme Court affirmed. View "Genesis Hospice Care, LLC v. Mississippi Division of Medicaid" on Justia Law

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In 2016, Washington charged Jason Catling with two counts of delivery of heroin. Pursuant to a plea deal, Catling pleaded guilty to one count in exchange for the State's agreement to dismiss the other, and to recommend a residential drug offender sentencing alternative (DOSA). During the sentencing hearing, Catling's attorney argued that because Catling's sole source of income was Social Security disability benefits, the trial court should not impose any legal financial obligations (LFOs), including mandatory obligations, based on the Washington Supreme Court's decision in City of Richland v. Wakefield, 380 P.3d 459 (2016), which had just issued the day before Catling's sentencing hearing. The trial court took the LFO matter under advisement, finding Catling's sole source of income were benefits totaling $753 per month. The trial court ultimately issued an order imposing LOFs totaling $800, finding LFOs could be ordered when a person was indigent and whose only source of income was social security disability. The Court of Appeals held that the particular obligations imposed here did not violate the federal antiattachment statute, but remanded for clarification of the payment order. The Supreme Court reversed the Court of Appeals in part, holding that the trial court erred in imposing a $200 filing fee on Catling. Further, the case was remanded to the sentencing court for a determination of whether Catling previously provided a DNA sample; if so, then the trial court's imposition of a $100 DNA collection fee was in error. The Supreme Court affirmed the imposition of the $500 crime victim fund assessment, but remanded for the trial court to revise the judgment and sentence and repayment order to comply with HB 1783, and to indicate the LFO could not be satisfied out of Catling's Social Security benefits. View "Washington v. Catling" on Justia Law

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After plaintiff's administrative claim for an increase in the family's adoption assistance program (AAP) payments based on California State Foster Parent Assn. v. Wagner, (9th Cir. 2010) 624 F.3d 974, 978, was denied, the trial court granted his petition for writ of mandate. The Court of Appeal reversed and held that the foster care maintenance payment rate increases mandated by Wagner and California State Foster Parent Assn. v. Lightbourne, (N.D. Cal., May 27, 2011, No. C 07-05086 WHA) 2011 U.S.Dist. Lexis 57483, *8, do not apply retroactively to plaintiff's adopted children. The court explained that the California Legislature specifically amended Welfare and Institutions Code section 16121 to confirm that initial adoption assistance agreements that predated Lighthouse were not subject to the new rate structure. View "California Department of Social Services v. Marin" on Justia Law

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Since his March 2008, birth, L.D.R. has consistently received medical care in the fields of pediatrics, otolaryngology, pulmonology, psychology, and speech pathology. His mother first sought social security benefits on his behalf when he was one year old. L.D.R.’s health, development, and behavioral issues deteriorated and improved at various times. A child is disabled under social security income rules if the child has a “medically determinable physical or mental impairment, which results in marked and severe functional limitations” that “has lasted or can be expected to last for a continuous period of not less than 12 months,” 42 U.S.C. 1382c(a)(3)(C)(i). The Social Security Administration determined that L.D.R. was disabled as of August 2015, just before he enrolled in second grade. The Seventh Circuit rejected a request for retroactive payments and a challenge to the constitutionality of the law prohibiting an award of benefits for a period before the application for benefits. The AuSgust 2015 disability date was well supported in the ALJ’s decision, which considered in particular detail L.D.R.’s various conditions, their history, the treatments he received, and L.D.R.’s reactions to these treatments. The prohibition on pre-application benefits satisfies rational basis scrutiny. View "L.D.R. v. Berryhill" on Justia Law

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While serving in the Navy, Scott developed a bilateral foot disability caused by prolonged standing. In 1973, the VA Regional Office (RO) awarded Scott service connection for bilateral pes planus (flatfoot) and granted him a 0% disability rating under DC (diagnostic code) 5276. In 1990, the RO added to Scott’s service connection hallux valgus deformity (angulation of the big toe toward the other toes) without altering his rating. In 2007, a VA medical examiner diagnosed Scott with plantar fibromas (masses of fibrous tissue in the arch of the foot) in addition to his prior diagnosis. The RO continued Scott’s 0% disability rating. In 2014, the RO increased Scott’s disability rating to 30%; the decision did not mention Scott’s plantar fibromas. In 2016, the Board of Veterans’ Appeals increased Scott’s disability rating to 50%, but did not address the effect of Scott’s plantar fibromas on his rating, finding that Scott was entitled to the rating “under DC 5276 . . . for [his] bilateral pes planus” under the benefit of the doubt rule, 38 U.S.C. 5107(b). The Board concluded that DC 5284, which broadly covers “Foot injuries, other,” without identifying any specific condition, was inapplicable because the service-connected condition, pes planus, is specifically listed. The Veterans Court affirmed. The Federal Circuit vacated. The Veterans Court improperly affirmed based on rationales the Board never provided; the Board erred by failing to consider DC 5284. Foot conditions not specifically listed in the rating schedule may be rated by analogy under DC 5284. View "Scott v. Wilkie" on Justia Law

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The Fifth Circuit affirmed the district court's decision to affirm the revocation of two physicians' Medicare privileges. The court held that the physicians billed for services using their own Medicare National Provider Identifiers without providing direct supervision while traveling outside of the country; the ALJ's summary judgment dismissal of the physicians' claims was supported by substantial evidence; the physicians' constitutional claims were rejected; the court agreed with its sister circuits that have determined that participation in the federal Medicare reimbursement program is not a property interest; and the court deferred to CMS's decision to bar the physicians from re-enrolling in the Medicare program for three years. View "Shah v. Azar" on Justia Law

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The Supreme Court dismissed the appeal brought by the Arkansas Department of Humanitarian Services (DHS) challenging the permanent injunction against its 2015 ARChoices Medicaid waiver rule, holding that this case was moot. During the course of this appeal, DHS promulgated a new rule. The circuit court found that DHS had properly promulgated the rule and dissolved the injunction. DHS argued before the Supreme Court that two exceptions to the mootness doctrine - matters capable of repetition yet evading review and matters of substantial public interest that are likely to be litigated in the future - applied in this case. The Supreme Court disagreed and dismissed this appeal, holding that none of the exceptions to the mootness doctrine applied. View "Arkansas Department of Human Services v. Ledgerwood" on Justia Law

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In 2010, Burmester applied for disability benefits alleging a 2008 onset of her disability. She described degenerative disc disease, pseudo-gout in her left knee, osteoarthritis in both knees and left thumb, a heart condition, and depression. Burmester’s education included one year of technical college; she worked as a hand-packager for many years. The application was denied. At a hearing, Burmester testified that her husband helped her out of bed, did the cooking, cleaning, and went grocery shopping and a friend helped with cleaning. Burmester was able to go to church; out to dinner once a month; use the computer to check her email and social media; and let her dog out. Following a remand, the ALJ again found that Burmester had the residual function capacity to perform light work, and was mentally limited to simple, routine, repetitive tasks requiring only simple work-related decisions and no more than occasional interaction with supervisors, coworkers, and the general public. Based on the testimony of a vocational expert, the ALJ found that Burmester could not continue her past relevant work but that a significant number of jobs existed in the national economy that Burmester could perform—such as router, price marker, or routing clerk. The district court and Seventh Circuit upheld the ALJ’s decision. The ALJ did not improperly evaluate Burmester’s credibility, nor erroneously reject the opinions of medical experts. The ALJ’s opinion that Burmester was not disabled was supported by substantial evidence. View "Burmester v. Berryhill" on Justia Law

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The Public Employees Retirement Law, Government Code section 21156, defines disability as being “incapacitated physically or mentally.” A governmental employee loses the right to claim disability benefits if terminated for cause. The Third Appellate District identified exceptions: under “Haywood,” a terminated-for-cause employee can qualify for disability retirement when the conduct which prompted the termination was the result of the disability; under “Smith,” a terminated employee may qualify for disability retirement if he had a “matured right” to a disability retirement before that conduct; Smith further recognized that “a court, applying principles of equity,” could deem an employee’s right to a disability retirement to be matured to survive a dismissal for cause. The Board of Administration of the California Public Employees Retirement System (CalPERS) adopted a precedential decision (Vandergoot) that an employee settling a pending termination for cause and agreeing not to seek reemployment is “tantamount to a dismissal,” precluding a disability retirement. Martinez, a former state employee, settled the termination for cause action against her and agreed to resign and not re-apply for employment. CalPERS denied her application for disability retirement. The trial court and court of appeal concluded that Haywood and Smith were binding as stare decisis and that “Vandergoot is a reasonable extension.” The courts rejected an argument that a 2008 enactment tacitly “superseded” Haywood and Smith. View "Martinez v. Public Employees' Retirement System" on Justia Law