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The Ninth Circuit reversed the denial of disability insurance benefits and supplemental security income to plaintiff. The panel held that SR 82-41 obligates the ALJ to make transferability of skills findings where, unlike Bray v. Commissioner of Social Security Administration, 554 F.3d 1219, 1223–26 (9th Cir. 2009), no Grid rule states that a person with the claimant's age, education, and work experience is disabled absent transferable skills. Therefore, the panel remanded for further proceedings. View "Barnes v. Berryhill" on Justia Law

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In November 2010, Hayes engaged Cybriwsky to represent him related to the denial of Hayes’s application for Social Security disability benefits. In February 2011, the case was remanded for further administrative hearings (42 U.S.C. 405(g)) because faulty recordings of the hearings rendered the record inaudible. On remand, the Administrative Law Judge entered a fully favorable decision for Hayes in August 2011. The district court affirmed in April 2012. The next month Cybriwsky sought attorney’s fees under the Equal Access to Justice Act, 28 U.S.C. 2414. The court granted attorney’s fees of $2,225 in August 2012. In April 2017, Cybriwsky moved, under 42 U.S.C. 406(b), seeking more than $11,000. in fees. He subsequently provided documentation of the fee arrangement, benefits paid to Hayes, and an itemized description of the work performed. By the time Cybriwsky filed his 2017 motion, the SSA had released the 25% of past-due benefits normally reserved to pay attorney’s fees; $5,300 was awarded to Hayes’s attorney at the administrative level and the remainder was released to Hayes. Any fees awarded to Cybriwsky would have to be recovered from Hayes, either directly or by having fees taken from Hayes’s monthly disability payments. The Sixth Circuit affirmed denial of the motion as untimely and determined that the circumstances did not merit the exercise of equitable tolling. View "Hayes v. Commissioner of Social Security" on Justia Law

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The VA determined that West, a Viet Nam veteran, was eligible for a disability pension. Two days later West died. Four days later—without knowing that West had died—the government sent West a check for $8,660--his pension benefit retroactive to June 2013. In March 2014, a Kentucky probate court appointed West’s ex-wife, Brenda, as the Estate's executor. Brenda endorsed the VA check, the estate’s only cash asset, and deposited it into an escrow account. After three months, the VA determined that West’s estate was not entitled to the money, 38 U.S.C. 5121(a), and directed the bank to wire the $8,660 back to the U.S. Treasury. The bank complied. The Estate did not learn until later that its account had been drained of funds. More than 18 months later, the Estate obtained a Kentucky probate court order requiring the government to return the funds. The government removed the matter to the district court, which remanded the matter back because the $8,660 was already subject to the probate court’s jurisdiction. The Estate unsuccessfully sought attorneys’ fees. The Sixth Circuit reversed the remand order; the dispute can be litigated only under the procedure set forth in the Veterans’ Judicial Review Act, 102 Stat 4105. The court noted “concerns about the government’s expropriation of the Estate’s funds without any advance notice or process.” View "Estate of West v. United States Department of Veterans Affairs" on Justia Law

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The Eighth Circuit affirmed the denial of plaintiff's claims for a period of disability, disability insurance benefits, and supplemental security income. The court held that Social Security Ruling (SSR) 00-4p makes clear that before relying on Vocation Expert (VE) evidence, adjudicators must identify and obtain a reasonable explanation for any conflicts between such evidence and the DOT. However, SSR 00-4p did not impose a duty on the ALJ to obtain a reasonable explanation when the VE simply testifies to information not found in the DOT—but that does not conflict with it. Therefore, the court agreed with the Commissioner that unless a VE's testimony appears to conflict with the DOT, there is no requirement that an ALJ inquire as to the precise basis for the expert's testimony regarding extra-DOT information. In this case, the ALJ described plaintiff's limitations to the VE, the VE responded with possible jobs, and the VE's testimony did not conflict with the DOT. Therefore, the ALJ was entitled to rely on the testimony and substantial evidence supported the agency's finding that plaintiff was not disabled. View "Courtney v. Commissioner" on Justia Law

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In 2000, Kaminski fell down a flight of stairs, suffering a head wound that caused a traumatic brain injury and a seizure disorder. He applied under the Social Security Act for disability insurance benefits and supplemental security income 13 years later. The Social Security Administration denied his applications; the district court upheld the denial. The Seventh Circuit reversed, finding that the administrative law judge improperly rejected his treating physician’s opinions. The treating physician’s opinions and the testimony of the vocational expert together show that Kaminski is disabled. View "Kaminski v. Berryhill" on Justia Law

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This case was a qui tam action alleging violations of the False Claims Act (“FCA”) involving fraudulent reimbursements under the Medicare Act. Plaintiff Gerald Polukoff, M.D., was a doctor who worked with Defendant Sherman Sorensen, M.D. After observing some of Sorensen’s medical practices, Polukoff brought this FCA action, on behalf of the United States, against Sorensen and the two hospitals where Sorensen worked (collectively, “Defendants”). Polukoff alleged Sorensen performed thousands of unnecessary heart surgeries and received reimbursement through the Medicare Act by fraudulently certifying that the surgeries were medically necessary. Polukoff further alleged the hospitals where Sorensen worked were complicit in and profited from Sorensen’s fraud. The district court granted Defendants’ motions to dismiss, reasoning that a medical judgment could not be false under the FCA. The Tenth Circuit reversed and remanded, holding that a doctor’s certification to the government that a procedure is “reasonable and necessary” is “false” under the FCA if the procedure was not reasonable and necessary under the government’s definition of the phrase. View "Polukoff v. St. Mark's Hospital" on Justia Law

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The Eighth Circuit affirmed the denial of social security disability insurance benefits on remand. The court held that the ALJ did not err in discounting the opinion of plaintiff's treating physician as not supported by objective medical evidence in the administrative record. Furthermore, the opinion was contrary to medically supported opinions of two specialists. The court agreed with the district court that the vocational expert identified another job plaintiff could perform with limited hand functioning, and there was nothing in the record suggesting that his impairments require that he be limited to occasional rather than frequent handling. View "Winn v. Commissioner" on Justia Law

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Under federal law, the Agency for Health Care Administration (AHCA) may only reach the past medical expenses portion - and not the future medical expenses portion - of a Medicaid recipient’s tort recovery to satisfy its Medicaid lien. Florida’s Medicaid program, administered by AHCA, paid $322,222 for Juan Villa’s medical care after Villa was injured in an accident. Villa settled with an alleged tortfeasor for $1 million. AHCA calculated the presumptively appropriate amount of its lien at $321,720 and asserted a lien in that amount against Villa’s settlement. An administrative law judge affirmed AHCA’s lien amount. The First District Court of Appeal affirmed, concluding that both Florida law and the federal Medicaid Act allow AHCA to secure reimbursement for its Medicaid expenses from the portions of Villa’s third-party settlement recovery allocated to both past and future expenses. The Supreme Court quashed the decision below, holding that the federal Medicaid Act prohibits AHCA from placing a lien on the future medical expenses portions of a Medicaid beneficiary’s third-party tort recovery to satisfy its Medicaid lien. View "Giraldo v. Agency for Health Care Administration" on Justia Law

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In 2010, Earley applied for disability benefits, 42 U.S.C. 423(d)(2)(A), 1382c(a)(3)(B) . In 2012, an ALJ rejected the application on the ground that Earley, who suffered from fibromyalgia, mild carpal tunnel syndrome, panic disorder, degenerative disk disease, and major depression, did not have a covered disability. She applied again for a new period of time. The same ALJ denied her benefits, citing Sixth Circuit precedent (Drummond) as requiring him to give preclusive effect to the work-capacity finding he had made during the first proceeding absent “new and material evidence documenting a significant change in the claimant’s condition.” The district court reversed, concluding that the Drummond “principles of res judicata” apply only when they favor an individual applicant, not the government. The Sixth Circuit disagreed. The key principles protected by Drummond—consistency between proceedings and finality with respect to resolved applications—apply to individuals and the government but do not prevent the agency from giving a fresh look to a new application containing new evidence or satisfying a new regulatory threshold that covers a new period of alleged disability while being mindful of past rulings and the record in prior proceedings. View "Earley v. Commissioner of Social Security" on Justia Law

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The Office of the Medicaid Inspector General (OMIG) may withhold payments to recover from Petitioner, the operator of a methadone clinic and provider of Medicaid-covered services, the full $1,857,401 in overpayments assessed following an audit. OMIG notified Petitioner than it had been overpaid $1,857,401 in claims from 2003 through 2007. OMIG informed Petitioner that it had twenty days to agree to settle these claims for a lower amount or OMIG would begin to withhold a percentage of Petitioner’s payments. When Petitioner did not agree to settle after twenty days and failed timely to commence an administrative appeal to challenge the audit findings, OMIG commenced withholding. Petitioner commenced this article 78 proceeding seeking to prohibit OMIG from liquidating the full amount in overpayments and a declaration that OMIG can collect only $1,460,914, the amount for which Petitioner declined to settle. The Court of Appeals held that OMIG was not precluded from seeking to withhold the full $1,857,401 amount. View "West Midtown Management Group, Inc. v. State" on Justia Law