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The First Circuit vacated and remanded the district court’s order upholding an administrative law judge’s (ALJ) conclusion that although Appellant had previously been eligible for Supplemental Security Income (SSI) benefits as a child, Appellant was ineligible for SSI benefits as an adult, holding that the record before the ALJ was insufficient to conclude that Appellant was no longer disabled. When Appellant was twelve years old, the Commissioner of Social Security Administration (SSA) determined that he was entitled to SSI benefits because he was found to have met the SSA's requirements for mental retardation. The Commissioner later found that Appellant was no longer disabled and that his benefits should stop. Appellant requested a hearing with an ALJ, who found that Appellant was not disabled under the Social Security Act. Upon de novo review, the First Circuit held that the record before the ALJ was not adequately developed enough to conclude that Appellant was no longer disabled, particularly in light of the fact that the ALJ was on notice, through both Social Security Administration filings and hearing testimony, that Appellant was undergoing psychiatric treatment. View "Torres-Pagan v. Berryhill" on Justia Law

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Arthur served on active Army duty, 1940-1945, as a prisoner of war of the German government for 25 months. He was service-connected for several disabilities and had VA claims pending when he died in 2011. Winters pursued those as a substituted claimant and her own claims for accrued benefits as his surviving spouse. In 2013, the Board of Veterans’ Appeals denied some claims and granted service-connected benefits for others, found that the awards were inextricably intertwined with Winters’s accrued benefits claim, and remanded for initial disability ratings and to readjudicate the accrued-benefits claim. The Board determined that a subsequent letter in which Winters sought earlier dates “d[id] not constitute [a] motion for revision,” directed the letter to the Regional Office, but did not notify Winters of its determination so that the 120-day appeal period did not start to run. In 2014, the Board denied Winters’s claims for entitlement to an earlier effective date and for accrued benefits. In 2016, the Veterans Court dismissed an appeal of the 2013 decision for lack of jurisdiction and vacated the 2014 decision as premature because the 2013 decision was not final. Winters sought attorney fees and expenses under the Equal Access to Justice Act, 28 U.S.C. 2412(d) for that decision. The Federal Circuit affirmed the denial of her application. The court lacked jurisdiction to award EAJA fees relating to an appeal over which it did not have jurisdiction. With respect to the 2014 Board decision, Winters was not a “prevailing party.” View "Winters v. Wilkie" on Justia Law

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This matter stemmed from a lawsuit filed by the State of Mississippi against the defendant pharmacies. The State alleged deceptive trade practices and fraudulent reporting of inflated “usual and customary” prices in the defendant’s reimbursement requests to the Mississippi Department of Medicaid. The State argued that Walgreens, CVS, and Fred’s pharmacies purposefully misrepresented these prices to obtain higher prescription drug reimbursements from the State. Finding that the circuit court was better equipped to preside over this action, the DeSoto County Chancery Court transferred the matter to the DeSoto County Circuit Court in response to the defendants’ request. Aggrieved, the State timely filed an interlocutory appeal disputing the chancellor’s decision to transfer the case. After a thorough review of the parties’ positions, the Mississippi Supreme Court found that though the chancery court properly could have retained the action, the chancellor correctly used his discretion to transfer the case, allowing the issues to proceed in front of a circuit-court jury. As a result, the Supreme Court affirmed the chancellor’s decision. View "Mississippi v. Walgreen Co." on Justia Law

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The Eighth Circuit reversed the district court's decision upholding the Social Security Commission's denial of plaintiff's applications for child insurance benefits and supplemental security income. The court held that the ALJ did not elicit a reasonable explanation to resolve an apparent conflict between testimony from the vocational expert and the Dictionary of Occupational Titles (DOT) when it determined that plaintiff's limitations did not prevent him from performing certain jobs in the national economy. In this case, the conflict was in regard to the DOT's listing related to the level of reasoning required for the job of hospital or industrial cleaner. Accordingly, the court remanded for further proceedings. View "Stanton v. Commissioner" on Justia Law

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The Supreme Court affirmed the judgment of the trial court in this qui tam case filed by Relators alleging that several laboratories illegally inflated the bills they submitted to Virginia’s Medicaid program, holding that the trial court did not err in concluding that Relators were entitled to twenty-eight percent of the proceeds of the gross proceeds of the settlement in this case. After the parties settled, the parties disagreed with respect to whether Relators were entitled to twenty-eight percent of the gross proceeds of the settlement or whether the twenty-eight percent share should come out of the Commonwealth’s net share of the proceeds. At issue was the provision in Va. Code 8.01-216.7(B) that the relator is entitled to a share “of the proceeds of the award or settlement.” The Supreme Court held that the proceeds of settlement means the gross proceeds and, accordingly, affirmed the judgment of the court below. View "Commonwealth v. Hunter Laboratories, LLC" on Justia Law

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Spicher suffers from osteoarthritis, degenerative disc disease, chronic obstructive pulmonary disease, fibromyalgia, and morbid obesity. In 2010, Spicher applied for Social Security Disability Insurance Benefits and Supplemental Security Income dating back to 2003. After a 2012 hearing, an ALJ found that Spicher was not disabled from 2003-2012. The district court remanded because the ALJ had not properly considered the limitations imposed by Spicher’s obesity, independently and in combination with her other impediments. On remand, Spicher focused on whether she had been disabled since December 2008, when her insured status expired. The ALJ consulted a second doctor who essentially adopted the findings of the medical reports already in the record. The ALJ stated that further consideration of Spicher’s obesity had not motivated her to change her conclusion, finding that Spicher could hold a sedentary position and perform three jobs identified by a vocational expert, and could occasionally crouch, crawl, balance, stoop, and kneel. The Seventh Circuit reversed, finding that the decision was not supported by substantial evidence. The ALJ did not address contradictory medical evidence when determining the types of sedentary jobs that Spicher could hold and failed to consider the interaction between her obesity and her non‐severe impairments. The court rejected a claim that the ALJ displayed antagonism toward Spicher in violation of her due process rights. View "Spicher v. Berryhill" on Justia Law

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The Eighth Circuit affirmed the district court's denial of social security disability benefits to plaintiff. The court held that the ALJ properly relied on testimony from the vocational expert's testimony that a certain needed modification is part of the functional workplace. In this case, the vocational expert testified based on her expertise that bariatric chairs were commonly provided to individuals in the workplace and identified jobs that an individual who, like plaintiff, needs a bariatric chair, could perform. Therefore, substantial evidence supported the ALJ's finding that jobs exist in the national economy that plaintiff could adjust to, and that finding did not result from an error of law. View "Higgins v. Commissioner" on Justia Law

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The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

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The Fourth Circuit affirmed the district court's grant of summary judgment to the school district in an action under the Individuals with Disabilities Education Act (IDEA), alleging that the school district failed to provide plaintiff, a former student, with a free appropriate public education (FAPE). The court held that the school district committed a procedural violation of the IDEA by failing to respond to parents' requests and conduct a timely evaluation of whether the student was eligible for special education or related services. Nonetheless, plaintiff failed to show that this defect in the process had an adverse effect on his education. Therefore, plaintiff was not actually deprived of a FAPE. View "T.B. v. Prince George's County Board of Education" on Justia Law

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Memorial Hospital at Gulfport and Singing River Health System (“Hospitals”) sought judicial review of a June 24, 2016 administrative decision which found the Division of Medicaid’s (“DOM’s”) 2014 Fiscal Year Methodology “correctly interprets statutes and regulations and is neither arbitrary or capricious.” The chancellor affirmed the decision of DOM. Finding no evidence in the record before it that DOM failed to comply with Sections 43-13-117 and 43-13-145 in allocating and distributing supplemental payments to Mississippi hospitals, the Mississippi Supreme Court affirmed. View "Memorial Hospital at Gulfport v. Dzielak" on Justia Law