Justia Public Benefits Opinion Summaries

Articles Posted in Constitutional Law
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The government alleges that Medicare overpaid Plaintiff and his medical practice approximately $5.31 million. While the third level of administrative review, a hearing before an Administrative Law Judge (“ALJ”), was pending, Medicare began to recover the overpaid funds by withholding new reimbursements. Plaintiff argued that recovery prior to an ALJ hearing and decision violates procedural due process. He moved for a preliminary injunction to prevent Medicare from recovering payments prior to the ALJ decision. The district court denied the preliminary injunction and Plaintiff appealed.   The Eighth Circuit affirmed the denial of the preliminary injunction finding that Plaintiff has not satisfied the requirements for a preliminary injunction. Further, he has not shown that he is likely to prevail on the merits of his procedural due process claim nor that he is likely to suffer irreparable harm. The court explained that if an audit shows that a provider has been overpaid, Medicare may seek to recover the overpaid funds. Moreover, if a Medicare contractor determines a provider has been overpaid, the provider may challenge that decision through administrative and judicial review.   Here, Plaintiff’s interest in avoiding erroneous recoupment outweighs the government’s interest in prompt repayment. However, there is no evidence in the record that any delay in recovery against Plaintiff will cause long-term harm to Medicare or prevent Medicare from providing services to other beneficiaries. Further, Plaintiff’s claims of irreparable harm are undercut by his apparent failure to try to ease the burdens of recoupment. View "Gurpreet Padda v. Xavier Becerra" on Justia Law

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In response to economic conditions related to the spread of COVID-19, Congress established several programs that made additional federal funds available to the states for providing enhanced unemployment-compensation benefits to eligible individuals. Alabama elected to participate in the programs, and Shentel Hawkins, Ashlee Lindsey, Jimmie George, and Christina Fox, were among the Alabamians who received the enhanced benefits. As the spread of COVID-19 waned, Governor Kay Ivey announced that Alabama would be ending its participation in the programs. When Alabama did so, the claimants received reduced unemployment-compensation benefits or, depending on their particular circumstances, no benefits at all. Two months later, the claimants sued Governor Ivey and Secretary of the Alabama Department of Labor Fitzgerald Washington in their official capacities, alleging that Alabama law did not permit them to opt Alabama out of the programs. After a circuit court dismissed the claimants' lawsuit based on the doctrine of State immunity, the claimants appealed. Finding no reversible error, the Alabama Supreme Court affirmed the circuit court. View "Hawkins, et al. v. Ivey, et al." on Justia Law

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Brooke Rojas was convicted of two counts of theft based on her improper receipt of food stamp benefits. Rojas initially applied for food stamp benefits from the Department of Human Services in August 2012 when she had no income. She received a recertification letter in December, which she submitted in mid-January 2013, indicating that she still had no income. And although she had not yet received a paycheck when she submitted the recertification letter, Rojas had started a new job on January 1. Rojas continued receiving food stamp benefits every month until July, when she inadvertently allowed them to lapse. She reapplied in August 2013. Although still working, Rojas reported that she had no income. The Department checked Rojas’s employment status in connection with the August application and learned that she was making about $55,000 a year (to support a family of seven). The Department determined that Rojas had received $5,632 in benefits to which she was not legally entitled. At trial, Rojas’s defense was that she lacked the requisite culpable mental state—she didn’t knowingly deceive the government; she just misunderstood the forms. Before trial, Rojas objected to the prosecution’s proposed admission of the August 2013 application because it exceeded the time period of the charged offenses and didn’t lead to the receipt of any benefits. The prosecution countered that the application was admissible as res gestae evidence—to show how the investigation began—and as evidence of specific intent. The court found it relevant as circumstantial evidence of Rojas’s mental state. In its opinion issued upon Rojas' appeal, the Colorado Supreme Court concluded it was "time for us to bury res gestae. ... By continuing to rely on res gestae as a standalone basis for admissibility and allowing the vagueness of res gestae to persist next to these more analytically demanding rules of relevancy, we have created a breeding ground for confusion, inconsistency, and unfairness." The Court's decision to abolish the res gestate doctrine in criminal cases prompted it to reverse judgment and remand for a new trial. View "Rojas v. Colorado" on Justia Law

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Plaintiff and her now-adult son K.S., a former high school student with a specific learning disability, filed suit under the Individuals with Disabilities in Education Act (IDEA), alleging that the school district neither provided K.S. with a free appropriate public education (FAPE) nor complied with procedural safeguards meant to ensure such.The Fifth Circuit affirmed the district court's decision affirming two administrative decisions concluding that the school district did not violate the IDEA's substantive and procedural requirements. The court reviewed the voluminous record and the magistrate judge's thorough report that the district court adopted, discerning no reversible error in the district court's holding that: (1) the school district did not violate its obligation to identify and evaluate K.S. as a student with a suspected disability; (2) the individualized education programs and transition plan created for K.S. complied with IDEA's substantive requirements; and (3) the school district's procedural foot-faults in failing to include K.S. for the first manifestation determination review and failing to consider certain relevant information were not actionable. View "H v. Riesel Independent School District" on Justia Law

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Plaintiffs, tenants living in substandard conditions in a "Section 8" housing project, filed suit seeking to compel HUD to provide relocation assistance vouchers. The Fifth Circuit held that, because 24 C.F.R. 886.323(e) mandates that HUD provide relocation assistance, its alleged decision not to provide relocation vouchers to plaintiffs is not a decision committed to agency discretion by law and is therefore reviewable. Furthermore, the agency's inaction here constitutes a final agency action because it prevents or unreasonably delays the tenants from receiving the relief to which they are entitled by law. Therefore, the district court has jurisdiction over plaintiffs' Administrative Procedure Act (APA) and Fair Housing Act (FHA) claims and erred in dismissing those claims.However, the court agreed with the district court that plaintiffs failed to state a claim for which relief can be granted on their Fifth Amendment equal protection claim. In this case, plaintiffs failed to state a plausible claim of intentional race discrimination. Accordingly, the court reversed in part, affirmed in part, and remanded for further proceedings. View "Hawkins v. United States Department of Housing and Urban Development" on Justia Law

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About 50 businesses that offer live adult entertainment (nude or nearly nude dancing) sought loans under the second round of the Paycheck Protection Program enacted to address the economic disruption caused by the Covid-19 pandemic. Congress excluded plaintiffs and other categories of businesses from the second round of the Program, 15 U.S.C. 636(a)(37)(A)(iv)(III)(aa), incorporating 13 C.F.R. 120.110. Plaintiffs asserted that their exclusion violated their rights under the Free Speech Clause of the First Amendment.The district court issued a preliminary injunction, prohibiting the Small Business Administration (SBA) from denying the plaintiffs eligibility for the loan program based on the statutory exclusion. The Seventh Circuit granted the government’s stay of the preliminary injunction and expedited briefing on the merits of the appeal. The SBA satisfied the demanding standard for a stay of an injunction pending appeal, having shown a strong likelihood of success on the merits. Congress is not trying to regulate or suppress plaintiffs’ adult entertainment. It has simply chosen not to subsidize it. Such selective, categorical exclusions from a government subsidy do not offend the First Amendment. Plaintiffs were not singled out for this exclusion, even among businesses primarily engaged in activity protected by the First Amendment. Congress also excluded businesses “primarily engaged in political or lobbying activities.” View "Camelot Banquet Rooms, Inc. v. United States Small Business Administration" on Justia Law

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Compensatory education is not an automatic remedy for a child-find violation under the Individuals with Disabilities Education Act (IDEA). Compensatory educational services are designed to counteract whatever educational setbacks a child encounters because of IDEA violations—to bring her back where she would have been but for those violations. At minimum, a parent must offer evidence that a procedural violation—like the child-find violation asserted here—caused a substantive educational harm, and that compensatory educational services can remedy that past harm.The Eleventh Circuit concluded that the district court was well within its "broad discretion and equitable authority" when it concluded that plaintiff had not shown that the school board's child-find violation resulted in educational deficits for the child that could be remediated with prospective compensatory relief. Furthermore, because the school began its special education referral process before plaintiff filed suit, she cannot show that she is entitled to attorney's fees. Accordingly, the court affirmed the district court's judgment. View "J.N. v. Jefferson County Board of Education" on Justia Law

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The Ninth Circuit affirmed the district court's grant of summary judgment in favor of the high school and school district in an action brought by plaintiff under Title II of the Americans with Disabilities Act (ADA) and section 504 of the Rehabilitation Act. Plaintiff, a student with attention deficit disorder, sought damages after he was assaulted and seriously injured by another student at a high school football game. Petitioner argues that guidance issued by the DOE in various Dear Colleague Letters should be binding, and that the school's failure to adopt all of the Letters' suggestions for preventing harassment of disabled students amounts to disability discrimination.The panel concluded that guidance issued by the DOE in the Letters was not binding and that plaintiff may not use the Letters to leapfrog over the statutory requirements to assert a cognizable claim under the ADA or the Rehabilitation Act. The panel explained that the Letters do not adjust the legal framework governing private party lawsuits brought under the ADA or Rehabilitation Act. Therefore, plaintiff's claims—which rely entirely on the enforceability of the Letters as distinct legal obligations—fail. In this case, the Letters did not make plaintiff's need for social accommodation "obvious," such that failure to enact their recommendations constituted a denial of a reasonable accommodation with deliberate indifference. Furthermore, no request for a social-related accommodation was ever made and no prior incidents of bullying or harassment involving plaintiff were observed or reported by the school prior to the assault during the football game. View "Csutoras v. Paradise High School" on Justia Law

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The Ninth Circuit affirmed the district court's dismissal based on failure to exhaust administrative remedies of plaintiffs' action under the Individuals with Disabilities Education Act (IDEA). Plaintiffs claim that the district court is failing its responsibilities to students under the IDEA by not timely identifying and evaluating students with disabilities, and, after identifying them, by providing them with insufficiently individualized, "cookie-cutter" accommodations and services. Although plaintiffs argue that exhaustion was not required because they are challenging district-wide policies that only a court can remedy, plaintiffs are unable to identify such policies. The panel agreed with the district court that plaintiffs have not satisfied any of the limited exceptions recognized by caselaw to the exhaustion requirement contained in 20 U.S.C. 1415(l). In this case, plaintiffs challenged what amounted to failures in practice by the school district, rather than policies or practices of general applicability. View "Student A v. San Francisco Unified School District" on Justia Law

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Decker employed Pehringer at its Montana open-pit surface mine, 1977-1999. There were periods when Pehringer did not work, including a roughly three-year-long strike. For most of his mining career, Pehringer was regularly exposed to coal dust while working primarily as a heavy equipment operator. After being laid off in 1999, Pehringer was awarded Social Security total disability benefits. He never worked again. In 2014 a month before his sixty-fifth birthday, Pehringer sought black lung benefits, citing his severe COPD, 30 U.S.C. 923(b). A physician determined that “Pehringer is 100% impaired from his COPD” and that coal “dust exposure and smoking are significant contributors to his COPD impairment.”The Benefits Review Board affirmed a Department of Labor (DOL) ALJ’s award of benefits. The Ninth Circuit affirmed, first rejecting a constitutional challenge to 5 U.S.C. 7521(a), which permits removal of an ALJ only for good cause determined by the Merits Systems Protection Board. DOL ALJ decisions are subject to vacatur by people without tenure protection; properly appointed, they can adjudicate cases without infringing the President’s executive power. The ALJ did not err in adjudicating Pehringer’s claim nor in rejecting untimely evidentiary submissions. Decker did not rebut the presumption of entitlement to benefits after a claimant established legal pneumoconiosis and causation, having worked for at least 15 years in substantially similar conditions to underground coal mines. View "Decker Coal Co. v. Pehringer" on Justia Law