Justia Public Benefits Opinion Summaries

This appeal concerned the implementation of a federally-assisted Medicaid program by the Commonwealth of Puerto Rico, represented by its Secretary of Health. This was the sixth time the First Circuit Court of Appeals considered issues related to a dispute between the Commonwealth and several federally qualified health centers (FQHCs). The FQHCs here took to federal courts their claims for reimbursement payments owed to them under the Medicaid program. The district court, among other things, set a formula in place by way of a preliminary injunction that calculated payments the Commonwealth owed the FQHCs for providing Medicaid services. The First Circuit (1) concluded the formula that the district court endorsed in its preliminary injunction was not sufficiently supported by the factual record, and therefore, the Court remanded for further reformulation; (2) affirmed the district court's denial of the FQHCs' request for indemnification from debts owed to third party managed care organizations; and (3) affirmed the district court's determination that the Eleventh Amendment precludes a federal court from imposing a judgment for money damages upon the Commonwealth to make payments for periods predating the date of the district court's preliminary injunction. View "Consejo de Salud De La Communidad de Playa de Ponce, Inc. v. Gonzalez-Feliciano" on Justia Law

Defendant Barbara Norris, an organizational payee with the Social Security Administration, pled guilty to social security representative payee fraud. The district court sentenced Defendant to eighteen months in prison, the top of her guideline range. Defendant appealed, arguing that her sentence was substantively unreasonable. The Eighth Circuit Court of Appeals affirmed, holding that the district court did not abuse its discretion in sentencing Defendant to eighteen months in prison, as the court properly applied its wide latitude to weigh the factors in the federal sentencing statute and assigned some factors greater weight than others in determining an appropriate sentence. View "United States v. Norri" on Justia Law

The Secretary of the Department of Health and Human Services (HHS) imposed a civil money penalty on Greenbrier Nursing and Rehabilitation Center, a skilled nursing facility in Arkansas, for noncompliance with Medicare participation requirements. The Eighth Circuit Court of Appeals denied Greenbrier's petition for review, holding (1) substantial evidence supported HHS's finding that Greenbrier was not in substantial compliance with 42 C.F.R. 483.25; (2) the finding that Greenbrier's noncompliance with section 483.25 rose to the level of immediate jeopardy was not erroneous; and (3) judicial review of two of Greenbrier's objections to the monetary penalty was barred, and Greenbrier received adequate notice of its noncompliance. View "Greenbrier Nursing v. U.S. Dep't of Health & Human Servs." on Justia Law

Petitioners Leroy and Glenda Morris brought suit under 42 U.S.C. 1983 and the Supremacy Clause to challenge the Oklahoma Department of Human Services' ("OKDHS") denial of Mrs. Morris' application for Medicaid benefits as inconsistent with federal law. After calculating the couple's resources and the Community Spouse Resource Allowance (CSRA), OKDHS determined that the Morrises were ineligible for benefits. In an effort to "spend down" their excess resources, the Morrises purchased an actuarially sound annuity payable to Mr. Morris. Despite this purchase, OKDHS determined that Mrs. Morris remained ineligible. The district court granted summary judgment in favor of OKDHS, upholding the agency's application of the Medicaid statutes. Upon review, the Tenth Circuit reversed and remanded the case for further proceedings. A couple may convert joint resources (which may affect Medicaid eligibility) into income for the community spouse (which does not impact eligibility) by purchasing certain types of annuities. In other words, a couple may purchase a qualifying annuity payable to the community spouse in addition to the community spouse's retention of the CSRA. View "Morris v. Oklahoma Dept. of Human Svcs." on Justia Law

Howard Back filed this suit alleging that Secretary of Heath and Human Services Kathleen Sebelius violated her duties under the Medicare Act and the Due Process Clause by failing to provide an administrative process for beneficiaries of hospice care to appeal a hospice provider's refusal to provide a drug prescribed by their attending physician. The district court granted the Secretary's motion for judgment on the pleadings because Back had not exhausted his administrative remedies. The Ninth Circuit Court of Appeals vacated the district court's judgment and dismissed the appeal as moot, holding that although the government led Back to believe there was no appeal process, such a process did exist. Accordingly, no controversy existed and the appeal was moot. View "Back v. Sebelius" on Justia Law

Plaintiff-Appellant Valinda Kornhauser filed suit to challenge the decision of the Commissioner of Social Security that denied her claim for disability benefits. The District Court referred the case to a Magistrate Judge for a report and recommendation ("R&R"). After receiving and considering memoranda on the matter, the Magistrate Judge issued an R&R recommending that the District Court vacate the Commissioner's decision and remand the case to the Commissioner for further proceedings. In his R&R, the Magistrate Judge, in addition to explaining why Plaintiff was entitled to a vacatur, observed that the memorandum her attorney had submitted failed to comply with Middle District of Florida Local Rule 1.05(a). The non-compliance, according to the Magistrate Judge, consisted of "smaller margins than authorized" by the rule and "footnotes . . . smaller than ten-point type." In a footnote to this observation, he stated: "These intentional violations would justify striking the memorandum. However, this sanction would unfairly punish the plaintiff. Consequently, I propose that, when plaintiff's counsel seeks attorney's fees, that the typical request for a cost-of-living increase be denied." Following the entry of judgment, Plaintiff petitioned the District Court for an award of attorney's fees under the Equal Access to Justice Act ("EAJA"). The parties stipulated to the amount of attorney fees, but after its consideration of the petition, the Magistrate Judge issue an R&R recommending that the district court award a lower amount in fees as have been stipulated because of Plaintiff's brief being submitted with small margins and unacceptable font sizing. Plaintiff's attorney filed an objection to the R&R, asking the district court not to adopt it because she did not intend to violate the local rule. Finding that the sanction was a reasonable exercise of the Magistrate Judge's disciplinary authority, the district court adopted the R&R with the sanction. Plaintiff appealed the imposition of the sanction. Upon review, the Eleventh Circuit vacated the sanction, finding "no procedural rule that sanctions the conduct involved" in this case. View "Kornhauser v. Comm'r of Social Security" on Justia Law

Plaintiffs appealed from the district court's dismissal of their amended complaint against Florida government defendants, SBHD, AHCA, and DCF. Plaintiffs alleged that defendants' billing practice violated both 42 U.S.C. 1396a(a)(25)(C), the "balance billing" provision of the federal Medicaid Act, and a similar Florida statute. The court concluded that section 1396a(a)(25)(C) did not confer upon plaintiffs a federal right enforceable under 42 U.S.C. 1983 and therefore, affirmed the district court's decision to dismiss the amended complaint. View "Martes, et al. v. CEO of South Broward Hospital Dist., et al." on Justia Law

Defendant appealed his conviction for social security fraud pursuant to 42 U.S.C. 408(a)(5). The court held that the district court committed no reversible error in the formulation of jury instructions; the district court acted within its discretion when it admitted computer-generated records into evidence; the prosecutor's comments did not warrant reversal of defendant's conviction; the district court committed no error when it denied defendant's motion for judgment of acquittal; and 42 U.S.C. 408(a)(5) was not unconstitutionally vague. Accordingly, the court affirmed the judgment. View "United States v. Berry" on Justia Law

Five Medicaid recipients filed a class action against the District, alleging that the District systematically denied Medicaid coverage of prescription medications without providing the written notice required by federal and D.C. law. The district court dismissed the case on the pleadings, concluding that plaintiffs lacked standing to pursue their claims for injunctive and declaratory relief. At least with regard to one plaintiff, John Doe, the allegations sufficiently established injury, causation, and redressability and the court concluded that Doe had standing to pursue his claims for injunctive and declaratory relief. Therefore, the court had no need to decide whether the other plaintiffs had standing and reversed the judgment, remanding for further proceedings. View "NB, et al. v. DC, et al." on Justia Law

This case began as a dispute over the results of CM's special education evaluation under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. At issue on appeal was: (1) the ALJ's dismissal of several of CM's claims against Lafayette prior to holding a due process hearing; and (2) the district court's dismissal of MM's, CM's parents, separate claims against the California Department of Education (CDE). The court held that the district court correctly dismissed MM's claims against Lafayette challenging the ALJ's statute of limitations ruling as being premature. The district court did not abuse its discretion in dismissing the fourth claim as duplicative and correctly held that the CDE had no authority to oversee the individual decisions of OAH's hearing officers. Accordingly, the court affirmed the judgment of the district court. View "M. M., et al. v. Lafayette Sch. Dist., et al." on Justia Law