Justia Public Benefits Opinion Summaries

D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

Colgan, a teacher at a special education high school, attempted to break up a fight between students but either fell or was pushed into a wall, leading to serious injuries. Colgan’s injuries and symptoms persisted despite treatment from several medical sources. Her treating physician, Dr. Ward, a concussion specialist, found that Colgan satisfied the medical criteria for mild traumatic brain injury and post-concussion syndrome with persistent cognitive defects and fatigue, chronic post-traumatic headaches, sleep disturbance, and dizziness; Colgan's debilitating headaches severely hampered her ability to carry out activities of daily living and basic job-related functions.Colgan successfully applied for workers’ compensation benefits. In 2016, Colgan sought social security disability insurance benefits. An ALJ denied Colgan’s claim, concluding that she had the residual functional capacity (RFC) to perform sedentary work, subject to physical and cognitive limitations (42 U.S.C. 423(d)(1)(A)). The district court affirmed. The Second Circuit vacated. The ALJ’s factual determination with respect to Colgan’s RFC was not supported by substantial evidence. The ALJ misapplied the treating physician rule to Dr. Ward’s “check-box” medical opinion, which was supported by voluminous treatment notes gathered over almost three years of clinical treatment View "Colgan v. Kijakazi" on Justia Law

The Supreme Court held that Corpus Christi pharmacist John McNeill, who participated in a Medicaid drug program run by the Texas Health and Human Services Commission, was entitled to an administrative contested case hearing as to his challenge to the results of a program audit by the Commission.After the Commission audited McNeill, the auditor determined that McNeill had been overpaid by $69,911. McNeill requested a hearing, after which the Commission issued a final notice that reduced the overpayment amount to $64,549. McNeill thrice requested a contested case hearing before the State Office of Administrative Hearings. The Commission denied each request. McNeill sued the Commission, its commissioner, and its inspector general, seeking a declaration that he was entitled to a contested case hearing. The trial court granted the Commission's plea to the jurisdiction based on sovereign immunity and dismissed the complaint. The court of appeals reversed. The Supreme Court reversed, holding (1) McNeill's appeal was timely; and (2) the Commission's inspector general acted ultra vires in failing to perform her ministerial duty to provide McNeill a contested-case hearing under Tex. Gov't Code 531.1201, and the inspector general was not entitled to sovereign immunity. View "Phillips v. McNeill" on Justia Law

In 2008, following a diagnosis of multiple sclerosis (MS), Karantsalis sued the city under the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 by failing to make its facilities and infrastructure accessible to individuals with disabilities. He later voluntarily dismissed the lawsuit, believing that he lacked constitutional standing because his symptoms were mild and did not prevent him from accessing and using the city’s programs or services. By 2019, Karantsalis’s MS and his symptoms had progressed dramatically: he had started falling, developed a limp, and needed a disabled parking permit. His neurologist had prescribed a wheelchair.He again sued the city under the ADA and Rehabilitation Act alleging the sidewalks, municipal gymnasium, and parking at public facilities were inaccessible. The district court dismissed the case with prejudice, holding that it was barred by the four-year statute of limitations, which was triggered before or during 2008 when Karantsalis became aware of his MS diagnosis. The Eleventh Circuit reversed. From the face of his complaint, Karantsalis’s injury did not occur until at least 2017. Karantsalis could not have sued before he lost his mobility and his ready access to and use of the city’s public services. View "Karantsalis v. City of Miami Springs" on Justia Law

Pupo first applied for supplemental security income (SSI) in June 2011, alleging that she was unable to work due to depression, body tremors, and high blood pressure. Her initial application was denied, but, in 2015, her case was remanded for further proceedings pursuant to sentence four of 42 U.S.C. 405(g). The district court affirmed the subsequent denial of Pupo’s application.The Fifth Circuit reversed and remanded. The decision is not supported by substantial evidence; the ALJ erred by not addressing one of Pupo’s medical diagnoses, her incontinence when assessing her residual functional capacity and the Appeals Council erred by not considering the new medical evidence submitted by Pupo following the ALJ’s denial of her SSI claim. Pupo submitted medical records showing that she had surgery because of her stress urinary incontinence nine days before the ALJ issued his decision. The ALJ did not err in failing to consider Pupo’s borderline age situation because he did not apply the grids mechanically but instead relied on testimony due to Pupo’s non-exertional limitations. View "Pupo v. Commissioner, Social Security Administration" on Justia Law

Family Rehab brought a procedural due process claim arguing that it is entitled to third step review before recoupment of Medicare overpayments. The district court granted summary judgment in favor of Family Rehab, and entered a permanent injunction barring HHS from recouping the disputed funds until the completion of third step review under 42 C.F.R. 405.1036(c)–(d).However, in reaching its decision, the district court did not have the benefit of the Fifth Circuit's decision in Sahara Health Care Inc. v. Azar, 975 F.3d 523 (5th Cir. 2020), in which the court rejected a similar due process claim under nearly identical facts. In this case, Family Rehab's claims all involve documentation issues that do not require cross-examination and credibility determinations. The court explained that Family Rehab's claims could have been resolved in the first two steps of administrative review by producing the relevant documents. Accordingly, the court reversed the district court's judgment. View "Family Rehabilitation, Inc. v. Becerra" on Justia Law

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

This case arose from the cancellation of long-term-care Medicaid benefits for two claimants when an Oklahoma agency concluded that the claimants’ resources exceeded the regulatory cap for eligibility. One claimant, Idabelle Schnoebelen died, mooting her claim. The eligibility of the other claimant, Nelta Rose, turned on whether her resources included a 2018 promissory note. In 2017 and 2018, Rose loaned money to her daughter-in-law in exchange for three promissory notes. The daughter-in-law provided the first two promissory notes in 2017 (before Rose applied for Medicaid benefits). The Oklahoma Department of Human Services initially approved Rose for Medicaid, declining to regard the 2017 promissory notes as resources. In 2018, the daughter-in-law provided the third promissory note. But the Department of Human Services concluded that the 2018 promissory note: (1) was a resource because the payment to the daughter-in-law did not constitute a bona fide loan; and (2) was a deferral that turned the 2017 promissory notes into resources. The extra resources put Rose over the eligibility limit for Medicaid, so the Department of Human Services cancelled Rose’s benefits. A district court concluded that the agency’s conclusion did not conflict with federal law. In the Tenth Circuit's view, however, a reasonable factfinder could disagree. Summary judgment was reversed and the matter remanded for further proceedings. View "Baker, et al. v. Brown, et al." on Justia Law

Alliance alleged that County and City policies and inaction have created a dangerous environment in the Skid Row area, claiming that the County violated its mandatory duty to provide medically necessary care and that the municipalities have facilitated public nuisance violations by failing to clear encampments, violated disability access laws by failing to clear sidewalks of encampments, and violated constitutional rights by providing disparate services to those within the Skid Row area and by enacting policies resulting in a state-created danger to area residents and businesses. The district court issued a preliminary injunction, ordering the escrow of $1 billion to address homelessness, offers of shelter to all unhoused individuals in Skid Row within 180 days, and numerous reports. The court found that structural racism was behind Los Angeles’s homelessness crisis and its disproportionate impact on the Black community.The Ninth Circuit vacated. The plaintiffs lacked standing on all but their ADA claim; no claims were based on racial discrimination. The district court impermissibly resorted to independent research and extra-record evidence. There was no allegation that any individual plaintiff was Black nor that there was a special relationship between the City and unhoused residents nor that any individual plaintiff was deprived of medically necessary care or general assistance. Two plaintiffs who use wheelchairs and cannot traverse Skid Row sidewalks because of homeless encampments had standing to bring ADA claims but had not shown a likelihood of success on the merits. View "LA Alliance for Human Rights v. County of Los Angeles" on Justia Law

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