Justia Public Benefits Opinion Summaries

Chang filed a qui tam action against the Center, asserting claims on behalf of the United States and the state under the False Claims Act (FCA). and the Delaware False Claims Act. Chang alleged that the Center had sought and received funding from the state and federal governments by misrepresenting material information. Both governments declined to intervene as plaintiffs. Chang filed an amended complaint and the Center answered. Nearly three years after Chang filed his original complaint, the U.S. and Delaware moved to dismiss the case, asserting that they had investigated Chang’s allegations and discovered them to be “factually incorrect and legally insufficient.” The court granted the motions without conducting an in-person hearing or issuing a supporting opinion. The Third Circuit affirmed. If the government chooses not to intervene, the relator may still “conduct the action” but the government may still “dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the Government of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion,” 31 U.S.C. 3730(c)(2)(A). Chang never requested a hearing; the FCA does not guarantee an automatic in-person hearing to relators before their cases may be dismissed. View "Chang v. Children's Advocacy Center of Delaware" on Justia Law

Plaintiff-relator Matthew Omlansky, by virtue of knowledge gleaned as a state employee involved with the Medi-Cal program, brought this qui tam action in the name of the State of California alleging that defendant Save Mart Supermarkets (Save Mart) had violated the False Claims Act in its billings to Medi-Cal for prescription and nonprescription medications, charging a higher price than cash customers paid in violation of 2009 statutory provisions capping Medi-Cal charges at a provider’s usual and customary price (“statutory cap”). Per the trial court, the gist of the alleged fraud upon Medi-Cal, Save Mart generally offered a lower price for medications to cash customers, and would also match a lower price that a competitor was offering (although it appears from an exhibit to the complaint that the latter applied only to prescriptions), but did not apply these discounts from its list prices in the billings it submitted to Medi-Cal. The State declined to intervene. The trial court sustained a demurrer to the original complaint because all of the alleged violations occurred during a period when the 2009 statutory cap was subject to a federal injunction. Plaintiff then filed an essentially identical amended complaint. The only significant change was an allegation in paragraph 45 that Save Mart’s billing practices favoring cash customers continued from December 2016 to March 2017 after the expiration of the injunction, specifying six examples of “illegal pricing.” The court sustained Save Mart’s demurrer to this pleading as to two of the six grounds raised, and denied leave to amend. It entered a judgment of dismissal. Plaintiff timely appealed, but the Court of Appeal concurred with the grounds for the trial court’s ruling, thereby affirming dismissal of Plaintiff’s complaint. View "Omlansky v. Save Mart Supermarkets" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits, claiming that he had various physical impairments and that he suffered from bipolar disorder. The Eleventh Circuit held that, although plaintiff's claim of bias was forfeited, the ALJ's conclusion contained errors that must be addressed. In this case, the ALJ failed to articulate good cause for discounting two treating physicians' opinions; substantial evidence does not support the finding that plaintiff's bipolar disorder was non-severe; and the ALJ failed to consider plaintiff's mental impairments when assessing his residual functional capacity. Accordingly, the court affirmed in part, reversed in part, and remanded with instructions. View "Schink v. Commissioner of Social Security" on Justia Law

Rodriguez, a Gulf War veteran, served as a Santa Cruz police officer. 1995-2007. He applied for industrial disability retirement in 2011 with the California Public Employee’s Retirement System based on his PTSD diagnosis that was caused in part by his work for the city. After litigation, the city granted Rodriguez disability retirement but denied his claim of industrial causation. He began receiving benefits in December 2016. Rodriguez requested a finding that his disability was industrial from the Workers’ Compensation Appeals Board in April 2017. The Board concluded that Rodriguez’s disability was industrial, but that he was barred from receiving industrial disability retirement benefits because his claim for a finding of industrial causation was untimely under the five-year time limitation in Government Code section 21171. The court of appeal reversed. Section 21171 applies only to rescind, alter or amend an earlier industrial determination. Section 21174 applies to initial determinations and states that a retiree claiming an industrial disability that is disputed will not receive the additional benefits “unless the application for that determination is filed with the Workers’ Compensation Appeals Board... within two years after the effective date of the member’s retirement.” If a claimant applies for a determination of industrial causation within two years of retirement but more than five years after the injury, the Board cannot modify its determination that an injury is industrial or not; nothing precludes the Board from making the initial determination of industrial causation. View "Rodriguez v. Workers' Compensation Appeals Board" on Justia Law

A1 learned that government auditors thought that the company had overcharged a federal agency by several million dollars for services provided to Medicare beneficiaries. A1 challenged the auditors’ decisions at two levels of the Medicare appeals process but changed the auditors’ minds only in a few minor ways. The government tried to start collecting the money, as the regulatory regime allows, 42 U.S.C. 1395ff(a)(5), (c)(3)(E). Fearing bankruptcy from the government’s recoupment efforts, A1 obtained a preliminary injunction, barring the government from recouping the money until A1 received a hearing before an administrative law judge. The Sixth Circuit vacated the injunction, first holding that although A1 did not proceed to the third and fourth levels of the administrative appeal, the district court had jurisdiction over A1’s constitutional claims. On the merits, the court identified unanswered questions regarding the statistics concerning the relief likely to be obtained at the third level of administrative review; details about A1’s choice not to take advantage of an option to escalate its claim to the fourth and final level of administrative review; and the parties’ awareness of a recoupment option that might have allowed A1 to obtain an ALJ hearing before making most or even all of its recoupment payments. View "A1 Diabetes & Medical Supply v. Alex Azar II" on Justia Law

In February 2015, Johnson’s landlord under the Housing and Community Development Act Section 8 housing assistance program (42 U.S.C. 1437f(o)) served a “lease violation notice” informing Johnson that she had violated her lease by following another tenant to his apartment and using profanity. In June 2015, Landlord issued a “notice to cease” stating that management had received a complaint from a resident alleging that she had used pepper spray against him. On February 29, 2016, Landlord served a “ninety-day notice of termination of tenancy.” In June, when Johnson failed to vacate, Landlord filed an unlawful detainer action. In August, the action was settled by a stipulation; Landlord agreed to reinstate Johnson’s tenancy on the condition that she conform her conduct to the lease. Landlord retained the right to apply for entry of judgment based on specified evidence of breach. In October, Landlord applied for entry of judgment, claiming that Johnson violated the stipulation. Johnson was evicted in January 2017. In February, the Oakland Housing Authority, which administers the Section 8 program, terminated Johnson's benefits. The court of appeal found no violation of Johnson’s procedural due process rights in terminating her from the program. Johnson was given sufficient notice of the grounds for termination: she failed to supply the Authority with required eviction documentation; she committed and was evicted for serious repeated lease violations. The hearing officer did not abuse its discretion in refusing to excuse the violation. View "Johnson v. Housing Authority of City of Oakland" on Justia Law

Crump applied for social security disability benefits based on her long history of numerous mental health impairments, including bipolar disorder and polysubstance abuse disorder. An administrative law judge denied benefits, finding that Crump, despite her severe impairments, could perform work limited to simple and repetitive tasks. The district court affirmed. The Seventh Circuit vacated. The ALJ did not adequately account for Crump’s difficulties with concentration, persistence, or pace in the workplace. An ALJ generally may not rely merely on catch-all terms like “’simple, repetitive tasks’” because there is no basis to conclude that they account for problems of concentration, persistence or pace. In addition, observing that a person can perform simple and repetitive tasks says nothing about whether the individual can do so on a sustained basis. Beyond disregarding the Vocational Expert’s opinion in response to a second hypothetical, the ALJ gave short shrift to the medical opinions of Crump’s treating psychiatrist. View "Crump v. Saul" on Justia Law

The ALJ who ruled on Hess’s application for social security disability benefits concluded that Hess had “moderate difficulties” in “concentration, persistence or pace,” but offered a detailed explanation for why she believed those difficulties were not serious and why Hess was capable of performing simple tasks. She found that Hess was “limited to jobs requiring understanding, remembering, and carrying out only simple instructions and making only simple work-related decisions[.]” In a series of hypothetical questions meant to include Hess’s limitations, she asked a vocational expert whether there were jobs in the national economy available to someone with those limitations. The expert said there were. The ALJ decided that Hess was not disabled and rejected his claim. The district court determined that the ALJ had erred because, in her hypothetical questions to the vocational expert, she failed to include or account for her finding that Hess had “moderate” difficulties in “concentration, persistence, or pace.” The Third Circuit reversed, refusing to elevate “form over substance.” An ALJ’s statement of a limitation confining a person to “simple tasks” is permissible after a finding of “moderate” difficulties in “concentration, persistence, or pace,” if the ALJ offers a “valid explanation” for it. The explanation given by the ALJ was “valid.” View "Hess v. Commissioner of Social Security" on Justia Law

Krell, a former ironworker, applied for Social Security disability benefits. Krell was notified that a vocational expert would testify at his hearing and that Krell had the right to request a subpoena for documents or testimony “that you reasonably need to present your case.” Krell’s counsel requested a subpoena to require the vocational expert to produce documents upon which the expert may rely in forming opinions, including statistics, reports, surveys, summaries, work product, and a description of the methodologies used by publishers or compilers of the statistics. The ALJ did not respond. At the hearing, the ALJ denied the request, reasoning that it had not specified what the documents would show and why these facts could not be shown without a subpoena and that counsel could challenge the testimony post‐hearing. During cross‐examination, the vocational expert stated that to determine available job numbers, he relied on Wisconsin occupational projections produced by the Department of Workforce Development. Krell made no post‐hearing challenge. The ALJ found that Krell was disabled and entitled to benefits, but only as of 2014, rather than 2011. Based on the expert’s testimony, the ALJ concluded that up to 2014, Krell was able to perform work existing in significant numbers in the economy. The Social Security Appeals Council denied review. The district court concluded that the ALJ had erred in denying Krell’s subpoena request. The Seventh Circuit reversed. While Krell’s case was pending, the Supreme Court held (Biestek) that a vocational expert is not categorically required to produce his supporting data. Krell advanced no reason why it was necessary for the expert to produce his underlying sources. View "Krell v. Saul" on Justia Law

Medi–Cal, California’s program under the joint federal-state Medicaid program (Welf. & Inst. Code 14000), provides health care services to certain low-income individuals and families, including the aged, blind, disabled, pregnant women, and others. (42 U.S.C. 1396). Beginning in 2013-2014, there were delays in the determination of applications for Medi-Cal benefits, sometimes with severe consequences for applicants who did not obtain needed medical care. Applicants and an advocacy organization sued the California Department of Health Care Services (DHCS). The court ordered DHCS to make Medi-Cal eligibility determinations within 45 days unless certain exceptions applied. The court of appeal reversed. The trial court did not abuse its discretion by declining to abstain but California law does not impose on DHCS a duty to make all Medi-Cal eligibility determinations within 45 days. There is an obligation to determine Medi-Cal eligibility within 45 days under federal regulation 32 CFR 435.912(c)(3)(ii), but that obligation is subject to exceptions so that the underlying obligation is not sufficiently clear and plain to be enforceable in mandate. It was not clear whether DHCS was out of compliance with an overall performance benchmark of processing 90% of applications within 45 days; absent such evidence, it was error to issue writ relief applicable across-the-board. View "Rivera v. Kent" on Justia Law