Justia Public Benefits Opinion Summaries

Plaintiff and his wife appealed the denial of his application for Medicaid benefits, arguing that the Department wrongfully denied the application because it had improperly counted against the wife's eligibility an annuity owned by the wife. The district court ruled in favor of plaintiffs and the Department appealed. The court concluded that, because the wife had no right, authority, or power to liquidate the annuity, the annuity benefits were not a resource, but rather was income indicated by the federal statute defining "unearned income." Therefore, the Department applied a more restrictive methodology under state law by classifying the annuity benefits as a resource that counted against plaintiff's eligibility for Medicaid benefits. The court rejected the Department's counter-arguments and the remaining arguments, and affirmed the judgment of the district court. View "Geston, et al. v. Anderson" on Justia Law

The Secretary appealed the district court's order certifying a nationwide class of Medicare beneficiaries and granting summary judgment in the beneficiaries' favor. The beneficiaries raised two claims: (1) the Secretary's practice of demand "up front" reimbursement for secondary payments from beneficiaries who have appealed a reimbursement determination or sought waiver of the reimbursement obligation was inconsistent with the secondary payer provisions of the Medicare statutory scheme; and (2) the Secretary's practice violated their due process rights. The court concluded that Patricia Haro had Article III standing on behalf of the class; John Balentine, as counsel for Haro, had Article III standing on his individual claim; and the beneficiaries' claims for injunctive relief were not moot and Article III's justiciability requirements were satisfied. The court concluded, however, that the beneficiaries' claim was not adequately presented to the agency at the administrative level and therefore the district court lacked subject matter jurisdiction under 42 U.S.C. 405(g). On the merits of Balentine's claim, the court concluded that the Secretary's interpretation of the secondary payer provisions was reasonable. Therefore, the court vacated the district court's injunctions, reversed the district court's summary judgment order, and remanded for consideration of the beneficiaries' due process claim. View "Haro v. Sebelius" on Justia Law

Relators brought a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A) and (B), alleging that the Mayo Foundation and others billed Medicare for surgical pathology services it did not provide. The government intervened and the parties settled. Relators then filed a Second Amended Complaint asserting additional claims. On appeal, relators challenged the district court's dismissal of their additional claim that Mayo fraudulently billed for services it did not provide whenever it prepared and read a permanent tissue slide but did not prepare a separate written report of that service. As a preliminary issue, the court concluded that relators satisfied their burden of showing that the public disclosure bar did not deprive the court of jurisdiction over relators' claim. On the merits, the court concluded that nowhere in the Medicare regulations or in the American Medical Association Codebook has the court found a requirement that physicians using the CPT codes for surgical pathology services must prepare the additional written reports that relators claimed Mayo fraudulently failed to provide. Accordingly, the court affirmed the judgment of the district court. View "Ketroser, et al. v. Mayo Foundation, et al." on Justia Law

Planned Parenthood and others filed suit challenging Ariz. Rev. Stat. 35-196.05(B) as a violation of the federal Medicaid Act, 42 U.S.C. 1396a. Ariz. Rev. Stat. 35-196.05(B) barred patients eligible for the state's Medicaid program from obtaining covered family planning services through health care providers who performed abortions in cases other than medical necessity, rape, or incest. The court concluded that the district court's entry of final judgment and a permanent injunction mooted Arizona's appeal of the district court's preliminary injunction. Therefore, the court dismissed that appeal (Case No. 12-17558), and considered only Arizona's appeal of the summary judgment order and permanent injunction (Case No. 13-15506). The court held that the Medicaid Act's free-choice-of-provider requirement conferred a private right of action under 42 U.S.C. 1983. The court also held that the Arizona statute contravenes the Medicaid Act's requirement that states give Medicaid recipients a free choice of qualified provider. Accordingly, the court affirmed the district court's summary judgment and permanent injunction. View "Planned Parenthood v. Betlach" on Justia Law

In a social security disability or Supplemental Security Income (SSI) case, an administrative law judge (ALJ) must evaluate the effect of a claimant's mental impairments on her ability to work using a "special technique" prescribed by the Commissioner's regulations. At the second step of a five-step analysis, the ALJ must determine whether the mental impairment is "severe" or "not severe." If "not," then the ALJ must determine and discuss them as part of his residual functional capacity (RFC) analysis at step four. A question that is frequently encountered in social security disability appeals cases is how much further discussion of a non-severe impairment is required at step four? The Tenth Circuit found that in assessing the claimant's RFC, the ALJ must consider the combined effect of all of the claimant's medically determinable impairments; the Commissioner's procedures do not permit the ALJ to simply rely on his finding of non-severity as a substitute for a proper RFC analysis. In this case, the ALJ found that Petitioner's alleged mental impairments were medically determinable but non-severe. He then used language suggesting he had excluded them from consideration as part of his RFC assessment, based on his determination of non-severity. Under the regulations, however, a finding of non-severity alone would not support a decision to prepare an RFC assessment omitting any mental restriction. The ALJ's specific conclusions he reached in this portion of his analysis were unsupported by substantial evidence. Accordingly, the Tenth Circuit reversed the district court's affirmance of the ALJ's decision and remand to the district court with instructions to remand to the Commissioner for further proceedings at step four. View "Wells v. Colvin" on Justia Law

This case involves a federal rent-subsidy program for Indian Tribes and Tribally Designated Housing Entities (TDHE) that lease housing to Indians. Fort Belknap, a TDHE, petitioned for review of HUD's decision to withhold overpayments from future program payments. The court held that 25 U.S.C. 4161(d) allows an appeal only when HUD takes action pursuant to section 4161(a). In this instance, because HUD has taken no action pursuant to section 4161(a), the court dismissed the petition for lack of jurisdiction. View "Fort Belknap v. Office of Pub. & Indian Hous." on Justia Law

The Department of Veterans Affairs promulgated a rule that purported to eliminate certain procedural and appellate rights for veterans appearing before the Board of Veterans’ Appeals. The National Organization of Veterans’ Advocates (NOVA) sought review. During the course of review it became clear that the new rule was invalid; the VA made assurances to NOVA and to the Federal Circuit about how the matter would be handled pending resolution. It later became clear that these assurances were not honored by the VA. The Federal Circuit ordered the VA to show cause why it should not be sanctioned. The VA, conceding error, provided a detailed remedial plan. After clarifications, NOVA indicated its satisfaction with, and agreement to, the plan, under which the VA agreed to notify relevant claimants before the Board, to vacate the affected Board decisions, and to provide affected claimants with a new hearing even if relevant deadlines would otherwise have expired. The Federal Circuit approved the plan and did not enter sanctions. View "Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs" on Justia Law

Mingo Logan challenged the award of benefits to claimant under the Black Lung Benefits Act (BLBA), 30 U.S.C. 921(c)(4). Because the court concluded that the ALJ did not in fact apply rebuttal limitations to Mingo Logan, and the Board affirmed the ALJ's analysis, the court did not reach Mingo Logan's challenge to the standard announced by the Board to rebut the section 921(c)(4) presumption of entitlement to benefits. The court affirmed the Board's award of benefits because it also found that Mingo Logan's other challenges to the ALJ's factual findings lacked merit. Accordingly, the court denied the petition for review. View "Mingo Logan Coal Co. v. Owen" on Justia Law

Claimant was awarded benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901-945. At issue was whether the awards of attorneys' fees properly reflected market-based evidence of counsel's hourly rate, as required by the lodestar analysis in Hensley v. Eckerhart. The court held that neither the ALJ nor the BRB abused its discretion in concluding that counsel provided sufficient market-based evidence of rates, and that the number of hours billed for attorneys' services reasonably reflected the work completed. The court also held that the award of fees for work performed by certain legal assistants was not supported fully by the record, and modified that award accordingly. View "Eastern Associated Coal Corp. v. DOWCP" on Justia Law

Plaintiff, a recipient of Supplemental Security Income (SSI) benefits, appealed from the district court's judgment sua sponte dismissing his amended complaint under 28 U.S.C. 1915(e)(2)(B). Plaintiff sought an Order to Show Cause, a temporary restraining order, and a preliminary injunction enjoining defendants from levying against his SSI benefits to enforce a child support order. At issue was whether 42 U.S.C. 659(a) authorized levy against SSI benefits provided under the Social Security Act, 42 U.S.C. 301 et seq., to satisfy the benefits recipient's child support obligations. The court concluded that SSI benefits were not based upon remuneration for employment within the meaning of section 659(a); section 659(a) did not preclude plaintiff's claims; and the Rooker-Feldman doctrine and the exception to federal jurisdiction for divorce matters did not preclude the district court from exercising jurisdiction over the matter. Accordingly, the court vacated the judgment to the extent the district court dismissed plaintiff's claims against the agency defendants and remanded for further proceedings. However, the court affirmed the portion of the judgment dismissing plaintiff's claims against Bank of America because his complaint had not alleged facts establishing that the bank was a state actor for purposes of 42 U.S.C. 1983. View "Sykes v. Bank of America" on Justia Law