Justia Public Benefits Opinion Summaries

After the court reversed and remanded for an award of social security disability benefits to plaintiff, plaintiff moved for an award of attorney's fees and costs under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The court concluded that the district court abused its discretion in denying the fees where the government's underlying action was not substantially justified in this case. Accordingly, the court reversed the district court's denial of plaintiff's motion and remanded for an award of fees and costs. View "Meier v. Colvin" on Justia Law

Gentiva, a provider of home healthcare services, contended that the Secretary violated the Medicare statute, 42 U.S.C. 1395ddd(f)(3), by delegating to an outside contractor the authority to determine whether Gentiva's Medicare reimbursement claims exhibited a "sustained or high level of payment error." The court affirmed the district court's decision to defer, under Chevron deference, to the Secretary's reasonable interpretation of section 1395ddd(f)(3). The court also agreed with the district court that section 1395ddd(f)(3) precluded the court from reviewing the merits of the "sustained or high level of payment error" determination. Accordingly, the court affirmed the judgment in its entirety. View "Gentiva Healthcare Corp. v. Sebelius" on Justia Law

Plaintiff appealed the denial of her application for Social Security disability benefits, disability insurance benefits, and supplemental security income. The court concluded that substantial evidence supported the ALJ's determination that plaintiff's doctor's opinion was inconsistent with the treatment record and thus not entitled to controlling weight; substantial evidence supported the ALJ's determination that plaintiff's impairments did not meet or equal a medical listing; because the residual functioning capacity (RFC) finding was supported by substantial evidence, it was proper for the ALJ to consider testimony of a vocational expert that was premised on the RFC; and the ALJ did not err in determining plaintiff's credibility. Accordingly, the court affirmed the district court's affirmance of the denial of benefits. View "Myers v. Astrue" on Justia Law

Oaks, a nursing facility, initiated contempt proceedings against the government because the government failed to abide by the district court's order enjoining the government from acting in accordance with a Notice of Termination relative to Oak's Medicare and Medicaid Provider Agreement. The court vacated the finding of contempt and reversed the judgment of the district court, concluding that the government complied with the injunction by delaying effectuation of the termination notice. View "Oaks of Mid City Resident Council v. Sebelius, et al." on Justia Law

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

States participating in Medicaid in a managed care environment are required to make, at least every fourth month, supplemental “wraparound” payments to federally-qualified health centers (FQHCs) equal to the difference between a rate set by statute multiplied by the number of Medicaid patient encounters, and the amount paid to FQHCs by managed care organizations (MCOs) for all Medicaid-covered patient encounters, 42 U.S.C.1396. Concerned that gaps in FQHC claim verification led to overpayments, the New Jersey Department of Human Services changed its calculation: instead of basing wraparound payments solely on the number of Medicaid encounters and total MCO receipts as self-reported by FQHCs, the state would rely on data reported by MCOs absent receipt of certain additional data from the FQHCs. Because MCOs report only encounters that they have approved and paid, prior MCO payment would be a prerequisite to wraparound reimbursement under the new system. An association of FQHCs sued, claiming that the change violated their due process rights as well as state and federal law, resulting in budget shortfalls. The district court granted the association summary judgment and a preliminary injunction. The Third Circuit affirmed the holding that the requirement that wraparound payments be contingent on prior MCO payment violated the Medicaid statute’s requirement that FQHCs receive timely full wraparound payment for all Medicaid-eligible claims. View "NJ Primary Care Assoc. v. NJ Dep't of Human Servs." on Justia Law

These consolidated cases involved claims for survivors' benefits under the Black Lung Benefits Act, 30 U.S.C. 901 et seq. Petitioners, the coal mine operators responsible for payment of respondents' benefits, petitioned for review, claiming that principles of res judicata foreclosed respondents - each of whom previously and unsuccessfully sought survivors' benefits under the Act - from relying on a recent amendment to the Act to pursue benefits again through a "subsequent claim." The court affirmed the Board's awards, concluding that res judicata did not bar the subsequent claims because the amendment created a new cause of action that was unavailable to respondents when they brought their initial claims. View "Union Carbide Corp. v. Richard" on Justia Law

The Clinics filed suit challenging California Welfare and Institutions Code 14131.10, which eliminated certain Medi-Cal benefits that the state deemed optional, including adult dental, podiatry, optometry, and chiropractic services. The court reversed the district court's holding that the Clinics have a private right of action to challenge the Department's implementation of the state plan amendments (SPA) prior to obtaining approval; affirmed that the Clinics have a private right of action to bring a claim pursuant to 42 U.S.C. 1983 challenging the validity of section 14131.10; and reversed the district court's interpretation of the Medicaid Act, 42 U.S.C. 1396 et seq., holding that section 14131.10 impermissibly eliminated mandatory services from coverage. View "California Ass'n of Rural Health Clinics v. Douglas" on Justia Law

Federal employees who are members of the National Guard are entitled to up to 15 days of annual military leave “without loss in pay, time, or performance or efficiency rating,” 5 U.S.C. 6323(a)(1). Before a 2000 amendment, the Office of Personnel Management interpreted the section as providing 15 calendar days of leave, rather than 15 workdays; federal employees who attended reserve training on non-work days were charged military leave. The Federal Circuit held that even before 2000, federal agencies were not entitled to charge employees military leave on non-workdays. Tierney worked at the DEA, 1974-2001, and was a member of the Air National Guard. He filed a Merit Systems Protection Board claim that the DEA charged him military leave for reserve duty on 44 non-workdays, so that he took annual leave or unpaid leave for military duty. An AJ ordered DEA to compensate Tierney for 17 days. The full Board reversed, finding that the Military Leave Summary and Tierney’s testimony were based solely on his military records and on speculation that DEA improperly charged military leave on intervening non-workdays and that the evidence was insufficient to prove that DEA charged him military leave on non-workdays or that he used annual leave for reserve duties. The Federal Circuit reversed and remanded, concluding that the decision was not supported by substantial evidence. View "Tierney v. Dep't of Justice" on Justia Law

Plaintiff-Appellant Tyla Newbold appealed a magistrate judge's order that granted her Social Security benefits from October 2006 to November 2007, but denied them thereafter. The Commissioner of the Social Security Administration determined Plaintiff had been disabled during that period due to physical and mental impairments, but that she recovered and the disability ceased. The issue on appeal to the Tenth Circuit was whether the administrative law judge (ALJ) used the proper medical-improvement standard in deciding Plaintiff ceased being disabled. Finding that the ALJ used the proper standard, the Tenth Circuit affirmed. View "Newbold v. Astrue" on Justia Law