Justia Public Benefits Opinion SummariesArticles Posted in Oregon Supreme Court
Larisa’s Home Care, LLC v. Nichols-Shields
The issue presented for the Oregon Supreme Court’s review was whether an adult foster care provider claiming unjust enrichment may recover the reasonable value of its services from a defendant who, through fraud, obtained a lower rate from the provider for the services. Plaintiff owned two adult foster homes for the elderly. Plaintiff had contracted with the Oregon Department of Human Services to provide services in a home-like setting to patients who qualified for Medicaid. For those patients, the rates charged would be those set by the department. Isabel Pritchard resided and received care in one of plaintiff’s adult foster homes until her death in November 2008. Because Prichard had been approved to receive Medicaid benefits, plaintiff charged Prichard the rate for Medicaid-qualified patients: approximately $2,000 per month, with approximately $1,200 of that being paid by the department. Plaintiff’s Medicaid rates were substantially below the rates paid by plaintiff’s “private pay” patients. Prichard’s application for Medicaid benefits, as with her other affairs, was handled by her son, Richard Gardner. Gardner had for years been transferring Prichard’s assets, mostly to himself (or using those funds for his personal benefit). Gardner’s misconduct was discovered by another of Prichard’s children: defendant Karen Nichols-Shields, who was appointed the personal representative for Prichard’s estate. In 2009, defendant contacted the police and reported her brother for theft. Ultimately, Gardner pleaded guilty to three counts of criminal mistreatment in the first degree. Gardner’s sentence included an obligation to pay a compensatory fine to Prichard’s estate, to which he complied. After defendant, in her capacity as personal representative, denied plaintiff Larisa’s Home Care, LLC’s claim against Prichard’s estate, plaintiff filed this action, essentially asserting Prichard had been qualified for Medicaid through fraud and that Prichard should have been charged as a private pay patient. The Oregon Supreme Court concluded that, generally, a defendant who obtains discounted services as a result of fraud is unjustly enriched to the extent of the reasonable value of the services. The Court therefore reversed the contrary holding by the Court of Appeals. Because the fraud here occurred in the context of a person being certified as eligible for Medicaid benefits, however, the Court remanded for the Court of Appeals to consider whether certain provisions of Medicaid law may specifically prohibit plaintiff from recovering in this action. View "Larisa's Home Care, LLC v. Nichols-Shields" on Justia Law
Moro v. Oregon
In the underlying litigation to this appeal, claimants were petitioners or represented petitioners who challenged legislation passed in 2013 that changed the pension benefits paid to certain members of the Public Employee Retirement System (PERS) by limiting the statutory cost-of-living adjustment (COLA) and eliminating a PERS income-tax offset for out-of-state retirees. In "Moro v. Oregon," (351 P.3d 1 (2015) (Moro I)), the Oregon Supreme Court largely agreed with petitioners’ argument that modifications to the COLA formula impaired petitioners’ contractual rights, thus violating Article I, section 21, of the Oregon Constitution. But the Court rejected petitioners’ similar challenge to the elimination of the income-tax offset. Petitioners, who were active and retired members of PERS, were the prevailing parties. Following the decision in Moro I, claimants petitioned for attorney fees and costs. State respondents and county/school district respondents filed objections. The Supreme Court referred those petitions to a special master for recommended findings of fact and conclusions of law. The special master reported his recommendations, and the parties subsequently filed objections and responses to those recommendations. The issues raised in those filings included which legal doctrines justified an award of attorney fees in this case; whether self-represented attorneys were eligible to receive an award of attorney fees; whether the fees sought by claimants were reasonable; and how to pay for an award of fees and costs. After review, the Oregon Supreme Court concluded that fees should be awarded based on the common-fund and substantial-benefit doctrines; that the self-represented attorneys were eligible to receive a fee award under those doctrines; that a reasonable fee award under the lodestar approach had to be based on reasonable hourly rates and reflect reductions to account for duplicative work and work on unsuccessful claims; and that an award in this case should be paid for as determined by the Public Employees Retirement Board (PERB) in a manner that was consistent with its statutory authority and fiduciary obligations. View "Moro v. Oregon" on Justia Law
Petock v. Asante
The primary question in this case was whether a workplace injury that Plaintiff Nancy Petock characterized as an aggravation or worsening of an earlier compensable injury can give rise to a new three-year period in which she could demand reinstatement or reemployment. The trial court held that it could not and granted Defendant Asante's (dba Asante Health System) summary judgment motion. Although the Court of Appeals agreed with the trial court that an aggravation of an earlier injury cannot give rise to new reinstatement rights, it concluded that there was a disputed issue of fact as to whether Plaintiff had sustained a "new and separate injury" in 2005 that would give rise to those rights, and remanded the case. On review, Plaintiff argued that the Court of Appeals erred in holding that an aggravation of an earlier injury cannot give rise to a right to reinstatement under ORS 659A.043 or a right to reemployment under ORS 659A.046. Though the Supreme Court disagreed with some of the appellate court's reasoning, it affirmed the decision to reverse the trial court for further proceedings: "Even if defendant were correct that the same facts cannot give rise to an aggravation claim and a compensable injury claim (a proposition with which [the Court] noted our disagreement), [the Court] fail[ed] to see the relevance of that proposition in the context of defendant's summary judgment motion. On this record, Plaintiff was free to argue that her 2005 injury was a compensable injury." View "Petock v. Asante" on Justia Law
White v. Public Employees Retirement Board
Plaintiffs Ursula White, Bruce Reiter and Margaret Retz, one retired member and two active members of the Public Employees Retirement System (PERS) challenged certain actions of the Public Employees Retirement Board (PERB) alleging that those actions violated PERB's fiduciary duty to manages PERS for the benefit of PERS members. Specifically, Plaintiffs alleged that PERB breached its duty when it settled "City of Eugene v. Oregon." Respondent PERB argued that it settled that case pursuant to the "PERS Reform and Stabilization Act of 2003" and by court order, and was consistent with it's charged fiduciary duties. The trial court entered judgment in favor of PERB, and Plaintiffs appealed. The Court of Appeals certified the appeal to the Supreme Court, which concluded that there were disputed factual issues with respect to one of the Plaintiffs' claims, and that the trial court erred in granting judgment in PERB's favor. The Court reversed that part of the trial court opinion directed at that Plaintiff, and remanded the case. View "White v. Public Employees Retirement Board" on Justia Law
Arken v. City of Portland
This opinion consolidated two cases brought before the Supreme Court on certified appeals from the Court of Appeals. Both cases involved the Public Employees Retirement Board's (PERB or the Board) revision or reduction of benefits with respect to "Window Retirees." These cases involved the Board's efforts to recoup overpayments of benefits to retirees that were predicated on a 20 percent earnings credit for calendar year 1999 that the Board approved by order in 2000. PERB sought to recoup these overpayments to the Window Retirees through an overpayment recovery mechanism set out in ORS 238.715.2. A number of members challenged the statutory mechanism for returning the payments, and the methodology the Board used in making its individualized determinations. Upon review, the Supreme Court determined that the trial court correctly granted summary judgment to the "Arken defendants" on all four of the claims raised by the "Arken plaintiffs." Furthermore, the Court determined that the trial court erred in granting summary judgment to the "Robinson petitioners" on their claims for relief. Because the Court concluded that PERB correctly applied ORS 238.715 to recoup overpayments that were made to the Window Retirees based on the 20 percent earnings credit for 1999, the Court also determined that the trial court erred in denying PERB's cross-motion for summary judgment.
Goodson v. Public Employees Retirement System
Petitioners sought judicial review of a final order of the Public Employees Retirement Board (PERB). They contested the reduction of their retirement benefits as a result of PERB's efforts to recoup benefit overpayments that Petitioners had received because of an erroneous 20 percent earnings credit for 1999. The Court of Appeals certified the matter to the Supreme Court, and upon review of the applicable legal authority, the Supreme Court affirmed PERB's final order.