Justia Public Benefits Opinion Summaries

The Department of Health and Human Services denied Medicare coverage of the BIO-1000, a piece of durable medical equipment used to treat osteoarthritis of the knee. In four decisions, the Medicare appeals counsel, the highest level of agency adjudication, ruled that the BIO-1000 had not been shown to be reasonable and necessary for the treatment at issue. The supplier of the device challenged those decisions. The district court granted summary judgment for the BIO-1000 supplier. The Ninth Circuit Court of Appeals reversed the district court's judgment and joined the Fourth Circuit in holding that the appeals council's coverage denials for the BIO-1000 were not arbitrary, capricious, or unsupported by substantial evidence, as (1) the appeals council adequately explained its reasons for denying coverage; and (2) the coverage denials were supported by substantial evidence. Remanded. View "Int'l Rehab. Scis. v. Sebelius" on Justia Law

Venti’s father received federal Civil Service Retirement System benefits. Venti’s father died in 1990, which should have terminated his benefits. The Office of Personnel Management continued to deposit the CSRS funds into a checking account that Venti had shared with his father. In 2003, Venti opened a new joint checking account at RFCU in the names of himself and his father and arranged for the CSRS benefits, as well as his own Social Security benefits, to be deposited in the new account. In 2005, OPM learned of the death of Venti's father and stopped depositing the CSRS benefits. In 2009, Venti was convicted of theft of government property (18 U.S.C. 641), one count for each of nine checks written in his father’s name during 2005, and was sentenced to 15 months. The First Circuit affirmed, rejecting an argument that one count was time-barred. If the count had been time-barred, the sentence would have been limited to one year because Venti would be treated as a misdemeanant rather than as a felon. View "United States v. Venti" on Justia Law

Defendant Barbara Norris, an organizational payee with the Social Security Administration, pled guilty to social security representative payee fraud. The district court sentenced Defendant to eighteen months in prison, the top of her guideline range. Defendant appealed, arguing that her sentence was substantively unreasonable. The Eighth Circuit Court of Appeals affirmed, holding that the district court did not abuse its discretion in sentencing Defendant to eighteen months in prison, as the court properly applied its wide latitude to weigh the factors in the federal sentencing statute and assigned some factors greater weight than others in determining an appropriate sentence. View "United States v. Norri" on Justia Law

Shideler suffers osteogenesis imperfecta, “brittle bone disease.” In 2006, at age 48, he applied for Social Security Disability Insurance benefits, 42 U.S.C. 423(d), alleging an onset date of 1995. His date last insured was 2000. The ALJ found that despite Shideler’s limitations, there were a sufficient number of jobs in the regional economy available to a person with his restrictions, and denied his application. The Appeals Council denied review. The district court and Seventh Circuit affirmed. The record supported the vocational expert’s testimony concerning available jobs as a clerk, assuming certain restrictions: never climb ladders, ropes, or scaffolds and only occasionally climb ramps or stairs; never crouch, kneel or crawl; never perform overhead reaching; avoid exposure to extreme heat and cold; and perform work that includes occasional, but not frequent, use of fingers. Despite his testimony that he had broken at least 55 bones over the course of his life, the record showed that Shideler had only four surgeries and made a full recovery. The record contained no evidence that Shideler visited any doctors between May 2000 and December 2006. View "Shideler v. Astrue" on Justia Law

The Secretary of the Department of Health and Human Services (HHS) imposed a civil money penalty on Greenbrier Nursing and Rehabilitation Center, a skilled nursing facility in Arkansas, for noncompliance with Medicare participation requirements. The Eighth Circuit Court of Appeals denied Greenbrier's petition for review, holding (1) substantial evidence supported HHS's finding that Greenbrier was not in substantial compliance with 42 C.F.R. 483.25; (2) the finding that Greenbrier's noncompliance with section 483.25 rose to the level of immediate jeopardy was not erroneous; and (3) judicial review of two of Greenbrier's objections to the monetary penalty was barred, and Greenbrier received adequate notice of its noncompliance. View "Greenbrier Nursing v. U.S. Dep't of Health & Human Servs." on Justia Law

Locane, born in 1983, was adopted and does not know her family medical history. She suffered her first symptoms within two weeks of being vaccinated in 1997 and was diagnosed with Crohn’s Disease. She sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-1 to -34, alleging that she suffered Crohn’s disease as a result of hepatitis B vaccination. A special master denied the claim, finding Locane’s disease began before her vaccination and that Locane failed to prove by a preponderance of the evidence that the vaccine caused or significantly aggravated her disease. The Federal Circuit affirmed. View "Locane v. Sec'y of Health & Human Servs." on Justia Law

Petitioners Leroy and Glenda Morris brought suit under 42 U.S.C. 1983 and the Supremacy Clause to challenge the Oklahoma Department of Human Services' ("OKDHS") denial of Mrs. Morris' application for Medicaid benefits as inconsistent with federal law. After calculating the couple's resources and the Community Spouse Resource Allowance (CSRA), OKDHS determined that the Morrises were ineligible for benefits. In an effort to "spend down" their excess resources, the Morrises purchased an actuarially sound annuity payable to Mr. Morris. Despite this purchase, OKDHS determined that Mrs. Morris remained ineligible. The district court granted summary judgment in favor of OKDHS, upholding the agency's application of the Medicaid statutes. Upon review, the Tenth Circuit reversed and remanded the case for further proceedings. A couple may convert joint resources (which may affect Medicaid eligibility) into income for the community spouse (which does not impact eligibility) by purchasing certain types of annuities. In other words, a couple may purchase a qualifying annuity payable to the community spouse in addition to the community spouse's retention of the CSRA. View "Morris v. Oklahoma Dept. of Human Svcs." on Justia Law

Howard Back filed this suit alleging that Secretary of Heath and Human Services Kathleen Sebelius violated her duties under the Medicare Act and the Due Process Clause by failing to provide an administrative process for beneficiaries of hospice care to appeal a hospice provider's refusal to provide a drug prescribed by their attending physician. The district court granted the Secretary's motion for judgment on the pleadings because Back had not exhausted his administrative remedies. The Ninth Circuit Court of Appeals vacated the district court's judgment and dismissed the appeal as moot, holding that although the government led Back to believe there was no appeal process, such a process did exist. Accordingly, no controversy existed and the appeal was moot. View "Back v. Sebelius" on Justia Law

Frederick, previously married to World War II veteran Hill, upon Hill's death became entitled to Dependency and Indemnity Compensation as surviving spouse of a veteran whose death resulted from service-related injury or disease, 38 U.S.C. 1310-1318. In 1986 she remarried at age 57. Until January 1, 2004, the law provided that a surviving spouse receiving DIC benefits lost entitlement to those benefits upon remarriage. The Veterans Benefits, Act of 2003, amending 38 U.S.C. 103(d)(2)(B), added language that “remarriage after age 57 of the surviving spouse of a veteran shall not bar the furnishing of DIC.” Congress also provided new DIC eligibility for surviving spouses who remarried after the age of 57, but before the date of enactment of the Act. The Regional VA Office denied Mrs. Frederick’s 2007 application for reinstatement as untimely. The Board of Appeals rejected her notice argument. The Veterans Court held that she was entitled to benefits. The Federal Circuit reversed, rejecting an argument that she is simply not covered by one-year limitation in subsection (e). View "Frederick v. Shinseki" on Justia Law

Plaintiff-Appellant Valinda Kornhauser filed suit to challenge the decision of the Commissioner of Social Security that denied her claim for disability benefits. The District Court referred the case to a Magistrate Judge for a report and recommendation ("R&R"). After receiving and considering memoranda on the matter, the Magistrate Judge issued an R&R recommending that the District Court vacate the Commissioner's decision and remand the case to the Commissioner for further proceedings. In his R&R, the Magistrate Judge, in addition to explaining why Plaintiff was entitled to a vacatur, observed that the memorandum her attorney had submitted failed to comply with Middle District of Florida Local Rule 1.05(a). The non-compliance, according to the Magistrate Judge, consisted of "smaller margins than authorized" by the rule and "footnotes . . . smaller than ten-point type." In a footnote to this observation, he stated: "These intentional violations would justify striking the memorandum. However, this sanction would unfairly punish the plaintiff. Consequently, I propose that, when plaintiff's counsel seeks attorney's fees, that the typical request for a cost-of-living increase be denied." Following the entry of judgment, Plaintiff petitioned the District Court for an award of attorney's fees under the Equal Access to Justice Act ("EAJA"). The parties stipulated to the amount of attorney fees, but after its consideration of the petition, the Magistrate Judge issue an R&R recommending that the district court award a lower amount in fees as have been stipulated because of Plaintiff's brief being submitted with small margins and unacceptable font sizing. Plaintiff's attorney filed an objection to the R&R, asking the district court not to adopt it because she did not intend to violate the local rule. Finding that the sanction was a reasonable exercise of the Magistrate Judge's disciplinary authority, the district court adopted the R&R with the sanction. Plaintiff appealed the imposition of the sanction. Upon review, the Eleventh Circuit vacated the sanction, finding "no procedural rule that sanctions the conduct involved" in this case. View "Kornhauser v. Comm'r of Social Security" on Justia Law