Justia Public Benefits Opinion Summaries

Daugherty, an ALJ hearing disability-benefits applications for the Social Security Administration, took bribes. Conn, who represented many claimants, paid Daugherty $400 per favorable decision; Conn received $5,000 or more per case out of the benefits that Daugherty awarded. Four physicians, including Huffnagle, submitted evaluations to support Daugherty’s decisions, even if the applicant failed to appear for examination. Conn and Daugherty pleaded guilty to federal felonies. One of the physicians was convicted. Huffnagle died. The total cost of benefits granted by Daugherty exceeds $500 million. Following an investigation, a notice under 42 U.S.C. 1320a–8(l), set in motion a process for redetermination of the benefits awarded in connection with the scheme. In a suit under 42 U.S.C. 405(g), 1383(c)(3), Jaxson claimed that the ALJ who presided over his redetermination should have considered Huffnagle’s report but declined to do so only because an internal claims-processing manual and ruling say that an ALJ cannot accept evidence that the Inspector General found is likely a product of fraud. The Seventh Circuit affirmed a ruling in favor of Jaxson. Jaxson may have a hard time persuading an ALJ that there is not even “reason to believe” that Huffnagle’s report is fraudulent but he is entitled to try; 42 U.S.C. 405(b)(1), requires a “reasonable notice and opportunity for a hearing”, and “hearing” means a procedure at which both sides can present views on potentially dispositive matters. View "Jaxson v. Saul" on Justia Law

Plaintiffs each brought an action asserting that the ALJ who denied their application for benefits was not properly appointed in accordance with the Appointments Clause of the Constitution.The Eighth Circuit held that the district court properly declined to consider the issue and affirmed the judgments. In these cases, none of the claimants raised the issue during the proceedings before the Social Security Administration and thus the district court properly concluded that they waived their argument. The court rejected plaintiffs' claims that their constitutional claims need not be exhausted and that exhaustion of this particular constitutional challenge would have been futile. The court further explained that this is not one of the rare situations in which a federal court should consider an issue that was not presented to the agency. View "Davis v. Saul" on Justia Law

General’s clinicians perform services in long-term care facilities. General bills Medicare under 42 U.S.C. 1395. A Centers for Medicare and Medicaid Services (CMS) contractor, AdvanceMed, initiated audits in 2002 after the CMS fraud unit received complaints about General’s billing practices. In 2004 AdvanceMed initiated an audit of General’s physicians without providing any notice to General. AdvanceMed sent records requests to physicians at 12 General facilities, covering 382 claims involving 278 patients in 2002-2004. General was not notified of these requests. AdvanceMed did not request any records from General. AdvanceMed determined that 35 of the 382 claims were allowed as billed; 33 claims were allowed at different levels than billed. The remaining 314 claims were denied: 3 did not meet policy guidelines, 73 had no documentation to support the services, and 238 were medically unnecessary.General learned of this audit when it received a letter in 2007, indicating that General had been overpaid by $16,778.80; the overpayment was extrapolated to a universe of 41,818 claims. The total amount of overpayment demanded was $1,836,646.56. The Appeals Council determined and the Sixth Circuit affirmed that no remedy should be granted because the lack of notice was inconsequential and did not prevent General from ably and thoroughly arguing the principal issues resulting from the audit, the validity of the sampling methodology, and the coverage of the reviewed claims. The addition of more medical records would not have materially impacted its findings. View "General Medicine, P.C. v. Azar" on Justia Law

At issue in this case was the correct interpretation of Ariz. Rev. Stat. 23-750(E)(5), which provides that income earned by any individual who performed certain services while employed by an entity that provides such services to or on behalf of an "educational institution" cannot be used to qualify for unemployment during breaks between academic terms if that person is guaranteed reemployment.Plaintiffs were employees of Chicanos For La Cause (CPLC), a nonprofit corporation that administered federally funded Early Head Start and Migrant Seasonal Head Start programs and provided services to help school districts comply with their obligations under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. When the summer break began, Plaintiffs applied for unemployment insurance benefits from Arizona Department of Economic Security (ADES), which granted benefits. The ADES Appeals Board reversed. The Supreme Court remanded the case to ADES to award unemployment benefits to two plaintiffs and for further proceedings to resolve the claims of the remaining plaintiffs, holding that section 23-750(E)(5) applies to plaintiffs only if they performed services for CPLC that CPLC supplied to the school districts. View "Rosas v. Arizona Department of Economic Security" on Justia Law

In separate claims, appellees Willie Carr and Kim Minor sought disability benefits from the Social Security Administration (“SSA”). In each case, the administrative law judge (“ALJ”) denied the claim, and the agency’s Appeals Council declined to review. While his case was pending in district court, the U.S. Supreme Court held that Securities and Exchange Commission (“SEC”) ALJs were “inferior officers” under the Appointments Clause, and therefore must be appointed by the President, a court, or head of the agency. Shortly thereafter, Minor also sued in district court to challenge the denial of benefits in her case. In response to the Supreme Court case, Lucia v. S.E.C., 138 S. Ct. 2044 (2018), the SSA Commissioner appointed the SSA's ALJs to address any Appointments Clause questions Lucia posed. After the Commissioner’s action, Carr and Minor each filed a supplemental brief, asserting for the first time that the ALJs who had rejected their claims had not been properly appointed under the Appointments Clause. The district court upheld the ALJs’ denials of the claims, but it agreed with the Appointments Clause challenges. The court vacated the SSA decisions and remanded for new hearings before constitutionally appointed ALJs. It held that appellees did not waive their Appointments Clause challenges by failing to raise them in their SSA proceedings. On appeal, the Commissioner argued Appellees waived their Appointments Clause challenges by failing to exhaust them before the SSA. The Tenth Circuit agreed with the Commissioner and reversed. View "Carr v. Commissioner, SSA" on Justia Law

The Orange County Department of Child Support Services (Department) has withdrawn money from Daniel Lak’s (Father) Social Security Disability Insurance benefits (SSDI) to pay for child/spousal support arrears since 2015. Father disputed the Department's authority to withdraw money, and at a hearing, sought reimbursement for overpayments and maintained the Department violated Family Code section 5246 (d)(3) by collecting more than five percent from his SSDI. The court denied Father’s requests and determined the Department could continue withdrawing money from SSDI for support arrears. On appeal, Father maintaned the court misinterpreted the law and failed to properly consider his motion for sanctions. Finding his contentions lack merit, the Court of Appeal affirmed the court’s order the Department did not overdraw money for arrears, Father failed to demonstrate he qualified for section 5246(d)(3)’s five percent rule, and sanctions were not warranted. View "Lak v. Lak" on Justia Law

Carr served Air Force active duty, 1976-1980, earning 45 months of education benefits under Chapter 34 (Vietnam-era GI Bill), Carr used 41 months and 11 days of those benefits for his own education before the entire Chapter 34 program expired. After September 11, 2001, Carr returned to active duty and would have been eligible for 36 additional months of benefits under Chapter 33 (Post-9/11 GI Bill), but 38 U.S.C. 3695 limited him to a cumulative total of 48 months. Carr transferred those benefits to his daughter, 38 U.S.C. 3319, who used paid for two semesters. Due to a VA error, she initially did not receive payments to cover the final days of the Fall 2010 semester and was informed, incorrectly, that she had exhausted her benefits. Later, it was discovered that she had 19 days of benefits remaining; one day was applied to the Fall 2013 semester. Chapter 33 permits extensions of education benefits “in a roundabout way” to the end of the semester, 38 C.F.R. 21.9635(o)(1). The regional office, the Board of Veterans’ Appeals, and the Veterans Court rejected Carr's Chapter 33 claim.The Federal Circuit reversed and remanded for consideration of the unaddressed regulatory challenge. . The Veterans Court resolved the appeal through statutory interpretation and did not address the transferred benefits regulation; 38 U.S.C. 3695(a)’s aggregate multi-program benefits cap does not preclude end-of-term extensions of benefits authorized under individual benefits programs. View "Carr v. Wilkie" on Justia Law

Immigrants have historically been eligible for various public benefits and the receipt of those benefits, with limited exceptions did not jeopardize the immigrant’s chances of becoming a lawful permanent resident or citizen. The Department of Homeland Security (DHS) issued a new rule, intended to prevent immigrants whom the Executive Branch deems likely to receive any amount of public assistance, from entering the country or adjusting their status. The rule purports to implement the “public charge” provision of 8 U.S.C. 1182(a)(4).The Seventh Circuit affirmed a preliminary injunction against the rule’s enforcement in favor of Cook County, Illinois. The county had standing because the law threatened immediate financial harm because it would cause immigrants to forego preventative health care. The interests of the county are among those protected or regulated by federal law. There is “abundant evidence” supporting the county’s interpretation of the “public charge provision” as being triggered only by long-term primary dependence and that provision does not provide DHS unfettered discretion. The rule is unlikely to survive “arbitrary and capricious” review; it is unclear how immigration officials are to make “public charge” predictions. Cook County lacks legal remedies for the harms imposed by the rule. View "Cook County v. Wolf" on Justia Law

Ehnert was placed at WPP by Staffmark as a temporary general laborer. It was understood that Ehnert would be considered for hire as a WPP employee. Ehnert suffered from various medical conditions but never requested accommodations. On May 23, 2012—the last day of his work placement—Ehnert was informed that he would not be hired by WPP. Ehnert completed applied for social security disability insurance (SSDI) benefits, representing that he had been unable to work due to a “disabling condition” since May 21, 2012. An ALJ granted Ehnert benefits. Ehnert then sued WPP and Staffmark, alleging discrimination on the basis of disability and age, under the Americans with Disabilities Act, the Pennsylvania Human Relations Act, and the Age Discrimination in Employment Act.The Third Circuit affirmed summary judgment for the defendants. Ehnert was unable to establish a prima facie case of discrimination because a necessary element was lacking for his ADA and PHRA claims--that he was otherwise qualified to perform the essential functions of the job as of the date WPP informed him that he would not be hired. Ehnert’s statements regarding his disability for SSDI purposes preclude his subsequent claim that, for the purposes of the ADA and the PHRA, he was “qualified” for the position; Ehnert failed to advance a reasonable explanation that reconciles those positions. View "Ehnert v. Washington Penn Plastic Co Inc." on Justia Law

The First Circuit affirmed the district court's judgment reversing the magistrate's order that had quashed an administrative subpoena duces tecum as to the recordings of certain telephone conversations, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that an employer's interception of the telephone calls was intentional.When investigating whether Patient Services, inc. (PSI) had engaged in an illegal kickback scheme, the Government issued an administrative subpoena duces tecum to PSI for all recorded conversations of PSI officers and employees. This appeal concerned conversations that were recorded on the extension of Karen Middlebrooks. Middlebrooks's telephone conversations were recorded while she was working in PSI's call center on the second floor where calls were regularly recorded. At issue was whether PSI intentionally continued recording Middebrooks's calls after her transfer to the third floor, where calls were not regularly recorded, in violation of Title III of the Omnibus Crime Control and Safe Streets Act. The magistrate judge ruled that the recordings violated Title III. The district court reversed. The First Circuit affirmed, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that PSI's interception of calls from Middlebrooks's extension after her move to the third floor was intentional. View "In re HIPAA Subpoena" on Justia Law