Justia Public Benefits Opinion Summaries

The First Circuit affirmed the district court’s decision affirming an administrative law judge’s (ALJ) finding that Appellant was not disabled within the meaning of the Social Security Act and thus not entitled to Supplemental Security Income benefits, holding that the ALJ’s determination was supported by substantial evidence. Specifically, the Court held (1) the ALJ did not err in according only slight weight to the testimony of an orthopedic physician who treated Appellant for a non-displaced fracture of her left femur; and (2) the ALJ was entitled to rely on testimony of an impartial vocational expert presented by the Commissioner of the Social Security Administration about available jobs that Appellant was entitled to perform. View "Purdy v. Berryhill" on Justia Law

Saunders served on active duty in the Army, 1987-1994. Saunders did not previously experience knee problems but, during her service, sought treatment for knee pain and was diagnosed with patellofemoral pain syndrome (PFPS). Saunders’s exit examination reflected normal lower extremities but noted Saunders’s history of knee swelling. The VA denied Saunders’s 1994 claim for disability compensation because she failed to report for a medical examination. In 2008, Saunders filed a new claim, which was denied. In 2011, a VA examiner noted that Saunders reported bilateral knee pain while running, squatting, bending, and climbing but had no anatomic abnormality, weakness, or reduced range of motion. Saunders had functional limitations on walking, was unable to stand for more than a few minutes, and sometimes required a cane or brace. The examiner concluded that Saunders’s knee condition was at least as likely as not caused by, or a result of, Saunders’s military service but stated there was no pathology to render a diagnosis. The Board of Veterans’ Appeals and Veterans Court rejected her claim under 38 U.S.C. 1110. The Federal Circuit reversed; “disability” in section 1110 refers to the functional impairment of earning capacity, not the underlying cause, which need not be diagnosed. Pain alone can serve as a functional impairment and qualify as a disability, no matter the underlying cause. View "Saunders v. Wilkie" on Justia Law

The Ninth Circuit reversed the district court's partial grant of summary judgment for the Department and held that the Department did not violate the dormant Commerce Clause in adopting Medi-Cal policies related to reimbursement to out-of-state hospitals. The panel held that when a state was acting as a market participant, rather than a market regulator, its decisions were exempted from the dormant Commerce Clause. In this case, the Department sets rates of reimbursement to hospitals for those who were essentially insured as beneficiaries under Medi-Cal in a manner much like that of a private insurer participating in the market. Therefore, the Department was acting as a market participant, rather than a regulator and was exempt from dormant Commerce Clause requirements. View "Asante v. California Department of Healthcare Services" on Justia Law

The Supreme Court affirmed in part and reversed in part a district court order granting in part and denying in part judicial review of the Montana Department of Public Health and Human Services (DPHHS) fair hearing proposed decision that DPHHS overpaid IMS under the Medicaid program and was entitled to reimbursement in the amount of $670,152 from Independence Medical Supply, Inc. (IMS). IMS appealed, and DPHHS cross appealed the district court’s order. The Supreme Court held (1) the district court did not abuse its discretion by affirming the hearing officer’s determination that physician affidavits introduced by IMS did not cure technical violations of the supply orders submitted to DPHHS; and (2) the district court erred in holding that a letter sent by DPHHS on January 8, 2014 commenced an action for recovery of the overpayment because DPHHS did not commence an action within the meaning of Mont. Code Ann. 27-2-102(1)(b) and Mont. R. Civ. P. 3. View "Independence Medical Supply, Inc. v. Montana Department of Public Health & Human Services" on Justia Law

Six judges who were elected to the superior court in mid-term elections in 2012, but who did not take office until January 7, 2013, claimed entitlement to benefits under the Judges’ Retirement System II (JRS II) as in effect at the time they were elected, rather than at the time they assumed office. On January 1, 2013, JRS II became subject to the California Public Employees’ Pension Reform Act of 2013 (PEPRA), Government Code section 75500, which amended virtually all state employee retirement systems to address the state’s enormous unfunded pension liability and return these systems to actuarially sound footing. PEPRA increases employee contributions, provides for fluctuating contribution rates based on market performance and actuarial projections, and bases the amount of monthly pension payments on an employee’s final three years of compensation, rather than on only the final year. The court of appeal held that the judges did not obtain a vested right in JRS II benefits as judges-elect, but rather obtained a vested right to retirement benefits only upon taking office after PEPRA went into effect. PEPRA’s provisions pertaining to fluctuating pension contributions do not violate the non-diminution clause of the California Constitution nor do they impermissibly delegate legislative authority over judicial compensation. View "McGlynn v. State of California" on Justia Law

RTSI produces and maintains traffic safety systems. Rosenberg was RTSI’s Vice President of Sales. RTSI contracted to manage Chicago's automated red light enforcement program. In 2012, the Chicago Tribune published articles, disclosing an improper relationship between a city employee (Bills) and RTSI. The city removed RTSI’s bid for the new contract. The City Office of Inspector General (OIG) investigated the bribery scheme. RTSI conducted an independent investigation and provided OIG with information. OIG advised Rosenberg that he had a duty to cooperate and that his statements would not be used against him in a criminal proceeding. Rosenberg described the bribery scheme between RTSI and Bills. RTSI terminated Rosenberg’s employment.The Tribune reported that RTSI courted Bills with thousands of dollars in free trips. Rosenberg sued RTSI under the qui tam provision of the City’s False Claims Ordinance, alleging that RTSI engaged in bribery and other illegal activities to obtain a city contract. The city intervened, making additional claims. The court dismissed Rosenberg as relator. The remaining parties settled and moved for dismissal with prejudice. Rosenberg unsuccessfully sought an award of a relator’s share of the settlement and attorney’s fees for his lawyer’s contributions to the case. The Seventh Circuit affirmed, noting that Rosenberg helped to perpetrate the fraud and referring to Rosenberg’s “audacity.” Rosenberg was neither the original source of the information nor was he a volunteer under the ordinance. View "Rosenberg v. Redflex Traffic Systems, Inc." on Justia Law

The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought by private ambulance companies challenging the reimbursement rate for their transportation of patients covered by Medi-Cal. The panel held that plaintiffs failed to carry their burden of producing evidence upon which a reasonable jury could return a verdict in their favor and thus the district court did not err in entering judgment in the Department's favor on the Takings Clause claim. The panel reasoned that the ambulance companies lacked a constitutionally protected property interest in a particular reimbursement rate, but the mandatory-care provision of Cal. Health & Safety Code 1317(d) implicated a constitutionally protected property right. The panel held that section 1317(d) did not effect a regulatory taking under the Penn Central test. The panel also held that the ambulance companies did not establish a due process claim regarding DHCS's failure to ensure that Medi-Cal reimbursement rates kept pace with their costs because they lacked a constitutionally protected interest in any particular reimbursement rate. View "Sierra Medical Services Alliance v. Kent" on Justia Law

The trial court did not err in dismissing Plaintiffs’ action for lack of subject matter jurisdiction due to Plaintiffs’ failure to exhaust administrative remedies in seeking damages for denied Medicaid reimbursement claims.The court of appeals reversed the trial court’s order, ruling that the trial court erred in dismissing Plaintiffs’ complaint without resolving certain factual issues and that Plaintiffs sufficiently demonstrated that it would be futile to pursue administrative remedies. The Supreme Court reversed, holding that the court of appeals erred in reversing the dismissal of Plaintiffs’ claims where Plaintiffs failed to exhaust their administrative remedies prior to filing suit and failed to demonstrate futility of the available remedies at this time. View "Abrons Family Practice & Urgent Care, PA v. North Carolina Department of Human Services" on Justia Law

In November 2014, the Board of Veterans’ Appeals denied Bly’s request for service connection for bilateral hearing loss. Bly appealed to the Veterans Court. After his opening brief was filed, Bly and the government filed a joint motion for partial remand. The Veterans Court granted the motion, citing to Rule 41(b) of the Veterans Court’s Rules of Practice and Procedure, and noting that “this order is the mandate of the Court.” Bly applied for attorneys’ fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, 31 days later. Remand orders from the Veterans Court may entitle veterans to EAJA fees and expenses. Under 28 U.S.C. 2412(d)(1)(B), such EAJA applications must be made “within thirty days of final judgment in the action.” The Veterans Court reasoned that its judgment became final immediately because the order remanded the case on consent and stated that it was the mandate of the court. The Federal Circuit vacated the denial of his application, reasoning that the consent judgment at issue became “not appealable” 60 days after the entry of the remand order under 38 U.S.C. 7292(a). View "Bly v. Shulkin" on Justia Law

Brown worked for BCP for 10 years. BCP had permitted Brown to wear shirts with BCP patches, rather than a uniform shirt. After discovering that it could order larger-size uniform shirts, BCP purchased such shirts for Brown in 2011. He was fired in January 2012 for wearing the wrong shirt. The Employment Development Department (EDD) denied his application for unemployment benefits. The trial court granted Brown’s writ petition, concluding that Brown had not engaged in misconduct sufficient to disqualify him from benefits because he had offered to go home and change shirts and was terminated on his first violation. In August 2013, EDD responded that EDD had paid Brown “all the benefits for which he has been found eligible,” noting that it was requiring Brown to submit certification forms and that an eligibility issue would need to be resolved before further benefits could be paid. in October 2014, Brown sought enforcement, claiming that EDD had imposed improper conditions, caused extended delays, and continued to withhold benefits. The court found EDD’s failure to comply “without good cause,” levied a $1,000 fine, awarded attorney fees, and determined that the rate of interest for wrongfully withheld unemployment benefits was seven percent, the judgment interest rate (Government Code 965.5(a), (d)). The court of appeal reversed, remanding for calculation of interest at 10 percent under Civil Code 3289(b). EDD’s statutory obligations are like contractual promises, subject to the statutory contractual rate of prejudgment interest. Brown’s right to prejudgment interest gave way to his entitlement to post-judgment interest with the trial court’s order. View "Brown v. California Unemployment Insurance Appeals Board" on Justia Law