Justia Public Benefits Opinion Summaries

Sunny Radebaugh contested both her inability to cross-examine the nurse who performed an annual assessment and the Department of Health and Social Services' reversal of an administrative law judge’s determination. Radebaugh was a Medicaid in-home nursing care benefits recipient, who had her benefits terminated by the Department after an annual assessment. The assessment concluded that Radebaugh’s physical condition had materially improved to the point where she no longer required the benefits. She challenged the termination of her benefits at an administrative hearing, and the nurse who performed the assessment did not testify. Following the hearing, the administrative law judge determined that the Department erroneously terminated her benefits. The Department, as final decision maker, reversed the administrative law judge’s determination and reinstated the decision to terminate Radebaugh’s benefits. Radebaugh appealed to the superior court, which first determined that the Department had violated her due process rights but then reversed itself and upheld the Department’s decision. After review, the Alaska Supreme Court concluded Radebaugh waived the right to challenge her inability to cross-examine the nurse who performed the assessment. The Court held that the agency sufficiently supported its final decision. The Court therefore affirmed the superior court’s affirmance of the Department’s final decision. View "Radebaugh v. Dept. of Health & Social Services" on Justia Law

The Eighth Circuit affirmed the denial of plaintiff's social security disability benefits, holding that substantial evidence supported the ALJ's decision to deny benefits. The court held that substantial evidence supported the ALJ's decision to assign little weight to the opinion of plaintiff's treating psychiatrist based on internal inconsistency and conflict with other evidence on the record; the ALJ did not err by assigning insufficient weight to the opinions of plaintiff's caseworker and Mental Health Paraprofessional (MHPP); and the ALJ's residual functioning capacity determination, as well as the other evidence in the record, reflected the limitations of plaintiff's ability to follow instructions, socialize, and maintain concentration. View "Chesser v. Berryhill" on Justia Law

Snyder represented a veteran, Beck, under a 2001 fee agreement (38 U.S.C. 5904). Eight months later, Snyder requested the Board of Veterans’ Appeals to cancel his fee agreement. In 2003 the VA awarded past-due benefits based on a 100% disability rating effective 1992. Snyder sought attorney fees. A VA regional officer (RO) determined that Snyder was entitled to $41,920.47, deductible from the past-due benefits. Beck filed notice of disagreement. Beck died. His widow sought to recover the disputed fees as accrued benefits. The RO denied that request. The Board dismissed Beck’s dispute over attorney fees, citing 38 C.F.R. 20.1302, and remanded Mrs. Beck’s claim. The RO determined Mrs. Beck could not recover the disputed attorney fees because her husband’s claim ceased to exist upon his death. She appealed. The VA’s General Counsel published a precedential opinion stating: A claim, pending at the time of a veteran’s death, challenging an attorney’s entitlement to payment of attorney fees under section 5904 from the veteran’s retroactive periodic monetary benefits may provide a basis for an accrued benefits claim under section 5121, because such a claim concerns entitlement to periodic monetary benefits allegedly due and unpaid to the veteran at the time of death. The Federal Circuit dismissed Snyder’s appeal. That 38 C.F.R. 20.1302 requires dismissal of a veteran’s appeal upon his death has no bearing on a claimant’s separate entitlement to accrued benefits under section 5121. The attorney fee dispute remains pending. View "Snyder v. Secretary of Veterans Affairs" on Justia Law

David, age 17 years 11 months, was a victim of past gun violence and is a wheelchair-bound diabetic in need of day-to-day medical assistance. He was living in a homeless shelter when a dependency petition was filed, alleging that he was abandoned by his mother and left without means of support. An investigation revealed that David had not been forthcoming about his family. The court dismissed the petition, finding that David had a support system in place but had chosen to leave it behind to be on his own. Had the petition not been dismissed, David would likely have qualified for transitional support as a nonminor dependent until age 21. The court of appeals dismissed an appeal. Dependency jurisdiction may not be initiated in the first instance over someone who is over age 18; it must be initiated before age 18, and by the plain terms of the Juvenile Court Law, may only be “retain[ed],” “continu[ed]” or “resum[ed]” for nonminors in certain circumstances until age 21. David’s case is now moot because he is 18 and any error by the juvenile court in failing to assume dependency jurisdiction is effectively unreviewable. View "In re David B." on Justia Law

Moshiri, other physicians, and hospital administrators were charged (42 U.S.C. 1320a-7b(b)) based on a kickback scheme. The former director of the podiatry residency program (Noorlag) testified that teaching contracts were a vehicle to pay physicians for referrals. Moshiri received $2,000 per month and was named as the Director of External Podiatric Office Rotations. Another doctor was named to that position at the same time. According to Noorlag, neither doctor was considered to hold that position, and neither performed the related duties. The Chair of the Counsel on Podiatric Medical Education, which oversees and certifies residency programs nationally and publishes standards, offered an expert opinion that teaching stipends are uncommon for attending physicians at residency programs and that he had never heard of such a physician being paid $2,000 per month. According to multiple witnesses, Moshiri did not conduct workshops and did not manage external rotations. Moshiri worked with residents about three times per month, while 11 other program physicians averaged 10 cases per month with residents. During the period at issue, the Hospital billed Medicare and Medicaid $482,000 for patients Moshiri treated. The Hospital’s Chief Operating Officer had recorded conversations in which Moshiri discussed his referrals. The agent who arrested Moshiri testified that Moshiri said that “the contract turned into basically paying for patients.” The Seventh Circuit upheld Moshiri’s conviction, rejecting challenges to the sufficiency of the evidence and to the expert testimony. View "United States v. Moshiri" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits and supplemental security income. The Fourth Circuit held that the ALJ did not give appropriate weight to the opinions of plaintiff's treating physicians and failed to adequately explain his decision to deny her benefits. Accordingly, the court vacated and remanded for further proceedings. View "Lewis v. Berryhill" on Justia Law

Neither the grant in an irrevocable trust of a right of occupancy and use in a primary residence to an applicant nor the retention of a life estate by the applicant in the applicant’s primary residence makes the equity in the home owned by the trust a countable asset for the purpose of determining Medicaid eligibility for long-term care benefits under the Federal Medicaid Act.At issue before the Supreme Judicial Court in these two cases was whether applicants were eligible for long-term care benefits under the Act Act where they created an irrevocable trust and deeded their home - their primary asset - to the trust but retained the right to use and reside in the home for the rest of their life. The Director of the Massachusetts Office of Medicaid (MassHealth) found that the applicants were not eligible for long-term care benefits. The superior court upheld MassHealth’s determinations. The Supreme Judicial Court reversed the judgments in both cases because MassHealth found that the equity in both homes was a “countable” asset whose value exceeded the asset eligibility limitation under the Act. View "Daley v. Secretary of Executive Office of Health & Human Services" on Justia Law

M.N. filed a due process complaint alleging that the District committed procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400(d)(1)(A). The ALJ denied all claims and the district court affirmed. The Ninth Circuit filed an amended opinion reversing the district court's judgment, holding that neither the duration of the hearing, the ALJ's active involvement, nor the length of the ALJ's opinion can ensure that the ALJ was thorough and careful in its findings of fact; plaintiffs' claim that the District committed a procedural violation of the IDEA by failing to adequately document its offer of the visually impaired (TVI) services was not waived; the District committed two procedural violations as to the individualized education plan (IEP); the District's failure to specify the assistive technology (AT) devices that were provided infringed M.N.'s opportunity to participate in the IEP process and denied the student a free appropriate education (FAPE); the panel remanded for a determination of the prejudice the student suffered as a result of the District's failure to respond to the complaint and the award of appropriate compensation; in regard to substantive violations, the panel remanded so the district court could consider plaintiffs' claims in light of new guidance from the Supreme Court in Endrew F. v. Douglas Cty. Sch. Dist., 137 S. Ct. 988 (2017); and M.N., as the prevailing party, was entitled to attorneys' fees. View "M.C. v. Antelope Valley Union High School District" on Justia Law

Ollis, a veteran, sought disability benefits under 38 U.S.C. 1151, which provides benefits for certain injuries incurred as a result of VA medical care. Ollis suffers from atrial fibrillation and claims a disability resulting from complications of a heart procedure to treat that condition. The procedure (miniMAZE) was allegedly recommended by a VA doctor but was performed by a private doctor. The VA denied Ollis’s application for benefits. The Board of Veterans’ Appeals and the Court of Appeals for Veterans Claims affirmed. The Federal Circuit vacated in part, remanding the question of whether Ollis’s VA doctors were negligent by recommending the mini-MAZE procedure to him. The Veterans Court focused on whether VA medical treatment caused Ollis to utilize Dr. Hall and Methodist Medical Center, rather than on whether VA medical treatment caused him to have the mini-MAZE procedure itself. On remand, the Veterans Court must also address the “not reasonably foreseeable” and “proximate cause of the disability” requirements. The court affirmed rejection of an argument that VA’s failure to provide him notice that a referral to a private facility for his miniMAZE procedure could extinguish his eligibility for benefits constituted a violation of his right to due process. View "Ollis v. Shulkin" on Justia Law

The First Circuit held that the five-day grace period outlined in 20 C.F.R. 422.210(c) does not apply to final decisions on remand where the individual does not file any written exceptions to the administrative law judge's decision and the Appeals Council does not assume jurisdiction of the case.Plaintiff applied for Title II disability benefits with the Social Security Administration. On remand, an ALJ issued a partially favorable decision on Plaintiff’s claim. Plaintiff did not file any written exceptions to the ALJ’s decision, and the Appeals Council did not review the ALJ’s decision. Therefore, the ALJ’s decision became the final decision of the Commissioner of Social Security. Plaintiff then filed a civil action challenging the ALJ’s decision on remand. The Commissioner moved to dismiss Plaintiff’s claim as untimely. The district court ruled against Plaintiff and dismissed her complaint for being untimely filed. Plaintiff appealed, asking the First Circuit to hold that the five-day grace period outlined in section 422.210(c) applies to final decisions on remand. The First Circuit declined Plaintiff’s request, holding that Plaintiff cannot apply the five-day grace period under section 422.210(c) to save her civil claim from being untimely. View "Walker-Butler v. Berryhill" on Justia Law