Justia Public Benefits Opinion Summaries

Appellant filed two amended qui tam actions against her employer, a pharmaceutical company and its subsidiary (collectively, Appellees), under the federal False Claims Act (FCA), alleging that Appellees failed adequately to disclose the risks associated with some of their drugs and that this failure resulted in the submission of false claims by third-party patients and physicians for government payment. The district court dismissed both of Appellant's actions under Fed. R. Civ. P. 9(b) for failure to plead fraud with particularity and under Fed. R. Civ. P. 12(b)(6) for failure to state a claim. Appellant subsequently sought to amend the second amended complaint, asserting more theories of FCA liability, but the district court refused to allow further amendment. The First Circuit Court of Appeals affirmed the district court's rulings regarding the dismissal of Appellant's claim under Rule 9(b) and the denial of Appellant's proposed amendments, holding (1) Appellant's claims on all theories which were presented failed under Rule 9(b); and (2) the district court did not err in denying Appellant's motion to amend. View "United States ex rel. Ge v. Takeda Pharm. Co. Ltd." on Justia Law

This appeal concerned the implementation of a federally-assisted Medicaid program by the Commonwealth of Puerto Rico, represented by its Secretary of Health. This was the sixth time the First Circuit Court of Appeals considered issues related to a dispute between the Commonwealth and several federally qualified health centers (FQHCs). The FQHCs here took to federal courts their claims for reimbursement payments owed to them under the Medicaid program. The district court, among other things, set a formula in place by way of a preliminary injunction that calculated payments the Commonwealth owed the FQHCs for providing Medicaid services. The First Circuit (1) concluded the formula that the district court endorsed in its preliminary injunction was not sufficiently supported by the factual record, and therefore, the Court remanded for further reformulation; (2) affirmed the district court's denial of the FQHCs' request for indemnification from debts owed to third party managed care organizations; and (3) affirmed the district court's determination that the Eleventh Amendment precludes a federal court from imposing a judgment for money damages upon the Commonwealth to make payments for periods predating the date of the district court's preliminary injunction. View "Consejo de Salud De La Communidad de Playa de Ponce, Inc. v. Gonzalez-Feliciano" on Justia Law

Palmquist, a veteran, injured in a helicopter crash that caused residual brain injury, was entitled to preference in federal employment, 5 U.S.C. 2108(3)(C), 3309(1), 3313(2)(A). The VA hired him as a medical support assistant. Aichner was his supervisor. Palmquist applied for promotion but did not receive an interview. He believed that the VA had not honored his preference, and told Aichner that he was going to complain to the equal employment opportunity specialist and his congressman. He did so. Aichner and Palmquist maintained a generally positive relationship for the next two years, but Palmquist was sometimes preoccupied, left the unit during working hours to do personal business, distracted other employees, and used his computer for personal purposes. Palmquist sought a new position. An interview went well. Interviewers warned Palmquist against unsolicited post-interview contact, but he e-mailed both to reiterate his qualifications. Aichner gave a generally favorable recommendation, but the recommendation was one factor in Palmquist not getting the job. The court rejected his claim under the Rehabilitation Act, 29 U.S.C. 701-796. The First Circuit affirmed. The Act does not entitle a plaintiff to relief when retaliation for complaints about disability discrimination is a motivating factor in, but not the “but-for” cause of, adverse employment action. View "Palmquist v. Shinseki" 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

For 20 years, George was a clerk-magistrate. In 1995, he was charged with conspiracy to commit honest-services wire fraud, 18 U.S.C. 371, 1343, 1346 for selling blank search warrants, used to commit robberies. George entered a plea for a sentence of 20 months and a $10,000 fine. George retired before his plea and began receiving a monthly benefit of $1,424.91, plus health-care. In 2003, the state retirement board suspended benefits; his attorney had advised him that he would remain eligible if he started receiving benefits before he entered a plea. The district court denied his petition for a writ of error coram nobis. The First Circuit affirmed. The Board authorized recoupment of benefits in excess of contributions. In 2010, the Supreme Court held that "intangible right of honest services," in 18 U.S.C. 1346, would be unconstitutionally vague unless limited to schemes involving bribes or kickbacks. George’s second petition was denied. The court found that, in light of Skilling, a fundamental error had occurred, but that cessation of benefits did not constitute a continuing collateral consequence sufficient to justify the remedy. The First Circuit affirmed, referring to a “Hail Mary pass.” A court has discretion to withhold the remedy where the interests of justice dictate.View "United States v. George" on Justia Law

The owner of supermarkets involved his family in a scheme to provide cash for food stamps, beyond what is permitted by Puerto Rico law. A conservative estimate put receipts from the fraud above $4 million, which was intermingled with more than $20 million in food stamp proceeds. Family members testified and he was convicted of conspiracy to commit food stamp fraud, 7 U.S.C. 2024(b) and 18 U.S.C. 371, and for knowingly conducting and attempting to conduct financial transactions affecting interstate commerce involving the proceeds of unlawful activity, 18 U.S.C. 1956(a)(1)(A)(i) and 1956(a)(1)(B)(i), and 2, sentenced to 108 months in prison, and ordered to forfeit $20 million. The First Circuit affirmed. The district court properly applied a sentencing enhancement for the owner's leadership participation in the scheme. Even legitimate funds are subject to forfeiture when they become involved in a scheme to conceal illegal funds. The court properly weighed the harm caused by the crime. View "United States v. Aguasvivas-Castillo" on Justia Law

In 2003, the New Hampshire Department of Health and Human Services and a certified class of Medicaid-eligible children reached a settlement agreement and proposed a consent decree that outlined the Department's obligations to provide dental services to Medicaid-enrolled children in accordance with federal law. The district court approved the Decree in 2004. Between 2007 and 2010, the district court denied four motions alleging that the Department was not in compliance. The First Circuit affirmed, upholding the district court's requirement that the Class to file a motion for contempt to enforce the Decree; denial of a 2010 motion for contempt; denial of a request for an evidentiary hearing in 2010; and holding the Class to a clear and convincing burden of proof on its 2010 motion to modify or extend the Decree. View "Hawkins v. Dep't of Health & Human Servs. for the State of NH" on Justia Law

The former governor and former financial director of the Tribe were convicted for conspiracy to defraud the United States (18 U.S.C. 371), and of violations of 18 U.S.C. 287, 666 and 669, involving misuse of federal grant and tribal monies at the Passamaquoddy Tribe Indian Township Reservation in Maine. The First Circuit vacated the conviction of the financial director for making material misstatements about how grant money intended for HIV and substance abuse prevention was spent, but otherwise affirmed. The evidence that the director knew that his statements were false was insufficient. The district court had jurisdiction; several counts involved mismanagement of federal grants and contracts, which are subject to regulations that the Tribe is not free to ignore, and do not constitute internal tribal matters.

Plaintiff brought action under the False Claims Act, 31 U.S.C. 3729, claiming that the company used a kickback scheme and knowingly caused submission of false Medicare, Medicaid, and TRICARE claims by hospitals and doctors. The district court held that hospital claims at issue were not false or fraudulent, and that doctor claims were false or fraudulent, but not materially so. The First Circuit reversed. If kickbacks affected the transactions underlying the claims, the claims failed to meet a condition of payment and were false, regardless of the hospital's participation in or knowledge of the kickbacks. It cannot be said, as a matter of law, that the alleged misrepresentations were not capable of influencing Medicare's decision to pay the claims.

The district court rejected a challenge to 5 U.S.C. 3328, which bars males who have knowingly and willfully failed to register for the draft by age 26 from employment by the executive branch. The First Circuit vacated and remanded for entry of a judgment denying relief for lack of subject matter jurisdiction. The exclusive remedy for the plaintiffs, who were dismissed or resigned from federal employment after discovery of their failure to register, is under the Civil Service Reform Act. Although the claims implicate constitutional violations, Congress intended to consolidate employee removal actions in a single forum. The Merit System Protection Board cannot grant relief by invalidating the statute, but a court could do so on review of board action. The court characterized the constitutional challenges as "unpromising."