Justia Public Benefits Opinion Summaries

Plaintiff appealed the district court's decision upholding the Commissioner's determination that he was not entitled to waiver of recovery of overpaid disability benefits. The court concluded that substantial evidence supported the Commissioner's decision where recovery of the overpayment did not defeat the purpose of Title II of the Social Security Act, 42 U.S.C. 301 et seq., and where recovery of the overpayment was not against equity or good conscience because plaintiff's mere receipt of disability benefits after notifying the Commissioner of his work activity did not satisfy 20 C.F.R. 404.510a. Accordingly, the court affirmed the judgment of the district court. View "Rodysill v. Colvin" on Justia Law

Plaintiff, the surviving spouse of Charles Kemp, appealed the denial of disability insurance benefits and supplemental security income. An ALJ found that Kemp was not disabled because he could perform a job a vocational expert (VE) identified in response to a hypothetical the ALJ posed. The court remanded the case for further proceedings because the court was unable to discern from the record whether there was a conflict between the occupational listing at issue and the VE's response to the hypothetical. View "Kemp v. Colvin" on Justia Law

Plaintiff and his wife appealed the denial of his application for Medicaid benefits, arguing that the Department wrongfully denied the application because it had improperly counted against the wife's eligibility an annuity owned by the wife. The district court ruled in favor of plaintiffs and the Department appealed. The court concluded that, because the wife had no right, authority, or power to liquidate the annuity, the annuity benefits were not a resource, but rather was income indicated by the federal statute defining "unearned income." Therefore, the Department applied a more restrictive methodology under state law by classifying the annuity benefits as a resource that counted against plaintiff's eligibility for Medicaid benefits. The court rejected the Department's counter-arguments and the remaining arguments, and affirmed the judgment of the district court. View "Geston, et al. v. Anderson" on Justia Law

Relators brought a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A) and (B), alleging that the Mayo Foundation and others billed Medicare for surgical pathology services it did not provide. The government intervened and the parties settled. Relators then filed a Second Amended Complaint asserting additional claims. On appeal, relators challenged the district court's dismissal of their additional claim that Mayo fraudulently billed for services it did not provide whenever it prepared and read a permanent tissue slide but did not prepare a separate written report of that service. As a preliminary issue, the court concluded that relators satisfied their burden of showing that the public disclosure bar did not deprive the court of jurisdiction over relators' claim. On the merits, the court concluded that nowhere in the Medicare regulations or in the American Medical Association Codebook has the court found a requirement that physicians using the CPT codes for surgical pathology services must prepare the additional written reports that relators claimed Mayo fraudulently failed to provide. Accordingly, the court affirmed the judgment of the district court. View "Ketroser, et al. v. Mayo Foundation, et al." on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits and supplemental security income. The court concluded that the ALJ erred in determining plaintiff's residual functional capacity as "frequent to occasional" handling and fingering, because "frequent" and "occasional" were separate terms of art with distinct meanings. Accordingly, the court reversed and remanded to the district court with directions to remand the case to the Commissioner for clarification of plaintiff's residual functioning capacity and for further proceedings. View "Owens v. Astrue" on Justia Law

Plaintiff appealed the denial of his application for social security disability insurance benefits. The court concluded that the ALJ met his duty to fully and fairly develop the record; the district court correctly upheld the ALJ's determination of plaintiff's residual functioning capacity (RFC); and the court rejected plaintiff's contention that the ALJ used an improper standard to discount plaintiff's credibility. Accordingly, the court affirmed the district court's grant of summary judgment in favor of the SSA. View "Kamann v. Astrue" on Justia Law

Plaintiff appealed the denial of his application for disability benefits and supplemental security income (SSI). The court concluded that the ALJ did not err in discounting the most severe subjective complaints of pain because the ALJ properly applied Polaski v. Heckler and provided valid reasons for discounting plaintiff and his mother's testimony; the ALJ properly weighed the opinions of plaintiff's treating physicians; the ALJ properly used the Medical-Vocational Guidelines (the "Grids") to determine whether there was substantial gainful employment plaintiff could perform; and the court agreed with the ALJ's conclusion that plaintiff did not satisfy the criteria for Listing 1.04 or any other listing in the Adult Listing of Impairments. Accordingly, the court affirmed the judgment. View "McDade v. Astrue" on Justia Law

Plaintiff appealed the denial of supplemental security income (SSI) benefits. Applying a deferential standard of review, the court held that substantial evidence supported the ALJ's finding that plaintiff did not meet the first element of Listing 12.05C for mental retardation - having a valid verbal, performance, or full scale IQ score of 60-70. The court also held that substantial evidence supported the ALJ's finding that plaintiff's condition did not medically equal Listing 12.05C. View "Phillips v. Colvin" on Justia Law

Plaintiff appealed the denial of her application for Social Security disability benefits, disability insurance benefits, and supplemental security income. The court concluded that substantial evidence supported the ALJ's determination that plaintiff's doctor's opinion was inconsistent with the treatment record and thus not entitled to controlling weight; substantial evidence supported the ALJ's determination that plaintiff's impairments did not meet or equal a medical listing; because the residual functioning capacity (RFC) finding was supported by substantial evidence, it was proper for the ALJ to consider testimony of a vocational expert that was premised on the RFC; and the ALJ did not err in determining plaintiff's credibility. Accordingly, the court affirmed the district court's affirmance of the denial of benefits. View "Myers v. Astrue" on Justia Law

Defendants, brothers Mathew and Timothy, appealed their convictions related to their participation in Social Security fraud. The court concluded that the government presented sufficient evidence for a reasonable jury to find beyond a reasonable doubt that Mathew knowingly participated in a conspiracy to defraud the United States and that he intended to steal government property; the court rejected Mathew's challenges to his theft of government property conviction by arguing that the government failed to establish that the Social Security funds Timothy received were a "thing of value of the United States;" the government also presented sufficient evidence to support Timothy's convictions; and Timothy's sentence was not unreasonable where the district court considered 18 U.S.C. 3553(a) factors and did not clearly err in weighing them. Accordingly, the court affirmed the convictions and Timothy's sentence. View "United States v. Shirley" on Justia Law