Justia Public Benefits Opinion Summaries

Mission purchased the assets of South Coast and attempted by an assets-only purchase to avoid South Coast's potential liabilities under South Coast's Medicare provider agreement. These liabilities encompassed potential mandated reimbursement to Medicare for any previous overpayments made to South Coast. The Secretary determined that Mission was not entitled to bill Medicare for patient services at its new facility until that facility had a provider agreement of its own. Mission appealed the Secretary's decision. The court rejected Mission's assertion that former 42 C.F.R. 489.13(d)(1)(i) permitted it to avoid South Coast’s Medicare liabilities. The court cited to the Fifth Circuit's opinion in United States v. Vernon Home Health, Inc.: “federal law governs cases involving the rights of the United States arising under a nationwide federal program such as the Social Security Act. The authority of the United States in relation to funds disbursed and the rights acquired by it in relation to those funds are not dependent upon state law.” It is equally true that private parties have no power to alter their legal obligations with Medicare under their provider agreements. The court also rejected Mission's argument that it is entitled to the benefit of the retroactivity provision in 42 C.F.R. 489.13(d)(2). The court concluded that the Secretary's interpretations and decisions rendered by the DAB in this case were reasonable. Accordingly, the court affirmed the judgment. View "Mission Hosp. Reg'l Med. Ctr. v. Burwell" on Justia Law

Petitioner and her son prevailed at both hearings concerning their due process complaint against the District. At issue on appeal is the district court's award of attorney fees, pursuant to the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1415, to petitioner's attorney, Tania Whiteleather. The district court awarded $7,780 in fees, substantially less than the $66,420 requested. The court concluded that the outcome of the administrative hearing was not more favorable to petitioner than the District's settlement offer and petitioner was not substantially justified in rejecting the settlement offer. The court concluded that it was not an abuse of discretion for the district court to apply the $400 rate without seeking additional rebuttal evidence from the District. Finally, the court concluded that petitioner's claim for paralegal fees was barred by collateral estoppel because the district court had already concluded that Dr. Susan Burnett was an education consultant in the expedited hearing appeal. Accordingly, the court affirmed the judgment. View "Beauchamp v. Anaheim Union High Sch. Dist." on Justia Law

After plaintiff's second application for disability benefits was denied by the ALJ, the government conceded that the ALJ made a legal error when it rejected the opinions of plaintiff's treating physician without giving sufficient reason. On appeal, plaintiff challenged the district court's decision to exercise its discretion and remand to the ALJ for further proceedings. The court concluded that the district court did not err in remanding this case to the ALJ for further factual proceedings, rather than for payment of benefits. Further, in light of the inconsistencies, conflicts, and gaps in the record that require further administrative proceedings, the court did not proceed to the next question: whether the ALJ would be required to find plaintiff disabled if the physician's inconsistent reports were credited as true. Accordingly, the court affirmed the judgment. View "Dominguez v. Colvin" on Justia Law

California Education Code 56346(f) requires school districts to initiate a due process hearing if the school district determines that a portion of an Individualized Education Program (IEP) to which a parent does not consent is necessary to provide a child with a Free Appropriate Public Education (FAPE) under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400–1450. The ALJ concluded that the district offered an appropriate placement but Mother's refusal to consent prevented the district from implementing and providing a FAPE. I.R. appealed, but the district court affirmed. The court concluded that the district court erred in concluding that the district could not initiate a due process hearing to address Mother's refusal to the IEP's recommended placement. In this case, the district waited a year and a half before initiating a hearing, which the court determined was too long a period of time. Therefore, to the extent that I.R. lost an educational opportunity and was deprived of educational benefits for an unreasonably prolonged period, the district can be held responsible for denying her a FAPE for that unreasonably prolonged period. The court reversed and remanded. View "I.R. v. L.A. U.S.D." on Justia Law