Justia Public Benefits Opinion Summaries

Articles Posted in U.S. D.C. Circuit Court of Appeals
by
Plaintiff brought this qui tam suit alleging that the District of Columbia and its schools violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by submitting a Medicaid reimbursement claim without maintaining adequate supporting documents. The district court dismissed the case, relying on the court's precedent in United States ex rel. Findley v. FPC-Boron Employees' Club. Because the court concluded that the Supreme Court had implicitly overruled Findley in Rockwell International Corp. v. United States, the court reversed. View "Davis v. DC" on Justia Law

by
States both appealed the district court's grants of summary judgment in favor of HHS, which upheld HHS's disallowance of certain Medicaid claims for Federal Financial Participation (FFP) as ineligible for "medical assistance" under the "Institution for Mental Diseases" (IMD) exclusion set forth in section 1905(a) of 42 U.S.C. 1396 et seq. (Medicaid Statute). Because HHS correctly concluded that the disputed claims were not eligible for FFP under the plain language of the IMD exclusion and the under-21 exception, the court affirmed the judgment of the district court. View "Virginia Dept. of Medical Assist. Svcs. v. HHS, et al." on Justia Law

by
Plaintiffs, parents of children who were eligible to receive a free and appropriate public education, filed suit to challenge the exclusion of mapping of cochlear implants from the regulatory definition of "related services" under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1401(26)(B). The court concluded that the phrase "audiology services" as used in the IDEA's "related services" definition did not unambiguously encompass mapping of cochlear implants. The court also found that the Mapping Regulations embodied a permissible construction of the IDEA because they were rationally related to the underlying objectives of the IDEA. The court further found that the Mapping Regulations did not substantially lessen the protections afforded by the 1983 regulations. Because the Department's construction of its own regulation was neither plainly erroneous nor inconsistent with the regulation, the court owed it deference. Accordingly, the court affirmed the district court's grant of summary judgment to the Department. View "Petit, et al. v. US Dept. of Education, et al." on Justia Law

by
This case arose when plaintiffs filed a class action complaint under 42 U.S.C. 1983, alleging that the District was violating the Medicaid Act, 42 U.S.C. 1396 et seq. Since 1993, a consent decree has governed how the District provides "early and periodic screening, diagnostic, and treatment services" under the Act. The District has now asked the district court to vacate that decree on two grounds: that an intervening Supreme Court decision has made clear that plaintiffs lack a private right of action to enforce the Medicaid Act, and that in any event, the District has come into compliance with the requirements of the Act. Because the court concluded that the district court's rejection of one of the District's two arguments did not constitute an order "refusing to dissolve [an] injunction[]" within the meaning 28 U.S.C. 1292(a)(1), the court dismissed the appeal for lack of jurisdiction. View "Salazar, et al. v. DC, et al." on Justia Law

by
Appellant sued to recover $373.00 in expenses he incurred from the alleged unlawful levy of his social security benefits under 26 U.S.C. 7433. The district court concluded that appellant's suit was untimely because he did not bring suit within two years of when he had a "reasonable opportunity to discover all essential elements of a possible cause of action." The court agreed and affirmed, holding that the two-year statute of limitations on appellant's cause of action began to run no later than June 2005 after he received notice of the levy on his benefits. Because appellant did not sue until December 2008, more than three years after he received notice of the levy, his claim was time-barred. View "Keohane v. United States" on Justia Law

by
Plaintiffs sued the Government, seeking to disclaim their legal entitlement to Medicare Part A benefits for hospitalization costs. Plaintiffs wanted to disclaim their legal entitlement to such benefits because their private insurers limited coverage for patients who were entitled to Medicare Part A benefits. Plaintiffs preferred to receive coverage from their private insurers rather than from the Government. The district court granted summary judgment for the Government because there was no statutory authority for those who were over 65 or older and receiving Social Security benefits to disclaim their legal entitlement to Medicare Part A benefits. The court understood plaintiffs' frustration with their insurance coverage. But based on the law, the court affirmed the judgment of the district court. View "Hall, et al. v. Sebelius, et al." on Justia Law

by
In a 2008 administrative appeal, the Secretary of Health and Human Services ruled that a Medicare beneficiary enrolled in Medicare Part C still qualified as a person "entitled to benefits" under Medicare Part A. As a result, Beverly Hospital received a smaller reimbursement from the Secretary for services it provided to low-income Medicare beneficiaries during fiscal years 1999-2002. The district court granted summary judgment for Beverly Hospital on the ground that the Secretary's interpretation violated the plain language of the Medicare statute. The court held that the statute did not unambiguously foreclose the Secretary's intepretation. The court, nonetheless, affirmed the district court on the alternative ground that the Secretary must be held to the interpretation that guided her approach to reimbursement calculations during fiscal years 1999-2002, an interpretation that differed from the view she now advanced. Under her previous approach, the hospital would have prevailed on its claim for a larger reimbursement.

by
Appellant challenged a judgment of the district court affirming the Social Security Administration's (SSA) denial of his application for disability benefits. Appellant contended that the ALJ did not properly apply the "treating physician rule" in evaluating his application and further argued that new evidence had come to light that warranted a remand to the agency. The court held that the ALJ did not, as required by the treating physician rule, explain his reasons for rejecting the opinion of appellant's treating physician. The court also held that a letter from the Board of Medicine validating appellant's complaint, as well as a judicial determination that a physician's report contained a false representation, qualified as new evidence within the meaning of 42. U.S.C. 405(g). Therefore, the court reversed the judgment of the district court and remanded for further proceedings.

by
Appellant filed suit in the district court when the Commissioner of the Social Security Administration (SSA) denied his application for disability benefits. At issue was whether the district court had authority to permit additional evidence to be taken on remand where the SSA asked the district court to remand the case so the agency could supplement the record and the district court obliged. The court held that because the district court misunderstood the full reach of its remedial authority, the court vacated the judgment and remanded the matter to the district court to consider the issue anew.

by
The District of Columbia filed this suit to recover its attorneys' fees from a lawyer who brought an administrative complaint against the District on behalf of a student with special educational needs under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400(d)(1)(A). At issue was whether the District was a "prevailing party" under the IDEA in this suit. The court held that the facts in this case followed closely in the wake of the court's precedent in District of Columbia v. Straus where that court held that the district was not a "prevailing party" where its own change of position was what had mooted the dispute, causing the case to be dismissed. Therefore, the court held that the District, in this case, was not a "prevailing party" where the District of Columbia Public Schools (DCPS) authorized an independent comprehensive psychological evaluation for the student, which mooted the only issue before the hearing officer. Accordingly, the district court's grant of summary judgment ordering the lawyer to pay attorneys' fees was reversed.