Justia Public Benefits Opinion Summaries

This case stemmed from the discovery in an unrelated case that the Center for Medicare & Medicaid Services ("CMS") had paid hospitals less than they were due because it had miscalculated the disproportionate share hospital ("DSH") payment. Appellants, a group of hospitals that received DSH payments, filed claims with the Provider Reimbursement Review Board ("PRRB") seeking full payments for the fiscal years 1987-1994. At issue was whether the district court lacked jurisdiction in the matter and whether the Medicare statute, 42 U.S.C. 1395oo(a), allowed for equitable tolling. The court held that a decision by the PRRB denying jurisdiction was a final decision subject to judicial review by the district court. The court also held that, given the factors emphasized in United States v. Brockamp did not apply to the facts presented, and without any other reasons for rebutting the presumption of equitable tolling, the court found that equitable tolling was available under 1395oo(a). The court noted that whether tolling was appropriate in this particular case, however, was a different question for the district court to answer on remand. The court also rejected appellants' alternative arguments and therefore, reversed and remanded for further proceedings.

This case involved cost-saving tools that Congress had devised for Medicare payments to cancer hospitals and specifically concerned Medicare reimbursements paid to one cancer hospital, appellant, in 2000 and 2001. The first issue on appeal related to the cancer hospitals' inpatient costs where appellant requested an increase to its target amount in 2000 and 2001 due to the high cost of certain new cancer drugs and where the Department of Health and Human Services ("HHS") denied that request. Appellant argued that it did not receive proper notice of the new net financial impact requirement and thus did not have a fair opportunity to satisfy the requirement at the administrative hearing. The court agreed and held that appellant did not receive timely notice of the requirement and, on remand to HHS, must be given an opportunity to satisfy it. The second issued on appeal concerned cancer hospitals' outpatient costs where appellant contended that HHS misapplied the statutory formula that provided hospitals a fraction of their reasonable costs and undercompensated appellant. The court rejected appellant's arguments and affirmed summary judgment in favor of HHS.

Forsyth Memorial Hospital, Inc. and other providers (collectively "appellants") appealed the district court's grant of summary judgment in favor of the Secretary of Health and Human Services ("HHS") upholding the denial of their reimbursement claims arising from the merger of Presbyterian Health Services Corporation ("Presbyterian") and Carolina Medicorp, Inc. ("Carolina"). At issue was whether the denial of the reimbursement claims was arbitrary and capricious, an abuse of discretion, contrary to law, or unsupported by substantial evidence. The court affirmed the denial of the reimbursement claims and held that the district court properly concluded that it was neither arbitrary and capricious nor contrary to law for the Administrator of the Centers for Medicare & Medicaid Services ("Administrator") to find that appellants were not entitled to reimbursement where, in the merger between Carolina and Presbyterian, no bona fide sale took place and the parties were related.

The Equal Rights Center ("ERC") sued Post Properties, Inc. ("Post") alleging that Post designed, constructed, and operated its apartment complexes in a manner that violated the Fair Housing Act ("FHA"), as amended by the Fair Housing Amendments Act of 1988 ("FHAA"), 42 U.S.C. 3601-3631, and Title III of the Americans with Disabilities Act ("ADA"), 42 U.S.C. 12181-12189. At issue was whether the district court properly granted summary judgment to Post on the ground that the ERC lacked standing to bring suit where it failed to demonstrate an injury in fact. The court held that the ERC failed to demonstrate that its injury was actual or imminent at the time of the filed suit and held that the district court erroneously concluded that the ERC could not establish standing because it chose to redirect its resources to investigate Post's allegedly discriminatory practice. Therefore, the court focused on whether the organizational plaintiff undertook expenditures in response to, and to counteract, the effects of a defendant's alleged discrimination rather than in anticipation of litigation and determined that the ERC failed to demonstrate that it suffered an injury in fact that was actual or imminent at the time it filed the suit.

Plaintiffs, two fair housing organizations in New Orleans and five African-American homeowners, claimed that a program to help homeowners rebuild after hurricanes Katrina and Rita employed a grant formula that violated the anti-discriminatory provisions of the Fair Housing Act. At issue was whether the district court properly denied plaintiffs' first motion for a temporary restraining order ("TRO") and injunction to enjoin defendants' actions related to the Louisiana Recovery Authority's Road Home Homeowner Assistance program. Also at issue was whether the district court properly granted plaintiffs' second motion for a TRO and preliminary injunction where the district court denied the initial request for a TRO and injunction. The court held that the district court properly denied the initially requested TRO and injunction where plaintiffs failed to demonstrate a likelihood of success on the merits. The court also held that the district court's grant of plaintiffs' second motion for a TRO and preliminary injunction was improper where the second motion also failed to demonstrate a likelihood of success on the merits.