Articles Posted in US Court of Appeals for the Eleventh Circuit

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The Eleventh Circuit affirmed the denial of disability insurance benefits and supplemental security income (SSI) to plaintiff. The court held that substantial evidence supported the ALJ's decision to give little weight to the treating physician's opinion because it was inconsistent with his own medical records and the records as a whole; the ALJ's finding that plaintiff had the residual functioning capacity (RFC) to perform a full range of unskilled sedentary work was supported by substantial evidence; Social Security Ruling 16-3p applied only prospectively and did not provide a basis for remand; and the Appeals Council was not required to consider new evidence because it was not chronologically relevant. View "Hargress v. Social Security Administration" on Justia Law

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The Eleventh Circuit affirmed the district court's dismissal of the Hospitals' suit to recover recoupments. At issue was whether, under the Medicare Act, 42 U.S.C. 1395w-21 to 1395w-29, the Hospitals must exhaust their administrative remedies before bringing suit for underpayment by the Medicare Advantage Organization (MAO) that manages enrollee benefits. The court held that the Hospitals, who were challenging CIP's recoupment decision, were parties to an "organization determination" who were subject to the administrative exhaustion requirements of the Medicare Act. The court noted that although it was sympathetic to the concern HHS has expressed in amicus briefs, the language of the Medicare Act and its implementing regulations was clear that billing disputes between MAOs and noncontract provider assignees qualify as "organization determinations" and were thus subject to the Act's exhaustion requirement. View "Tenet HealthSystem GB, Inc. v. Care Improvement Plus South Central Insurance Co." on Justia Law

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Richard Culbertson was counsel for the four plaintiffs in these consolidated Social Security disability benefits cases. At issue in this appeal was the attorney's fees for Culbertson under 42 U.S.C. 406 and the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The Eleventh Circuit held that the district court did not err in its interpretation and application of Dawson v. Finch, 425 F.2d 1192 (5th Cir. 1970) and by imposing a 24% cap on section 406 fees; it was necessary for the district court to add the requested section 406(b) fee together with his EAJA award; and the district court did not abuse its discretion and did not exceed its authority. Accordingly, the court affirmed the judgment. View "Wood v. Commissioner of Social Security" on Justia Law