Justia Public Benefits Opinion Summaries

Articles Posted in US Court of Appeals for the First Circuit
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The First Circuit affirmed the district court's judgment reversing the magistrate's order that had quashed an administrative subpoena duces tecum as to the recordings of certain telephone conversations, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that an employer's interception of the telephone calls was intentional.When investigating whether Patient Services, inc. (PSI) had engaged in an illegal kickback scheme, the Government issued an administrative subpoena duces tecum to PSI for all recorded conversations of PSI officers and employees. This appeal concerned conversations that were recorded on the extension of Karen Middlebrooks. Middlebrooks's telephone conversations were recorded while she was working in PSI's call center on the second floor where calls were regularly recorded. At issue was whether PSI intentionally continued recording Middebrooks's calls after her transfer to the third floor, where calls were not regularly recorded, in violation of Title III of the Omnibus Crime Control and Safe Streets Act. The magistrate judge ruled that the recordings violated Title III. The district court reversed. The First Circuit affirmed, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that PSI's interception of calls from Middlebrooks's extension after her move to the third floor was intentional. View "In re HIPAA Subpoena" on Justia Law

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The First Circuit affirmed the order of the district court finding that Plaintiff was disabled as defined under 20 C.F.R. 404.1520 and awarding her benefits, holding that there was very strong evidence of Plaintiff's disability, without any contrary evidence, to justify an award of benefits.At age thirty-four, Plaintiff filed applications for Social Security Disability Benefits and Supplemental Security Income. The Commissioner of Social Security denied Plaintiff's applications. In an independent assessment of her claim, an ALJ agreed with the Commissioner's decision, finding that Plaintiff was not disabled as defined under the Social Security Act. A federal magistrate judge found that substantial evidence did not support the ALJ's denial of benefits and recommended reversing the Commissioner's decision and remanding the case for further development of the facts. The district court agreed with the magistrate judge's findings but bypassed the need for further fact-finding and awarded benefits. The First Circuit affirmed, holding that there was overwhelming evidence to support a finding of disability and an award of benefits and that a remand for further proceedings was unnecessary. View "Sacilowski v. Saul" on Justia Law

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The First Circuit issued this narrow opinion in response to the Commonwealth of Massachusetts's appeal from the district court's denial of its "Motion Regarding Substantial Compliance and To Terminate Monitoring and Court Supervision" and reversed, holding that the district court's analysis was flawed.The underlying suit was long-running class-action litigation concerning the Commonwealth of Massachusetts's compliance with federal statutory requirements for provision of services to a plaintiff class of Medicaid-eligible children with serious emotional disturbances. The district court found the Commonwealth liable for violating Medicaid provisions as to "reasonable promptness" and "early and periodic screening, diagnosis, and treatment" services. The court then issued remedial orders and a court monitor was appointed. Later the Commonwealth filed the motion at issue. Plaintiffs agreed that the court could terminate monitoring and reporting over the portions of the judgment the Commonwealth was in substantial compliance with. The district court denied the motion in its entirety. The First Circuit reversed, holding that the district court's analysis was flawed from the outset. View "Rosie D. v. Baker" on Justia Law

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The First Circuit declared that exclusion of otherwise eligible residents of Puerto Rico from receiving the disability benefits that are granted to persons residing in the fifty States, the District of Columbia, and the Northern Mariana Islands under the Supplemental Security Income (SSI) provisions of Title XVI of the Social Security Act, 42 U.S.C. 1381-1383(f) is not rationally related to a legitimate government interest and is invalid.While residing in New York, Defendant became eligible and commenced receiving SSI disability benefits. The benefits were discontinued when the Social Security Administration became award that Defendant had moved to Puerto Rico. The United States subsequently brought suit against Defendant seeking to collect the amount the SSA claimed was owed by Defendant due to the allegedly improper payment of SSI benefits since Defendant's relocation to Puerto Rico. Defendant raised as an affirmative defense that the exclusion of Puerto Rico residents from the SSI program violated the Equal Protection Clause. The district court granted summary judgment for Defendant, holding that Congress's actions in this case failed to pass rational basis constitutional muster. The First Circuit affirmed, holding that the Fifth Amendment forbids the categorial exclusion of Puerto Rico residents from SSI coverage. View "United States v. Vaello-Madero" on Justia Law

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The First Circuit affirmed the judgment of the district court concluding that transfers of assets by individuals age sixty-five or older into "pooled special needs trusts" are among those transfers that the Medicaid statute counts against eligibility for long-term care benefits, holding that when a beneficiary who is age sixty-five years or older gives up her assets for less than fair market value to a pooled special needs trust, there has been a transfer that triggers a temporary period of ineligibility.Following Yvonne Richardson's deposit of funds into her Maine Pooled Disability Trust (MPDT) account, the Maine Department of Health and Human Services (MDHHS) issued a notice threatening to suspend Medicaid coverage. Richardson and MPDT filed this lawsuit seeking a declaration that her transfer of assets into a pooled special needs trust was not a transfer that affected Medicaid eligibility. The district court dismissed the complaint, concluding that MDHHS correctly applied the governing statute in reaching its conclusion. The First Circuit affirmed, holding that the district court's judgment granting MDHHS's motion to dismiss rested on a reasonable interpretation of the statute. View "Maine Pooled Disability Trust v. Hamilton" on Justia Law

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The First Circuit reversed the order of the district court ruling that the automatic stay provision of the Puerto Rico Oversight, Management, and Economic Stability Act (PROMESA) did not apply to proceedings to determine the amount of federal court-ordered payments that the Commonwealth owed to several federally qualified health centers (FQHCs) per a 2010 injunction, holding that the automatic stay applied in this case.In 2003, several FQHCs sought to enjoin the Secretary of the Department of Health of Puerto Rico from failing to reimburse them for their reasonable costs of providing services to Medicaid patients. In 2018, the Commonwealth filed a motion notifying the district court that the Commonwealth had filed for bankruptcy under Title III of PROMESA and, therefore, the litigation was subject to the automatic stay. The district court ruled that the automatic stay did not apply. The First Circuit reversed, holding that certain provisions of PROMESA did not preclude the automatic stay’s application in this case. View "Migrant Health Center, Inc. v. Commonwealth of Puerto Rico" on Justia Law

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The First Circuit vacated and remanded the district court’s order upholding an administrative law judge’s (ALJ) conclusion that although Appellant had previously been eligible for Supplemental Security Income (SSI) benefits as a child, Appellant was ineligible for SSI benefits as an adult, holding that the record before the ALJ was insufficient to conclude that Appellant was no longer disabled.When Appellant was twelve years old, the Commissioner of Social Security Administration (SSA) determined that he was entitled to SSI benefits because he was found to have met the SSA's requirements for mental retardation. The Commissioner later found that Appellant was no longer disabled and that his benefits should stop. Appellant requested a hearing with an ALJ, who found that Appellant was not disabled under the Social Security Act. Upon de novo review, the First Circuit held that the record before the ALJ was not adequately developed enough to conclude that Appellant was no longer disabled, particularly in light of the fact that the ALJ was on notice, through both Social Security Administration filings and hearing testimony, that Appellant was undergoing psychiatric treatment. View "Torres-Pagan v. Berryhill" on Justia Law

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The First Circuit affirmed the district court’s order upholding an administrative law judge’s (ALJ) denial of Appellant’s application for Social Security Disability Insurance Benefits and Supplemental Security Income. The Court held (1) even if this Court reviews the ALJ’s ruling on the understanding that it must apply a certain Social Security Ruling in reviewing the ALJ’s ruling, the ALJ’s determination that Appellant was not disabled still must be upheld; (2) substantial evidence supported the ALJ’s determination that Appellant’s ability to carry out certain daily activities undermined his contention that he was unable to perform light work; and (3) Appellant’s remaining allegations of error were without merit. View "Coskery v. Berryhill" on Justia Law

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The district court properly placed the burden of proof on a grocery store (Store) in this action brought by Plaintiffs alleging that the Store unlawfully trafficked in Supplemental Nutrition Assistance Program (SNAP) benefits.The Food and Nutrition Service (FNS), the bureau within the United States Department of Agriculture (USDA) charged with administering the SNAP regime, concluded that the Store had engaged in trafficking and permanently disqualified the Store from SNAP participation. The Store brought an action in Maine’s federal district court challenging the agency’s final decision. The district court granted summary judgment for the USDA. The First Circuit affirmed, holding (1) the burden of proof is imposed on the claimant - here, the Store; and (2) no rational fact-finder could conclude that the Store had demonstrated by a preponderance of the evidence that the finding of trafficking was incorrect. View "Irobe v. United States Department of Agriculture" on Justia Law

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The First Circuit affirmed the district court’s ruling that the “set-off rule” announced by the United States Secretary of Health and Human Services (Secretary) in the form of answers to Frequently Asked Questions (FAQs) posted on medicaid.gov represented a substantive policy decision that could not be adopted without notice and comment.In 1981, Congress authorized the payment of sums in addition to Medicaid payments hospitals that treat indigent patients receive in order to cover the full costs of care. Congress later passed a law seeking to cap those payments at each hospital’s “costs incurred.” At issue was to what extent “costs incurred” equals the total costs of service rather than the costs net of payments from sources such as Medicare and private insurance. With two exceptions, Congress stated that “costs incurred” are “as determined by the Secretary.” In 2010, the Secretary made its FAQs announcement that the payments to be offset against total costs in calculating “costs incurred” also included reimbursements received from Medicare and private insurance. The First Circuit held that the Secretary’s rule was procedurally improper for having failed to observe the notice-and-comment procedures prescribed by the Administrative Procedure Act. View "New Hampshire Hospital Ass’n v. Hargan" on Justia Law