Articles Posted in US Court of Appeals for the Sixth Circuit

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In 1990, an Ohio state court ordered Jacobs to pay Collin $13,800 in child-support payments. Jacobs subsequently began to receive social security benefits, but, by January 2014, Jacobs’s arrearage totaled $45,356. The state court directed the Commissioner to garnish Jacobs’s social-security payments, 42 U.S.C. 659. In October 2015, the Commissioner mistakenly terminated the garnishment. A year later Collin asked the court to order the Commissioner to resume the garnishment and to pay a lump sum equal to the amount the Commissioner had failed to garnish. The Commissioner voluntarily resumed the garnishment. The Sixth Circuit affirmed dismissal, holding that Collin’s demand was for “money damages,” so the United States was immune from suit. Section 659(a) provides that moneys payable by[] the United States . . . to any individual . . . shall be subject, in like manner and to the same extent as if the United States . . . were a private person, to withholding . . . to enforce the legal obligation ... to provide child support"; but 5 C.F.R. 581.305(e)(2) states “Neither the United States ... nor any governmental entity shall be liable ... to pay money damages for failure to comply with legal process.” The relief Collin seeks is not enforcement of “the statutory mandate itself” but instead damages for the failure to withhold, for which the government has not waived its immunity. View "Collin v. Commissioner of Social Security" on Justia Law

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Biestek, age 54, worked for most of his life as a carpenter and a construction laborer, frequently transporting scaffolding, panels, and other construction materials around work sites. He completed at least one year of college and received additional vocational training as a bricklayer and carpenter. He stopped working in June 2005, allegedly due to degenerative disc disease, Hepatitis C, and depression. Biestek applied for Supplemental Security Income and Disability Insurance Benefits in March 2010, alleging a disability onset of October 2009. A Social Security Administration ALJ denied Biestek’s application. The district court remanded because the ALJ had not obtained necessary medical-expert testimony and did not pose a sufficiently specific hypothetical to the vocational expert. The ALJ subsequently issued a partially favorable decision finding Biestek disabled starting in May 2013, on his fiftieth birthday, the point at which the Agency deems an applicant “closely approaching advanced age” and presumptively disabled under 20 C.F.R. 404. The ALJ found that Biestek was “not disabled” before that date. The Sixth Circuit affirmed. Substantial evidence supported the ALJ’s finding the that Biestek did not meet or medically equal the back-pain-related impairment listed at 20 C.F.R. 404. The ALJ properly evaluated the testimony of medical experts and a vocational expert. View "Biestek v. Commissioner of Social Security" on Justia Law

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In 1988, an ALJ awarded Smith supplemental security income (SSI). Smith received benefits until 2004 when he was found to be over the resource limit. Smith filed another SSI application in 2012, alleging additional medical conditions. The application was denied on March 26, 2014. Smith claims that he mailed a request for review on April 24, 2014. On September 21, Smith faxed a correspondence to the Social Security Administration, inquiring about the status of his appeal, with a copy of his request, dated April 24, 2014. A representative informed Smith that his request was not in the “electronic folder,” that if the Council had received the request, it would have mailed a receipt, and that his appeals request was filed as of October 1, 2014. The Council dismissed the request as untimely, finding no good cause to extend the deadline because Smith could not provide evidence that it was sent within the appropriate time. The district court determined that there was no judicial review available because the dismissal did not constitute a final decision and Smith made no colorable constitutional claims. The Sixth Circuit affirmed, rejecting arguments that Smith suffered due process violations because his request was timely submitted, different ALJs presided over his hearing and signed his decision, and the ALJ referenced the 1988 decision but failed to attach a copy as an exhibit. View "Smith v. Commissioner of Social Security" on Justia Law

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In 1988, an ALJ awarded Smith supplemental security income (SSI). Smith received benefits until 2004 when he was found to be over the resource limit. Smith filed another SSI application in 2012, alleging additional medical conditions. The application was denied on March 26, 2014. Smith claims that he mailed a request for review on April 24, 2014. On September 21, Smith faxed a correspondence to the Social Security Administration, inquiring about the status of his appeal, with a copy of his request, dated April 24, 2014. A representative informed Smith that his request was not in the “electronic folder,” that if the Council had received the request, it would have mailed a receipt, and that his appeals request was filed as of October 1, 2014. The Council dismissed the request as untimely, finding no good cause to extend the deadline because Smith could not provide evidence that it was sent within the appropriate time. The district court determined that there was no judicial review available because the dismissal did not constitute a final decision and Smith made no colorable constitutional claims. The Sixth Circuit affirmed, rejecting arguments that Smith suffered due process violations because his request was timely submitted, different ALJs presided over his hearing and signed his decision, and the ALJ referenced the 1988 decision but failed to attach a copy as an exhibit. View "Smith v. Commissioner of Social Security" on Justia Law

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Kerr sought judicial review of the final determination that Kerr’s husband was not disabled and not entitled to any Social Security disability insurance benefits before his death. Kerr was due to receive any payment owed to Mr. Kerr. The parties stipulated to reversal and remand under 42 U.S.C. 405(g). Kerr then sought an award of $3,206.25 in attorney fees under the Equal Access to Justice Act, 28 U.S.C. 2412(d), with any fees awarded “be made payable to Plaintiff’s counsel,” attaching an “Affidavit and Assignment of EAJA Fee.” The Commissioner did not oppose the motion. The district court granted the award, declined to honor Kerr’s assignment, and concluded that it was required to order payment to Kerr as the prevailing party. The court held that it could not “ignore the Anti-Assignment Act,” which prohibits “an assignment of a claim against the United States that is executed before the claim is allowed, before the amount of the claim is decided, and before a warrant for payment of the claim has been issued” but “le[ft] it to the Commissioner’s discretion to determine whether to waive the Anti-Assignment Act and make the fee payable to Mr. Marks.” The Commissioner responded that she would accept [Kerr’s] assignment and suggested that the court deny as moot Kerr’s Rule 59(e) motion. The district court and Sixth Circuit agreed that Kerr’s motion was moot, and did not reconsider the application of the AAA to the EAJA assignment. View "Kerr v. Commissioner of Social Security" on Justia Law

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Bowling worked as a coal miner for 29 years, most recently for Island Fork. In 2002, Bowling unsuccessfully sought Black Lung Benefits Act (BLBA) benefits. In 2010, Bowling filed the current claim. In the meantime, the Affordable Care Act amended the BLBA to reinstate a rebuttable presumption that claimants with respiratory disabilities and 15 years or more of underground coal-mining work experienced those disabilities as a result of pneumoconiosis, 30 U.S.C. 921(c)(4). The District Director designated Island Fork as the responsible operator and awarded benefits. At a hearing, the ALJ learned that Island Fork and its insurer, Frontier were insolvent. Frontier declared insolvency after the Proposed Order issued. At the initial stages, if the District Director determines that an operator is not financially capable, the Director can select another operator—such as a previous employer—to be the responsible operator; once the claim reaches the ALJ, there is no mechanism to designate a different responsible operator. The Trust Fund, created by the BLBA, provides benefits when there are no responsible operators available, including when an operator is deemed at the ALJ stage not to be financially capable. KIGA, created by the Kentucky Insurance Guaranty Association Act, provides benefits when a member insurance company is insolvent. The ALJ decided that Island Fork was still the responsible operator because benefits could be paid by KIGA. The Sixth Circuit affirmed. The exclusions in the Guaranty Act do not apply; KIGA is liable. View "Island Fork Construction v. Bowling" on Justia Law

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Federal Medicaid funds are not available for state medical expenditures made on behalf of “any individual who is an inmate of a public institution (except as a patient in a medical institution),” 42 U.S.C. 1396d(a)(29)(A). "Inmate of a public institution" means a person who is living in a public institution. However, an individual living in a public institution is not an “inmate of a public institution” if he resides in the public institution “for a temporary period pending other arrangements appropriate to his needs.” Ohio submitted a proposed plan amendment aimed at exploiting this distinction: it sought to classify pretrial detainees under age 19 as noninmates, living in a public institution for only “a temporary period pending other arrangements appropriate to [their] needs,” for whom the state could claim Medicaid reimbursement. The Centers for Medicare and Medicaid Services rejected the amendment, finding that the inmate exclusion recognizes “no difference” between adults and juveniles, or convicted detainees and those awaiting trial. The Sixth Circuit denied a petition for review, agreeing that the involuntary nature of the stay is the determinative factor. The exception does not apply when the individual is involuntarily residing in a public institution awaiting adjudication of a criminal matter. View "Ohio Department of Medicaid v. Price" on Justia Law

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Critical Access Hospitals are reimbursed by Medicare for the reasonable and necessary costs of providing services to Medicare patients. The Medicaid program requires states to provide additional (DSH) payments to hospitals that serve a disproportionate share of low-income patients, 42 U.S.C. 1396a(a)(13)(A)(iv). In Kentucky, DSH payments are matched at 70% by the federal government. Kentucky’s contribution to DSH programs comes from payments from state university hospitals and Kentucky Provider Tax, a 2.5% tax on the revenue of various hospitals, including Appellants, The amount of DSH payments a hospital receives is unrelated to the amount of KP-Tax it paid. During the years at issue, DSH payments covered only 45% of Appellants' costs in providing indigent care. Appellants filed cost reports in 2009 and 2010 claiming their entire KP-Tax payment as a reasonable cost for Medicare reimbursement. Previously, they had received full reimbursement; for 2009 and 2010, however, the Medicare Administrative Contractor denied full reimbursement, offsetting the KP-Tax by the amount of DSH payments Appellants received. The Provider Reimbursement Review Board and Centers for Medicare and Medicaid Services upheld the decision. The Sixth Circuit affirmed, reasoning that the net economic impact of Appellants’ receipt of the DSH payment in relation to the cost of the KP-Tax assessment indicated that the DSH payments reduced Appellants’ expenses such that they constituted a refund. View "Breckinridge Health, Inc. v. Price" on Justia Law