Justia Public Benefits Opinion Summaries

Silver’s qui tam action, filed under the False Claims Act (FCA), 31 U.S.C. 3729–33, alleged that PharMerica, which owns and operates institutional pharmacies serving nursing homes, unlawfully discounted prices for nursing homes’ Medicare Part A patients (reimbursed by the federal government to the nursing home on a flat per-diem basis) in order to secure contracts to supply services to patients covered by Medicare Part D and Medicaid (reimbursed directly to the pharmacy by the government on a cost basis) in the same nursing homes--a practice called swapping. The district court dismissed, based on the FCA’s public disclosure bar. The Third Circuit reversed. The district court improperly determined that documents publicly describing the generalized risk of swapping in the nursing home industry served to bar his specific claim, which depended on non-public information that PharMerica was actually engaging in swapping in specific contracts. The district court also erred in concluding, on the basis of Silver’s testimony, that he relied upon certain publicly available information to reach his conclusion and that the information itself disclosed the fraud, without independently determining that the relevant public document did, in fact, effectuate such a disclosure. View "Silver v. Omnicare Inc" on Justia Law

The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act, 42 U.S.C. 1437f(t) (Section 8). Enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.”because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent. The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit initially affirmed. On rehearing, the Third Circuit reversed. The statute’s plain language and history indicate that enhanced voucher holders may not be evicted absent good cause, even at the end of a lease term. The court remanded so that the district court may consider whether Harvey has good cause to evict. View "Hayes v. Harvey" on Justia Law

Accredo delivers clotting medication and provides nursing assistance for hemophilia patients. Accredo makes donations to charities concerned with hemophilia, including HSI and HANJ, which allegedly recommended Accredo as an approved provider for hemophilia patients. Greenfield, a former Accredo area vice president, sued, alleging violations of the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), and the False Claims Act, 31 U.S.C. 3729(a)(1)(A)-(B). If Greenfield prevailed, he would get at least 25% of any civil penalty or damages award. The government did not intervene. The district court, following discovery, granted Accredo summary judgment, finding that Greenfield failed to provide evidence of even a single federal claim for reimbursement that was linked to the alleged kickback scheme. The Third Circuit affirmed. The Anti-Kickback Statute prohibits kickbacks regardless of their effect on patients’ medical decisions. Because any kickback violation is not eligible for reimbursement, to certify otherwise violates the False Claims Act but there must be some connection between a kickback and the reimbursement claim. It is not enough to show temporal proximity. Greenfield was required to show that at least one of the 24 federally-insured patients for whom Accredo provided services and submitted reimbursement claims was exposed to a referral or recommendation by HSI/HANJ in violation of the Anti-Kickback Statute. View "Greenfield v. Medco Health Solutions Inc" on Justia Law

The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act of 1937, 42 U.S.C. 1437f(t) (Section 8). Because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent, enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.” The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Toward the end of their most recent lease term, Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate the premises, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit affirmed. The Act does not obligate property owners to renew enhanced-voucher tenancies after the initial lease term. View "Hayes v. Harvey" on Justia Law

McGann, who is blind and deaf, requested from Cinemark an American Sign Language (ASL) tactile interpreter so that he could experience a movie in his local Cinemark theater during one of its regular showings. Cinemark denied his request. McGann filed suit under the Americans with Disabilities Act (ADA), 42 U.S.C. 12101 ADA. After a bench trial in which the parties stipulated to all relevant facts, the district court entered Judgment in favor of Cinemark. It reasoned that McGann’s requested tactile interpreter was not an auxiliary aid or service under the ADA and that the ADA did not require movie theaters to change the content of their services or offer “special” services for disabled patrons. The Third Circuit vacated. The tactile interpreter McGann requested is an “auxiliary aid or service.” A a public accommodation may avoid ADA liability for failure to provide an auxiliary aid or service only if it shows that the aid or service in question “fundamentally alter[s] the nature” of its goods or services, or “would result in an undue burden, i.e., significant difficulty or expense.” The court remanded for consideration of CInemark’s possible defense. View "McGann v. Cinemark USA Inc" on Justia Law

Elliott worked in a coal mine until 1993 and developed a chronic cough. Three after his retirement, he developed more acute breathing problems. Elliott sought Black Lung Benefits Act, 30 U.S.C. 901–45, benefits in 2012. Helen Mining conceded it was the responsible employer, but challenged Elliott’s entitlement to benefits. The parties stipulated that Elliott had a totally disabling respiratory impairment. Because Helen Mining conceded disability and because Elliott demonstrated more than 15 years of employment, the ALJ determined that section 921(c)(4) applied and that the other elements, including causation, would be presumed, and shifted the burden to Helen Mining. Helen Mining offered the opinions of two doctors, attributing Elliott’s respiratory impairment to adult-onset asthma unrelated to coal dust exposure. The ALJ did not find their testimony persuasive, concluded that Helen Mining had failed to rule out coal dust-induced pneumoconiosis as a cause of Elliott’s disability, and awarded benefits. The Benefits Review Board upheld the award. The Third Circuit affirmed, upholding the application of the 2013 regulation, specifying the standard a coal mine operator must meet to rebut the presumed element of disability causation, 20 C.F.R. 718.305(d)(1). The regulation permissibly fills a statutory gap and Helen Mining did not meet that rebuttal standard. View "Helen Mining Co v. Elliott" on Justia Law