Justia Public Benefits Opinion Summaries

In 2011, Bogina sued under the False Claims Act, 31 U.S.C. 3729, seeking compensation for exposing fraud allegedly perpetrated against the federal government and several state governments. Defendants included a major supplier of medical equipment to institutions reimbursed by Medicare and other federal programs and its customer, a chain of nursing homes. The district judge dismissed the federal claims as being too similar to those in a prior suit and relinquished jurisdiction over the state claims. The Seventh Circuit affirmed, finding differences between this suit and an earlier suit “unimpressive” and stating that it did not matter that the alleged fraud continued. View "Bogina v. Medline Indus., Inc." on Justia Law

The Hospital challenged the method used by the Secretary to calculate its reimbursement for services it provided during 2003 and 2004 - the two years after statutory caps on reimbursements for psychiatric hospitals expired but before psychiatric hospitals were moved to a prospective-payment system. The court affirmed the district court's denial of the hospital's motion for summary judgment and grant of HHS's cross-motion for summary judgment because HHS’s interpretation was not only reasonable but also the best interpretation of the controlling statute, 42 U.S.C. 1395ww, and regulation, 42 C.F.R. 413.40. View "Washington Regional Medicorp v. Burwell" on Justia Law

In 2008, Javidan shadowed Shahab, who was involved with fraudulent home-health agencies. Javidan, Shahab, and two others purchased Acure Home Care. Javidan managed Acure, signing Medicare applications and maintaining payroll. She had sole signature authority on Acure’s bank account and, was solely responsible for Medicare billing. Javidan illegally recruited patients by paying “kickbacks” to corrupt physicians and by using “marketers” to recruit patients by offering cash or prescription medications in exchange for Medicare numbers and signatures on blank Medicare forms. Javidan hired Meda as a physical therapist. Meda signed revisit notes for patients that he did not visit. He told Javidan which patients were not homebound and which demanded money for their Medicare information. The government charged both with health care fraud conspiracy (18 U.S.C. 1347) and conspiracy to receive kickbacks (18 U.S.C. 371). At trial, Javidan testified that she did not participate in and was generally unaware of Acure’s fraudulent business practices. Meda called no witnesses. Javidan and Meda were sentenced to terms of 65 and 46 months of imprisonment, respectively. The Sixth Circuit affirmed, rejecting Meda’s claims that his conviction violated the Double Jeopardy Clause and that he was subjected to prosecutorial vindictiveness for refusing to plead guilty and requesting a jury trial in prior case and Javidan’s claims of improper evidentiary rulings and sentence calculation errors. View "United States v. Javidan" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits, contending that the ALJ failed to resolve a conflict between the vocational expert's testimony and the Dictionary of Occupational Titles. The court held that an ALJ has not fully developed the record if it contains an unresolved conflict between the expert’s testimony and the Dictionary; nor has the ALJ fulfilled this duty if he ignores an apparent conflict because the expert testified that no conflict existed. In this case, the ALJ did not fulfill his duty to make an independent identification of apparent conflicts. Accordingly, the court reversed and remanded for further proceedings. View "Pearson v. Colvin" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits, contending in part that the district court should have remanded the case to the Commissioner for further proceedings to consider new evidence. The court agreed with the Sixth Circuit's rejection of the notion that the mere existence of a subsequent decision in the claimant's favor, standing alone, warranted reconsideration of the first application. In this case, the only “new evidence” plaintiff cites in support of her request for remand is the later favorable decision. The court concluded that the later decision is not evidence for purposes of 42 U.S.C. 405(g). Because plaintiff does not offer any other new evidence, she has not established that remand is warranted. The court also concluded that the ALJ's conclusion that plaintiff was able to perform light work was supported by substantial evidence and that the ALJ gave adequate weight to the opinion of her treating physician, finding it inconsistent with the medical records and other evidence. Accordingly, the court affirmed the judgment. View "Hunter v. SSA" on Justia Law

After plaintiff's second application for disability benefits was denied by the ALJ, the government conceded that the ALJ made a legal error when it rejected the opinions of plaintiff's treating physician without giving sufficient reason. On appeal, plaintiff challenged the district court's decision to exercise its discretion and remand to the ALJ for further proceedings. The court concluded that the district court did not err in remanding this case to the ALJ for further factual proceedings, rather than for payment of benefits. Further, in light of the inconsistencies, conflicts, and gaps in the record that require further administrative proceedings, the court did not proceed to the next question: whether the ALJ would be required to find plaintiff disabled if the physician's inconsistent reports were credited as true. Accordingly, the court affirmed the judgment. View "Dominguez v. Colvin" on Justia Law

Dean, a preference-eligible veteran, applied for a position as a “Recent Graduate” Wage and Hour Specialist within the Department of Labor. The announcement stated that the position “is a part of the Pathways Employment Program,” open only to “[e]ligible recent graduates from qualifying educational institutions” and separately identified job qualifications (which did not include a minimum educational requirement) and program eligibility, which required a “degree or certificate from a qualifying educational institution within the previous two years,” or previous six years for certain veterans; 34 veterans met the requirements. Dean was not considered because he had not graduated within the timeframe. Dean filed an unsuccessful Veterans Employment Opportunities Act (VEOA) appeal. The Board cited 5 U.S.C. 3302(1), authorizing the President to except positions from the competitive service, and 5 U.S.C. 3308, limiting OPM’s ability to include minimum educational requirements for positions in the competitive service that are subject to examination. The Federal Circuit affirmed, finding that that the Board had jurisdiction under section 3330a of the VEOA because sections 3302(1) and 3308 are statutes relating to veterans’ preference, and that Dean’s veterans’ preference rights under those sections were not violated. View "Dean v. Dep't of Labor" on Justia Law

Plaintiff appealed the denial of disability insurance benefits and supplemental security income, contending that the ALJ failed to properly weigh certain medical opinions in the record. The court concluded that the ALJ did not err in discussing, reviewing or giving less weight to plaintiff's primary treating psychiatrist's opinion. In this case, the ALJ noted that the psychiatrist's opinion was inconsistent with the totality of the medical evidence and not supported by petitioner’s demonstrated level of functioning. Further, the court concluded that the ALJ properly explained her reasons for giving little weight to the “other” medical sources, and the ALJ did not err in finding the totality of the medical evidence and plaintiff's demonstrated level of functioning were inconsistent with these “other” medical sources’ opinions. Accordingly, the court affirmed the judgment. View "Lawson v. Colvin" on Justia Law

Plaintiff appealed the denial of supplemental security income (SSI) where the ALJ found that plaintiff was not disabled because he could perform sedentary work. The court concluded that the ALJ correctly gave less weight to the nurse practitioner's medical opinion where it was inconsistent with other opinions from plaintiff's treating physicians. Further, the ALJ did not err by failing to obtain vocational expert testimony and instead relying solely on the Medical-Vocational Guidelines. Accordingly, the court affirmed the judgment. View "Crawford v. Colvin" on Justia Law

Plaintiff appealed the denial of supplemental security income (SSI) and disability insurance benefits (DIB). The court concluded that there is no proof that the ALJ did not consider the nurse practitioner's opinion as an "other" medical source; the ALJ rightly disregarded the nurse practitioner's opinion that plaintiff was unable to work because that involves an issue reserved for the Commissioner and is not the type of "medical opinion" to which the Commissioner gives controlling weight; and the ALJ's determination of plaintiff's residual functioning capacity (RFC) that she could perform the standing and walking requirements of light work is supported by substantial evidence. Further, substantial evidence supports the ALJ's decision to not include additional manipulative limitations. Accordingly, the court affirmed the district court's order upholding the denial of SSI and DIB benefits. View "Cypress v. Colvin" on Justia Law