Justia Public Benefits Opinion Summaries

Toomer served in the Army, 1971 to 1974. He sought benefits for degenerative disc disease, claiming connection to a 1972 in-service back strain from lifting heavy objects. In 2004, a VA Regional Office denied the claim. In 2009, the Board of Veterans’ Appeals affirmed, relying on a 2007 VA examination. Although Toomer was treated for a back strain in 1972, there was no evidence from subsequent clinical visits that his current pain was connected to that injury: a 1972 x-ray was normal; after January 1973, there were no complaints of back pain during service; and there were potential post-service injuries, considering his occupation as a construction worker. The Decision was mailed on June 2, 2009. On July 27, Toomer informed the VA that he had not received it. On August 4, the VA mailed another copy, noting that the veteran has “120 days from the date this decision was mailed to you (as shown on the first page of this decision) to file a Notice of Appeal,” On October 28, more than 120 days from the decision date, but within 120 days of the August letter, Toomer appealed to the Veterans Court, which dismissed. The Federal Circuit affirmed, stating that even if it disagreed with that court’s finding that dates on the correspondence were not misleading, and did not constitute “extraordinary circumstances,” revisiting this finding was beyond its jurisdiction. View "Toomer v. McDonald" on Justia Law

Petitioner Rachel Parks appealed an administrative law judge's denial of her application for supplemental security income on behalf of her minor son, D.P. D.P. suffered from attention deficit hyperactivity disorder and borderline intellectual functioning. An administrative law judge denied Parks’s application because D.P. did not suffer from a condition that entitled him to supplemental security income. Parks filed a request for review with the Appeals Council, and she submitted new evidence of D.P.’s academic struggles. The Appeals Council supplemented the record with the new evidence, but denied review. Parks then filed a complaint in the district court, which affirmed the denial of her application. She argued on appeal to the Eleventh Circuit: (1) the administrative law judge's denial of Parks's application was not supported by substantial evidence; and (2) the Social Security Appeals Council needed to make explicit findings of fact about new evidence that it added to the record when it denied review. Because the administrative law judge’s decision was supported by substantial evidence and the Appeals Council was not required to make specific findings about Parks’s new evidence, the Eleventh Circuit affirmed. View "Parks v. Commissioner, Social Security Administration" on Justia Law

The Department of Social Services (DSS) provided Medicaid benefits to Darlene Hollman while she was in a nursing home. Hollman had an interest in real estate at the time, but DSS did not record a lien on the property for the benefits it had provided until after Hollman died. Hollman’s children challenged the validity of the lien. The circuit court granted summary judgment in favor of DSS, concluding that an enforceable medical assistance lien was created on the property at the time the nursing home assistance was provided and that Hollman’s interest in the property transferred at death to the children subject to the lien. The Supreme Court reversed, holding (1) DSS’s medical assistance lien did not attach to Hollman’s interest in the property before her death, and Hollman’s interest passed to her children immediately upon her death; (2) because the lien had not been recorded at the time of Hollman’s death, Hollman had no interest upon which the lien could attach; and (3) therefore, Hollman’s interest passed to her children free of DSS’s lien. View "Hollman v. S.D. Dep’t of Soc. Servs." on Justia Law

Zakarzecka worked as a home healthcare provider for Meuse, an elderly blind man. He required Zakarzecka to wear special shoes inside the house and to change into street shoes when answering the door or going outside. When Zakarzecka heard a deliveryman on May 10, she hurriedly attempted to change her shoes at the top of the stairwell. She fell down the stairs, breaking both wrists and suffering partial loss of the use of both hands. She sought compensation under the Workers’ Compensation Act (820 ILCS 305/1). Because Meuse lacked workers’ compensation insurance, Zakarzecka named the custodian of the Injured Workers’ Benefit Fund, the Illinois State Treasurer. An arbitrator awarded temporary total disability benefits and compensation for the permanent and partial loss of her hands to Zakarzecka, against the Fund. The Commission affirmed. As custodian , the Treasurer sought judicial review. The circuit court confirmed the ruling. The appellate court initially reversed. On rehearing, Zakarzecka argued, for the first time, that judicial review was barred because the Treasurer had not filed an appeal bond, a statutory prerequisite for invoking the circuit court’s jurisdiction, 820 ILCS 305/19(f)(2). Agreeing that a bond was required, the appellate court dismissed for lack of jurisdiction. The Illinois Supreme Court affirmed. View "Ill. State Treasurer v. Ill. Workers' Comp. Comm'n" on Justia Law

This case was the companion interlocutory appeal with facts that mirrored Iowa Dep’t of Human Servs. v. DeWitt Bank and Trust Co., decided on the day of this opinion. As in DeWitt Bank, the Iowa Department of Human Services filed an application for relief against defendant healthcare providers under Iowa Code 249A.44. The district court appointed a receiver. Bank Iowa, a lender that held perfected security interests in Defendants’ property, intervened and challenged the receiver’s applications for fees and expenses. The district court concluded that receivership expenses should be paid out of property in which the Bank had prior lien interests. The Supreme Court reversed based on the reasoning set forth in DeWitt Bank, holding that Iowa follows the common law rule that a receiver may be charged against a third party’s security interest only to the extent the secured creditor has received a benefit from the receivership or the secured creditor has consented to the receivership. Remanded. View "Iowa Dep’t of Human Servs. v. Morse Healthcare Servs., Inc." on Justia Law

DeWitt Bank & Trust Company (Bank) held perfected security interests on real and personal property of Community Care, Inc. (CCI). When the Iowa Department of Human Services (DHS) determined that CCI had committed Medicaid fraud, DHS filed an application for injunctive relief under Iowa Code 249A.44. The district court enjoined CCI from transferring property or taking action inconsistent with DHS’s right to recover overpayments of medical assistance from CCI. CCI subsequently ceased operations, and the district court appointed a receiver for CCI. The Bank sought clarification that the receiver’s fees and expenses would not be paid out of CCI assets in which the Bank had a prior perfected security lien. The district court denied substantive relief, concluding that Iowa law requires the expenses of the receiver to be paid before secured creditors. The Supreme Court reversed, holding (1) Iowa law does not authorize a receiver to be paid out of assets that are subject to a prior perfected line; and (2) rather, Iowa follows the common law rule that the costs of a receiver may be charged against a third party’s security interest only to the extent the secured creditor has received a benefit from the receivership or the secured creditor has consented to the receivership. View "Iowa Dep’t of Human Servs. v. Cmty. Care, Inc." on Justia Law

The Medicare program provides federally funded healthcare to the elderly and the disabled. See Title XVIII of the Social Security Act, 42 U.S.C. 1395. Under a “complex statutory and regulatory regime” called Medicare Part A, the Government reimburses participating hospitals for care that they provide to inpatient Medicare beneficiaries. Most hospitals are reimbursed for inpatient hospital services pursuant to a standardized rate, but the Social Security Act also provides a method for calculating reimbursement rates for certain rural hospitals that qualify as “sole community hospital[s]” (SCHs) or that qualify as “medicare-dependent small rural hospital[s]” (MDHs). SCHs and MDHs receive reimbursement based on either the standard rate or a hospital-specific rate derived from its actual costs of treatment in one of the base years specified in the statute, whichever is higher. MDHs and SCHs challenged revisions to the rules covering their Medicare reimbursements for inpatient hospital services, arguing that the Medicare statute forbids the Secretary from modifying the hospitals’ reimbursements with budget neutrality adjustments from years prior to the base year. The district court rejected the claims. The D.C. Circuit affirmed, finding that the revisions were neither arbitrary nor manifestly contrary to the statute. View "Adirondack Med. Ctr. v. Burwell" on Justia Law

The plaintiff applied for social security disability benefits in 2009, at the age of 43, claiming to be disabled by a cyst (a liquid-filled sphere) in her pineal gland, a small endocrine gland in the brain that produces melatonin, which regulates sleep. The cyst caused her to experience vertigo, blurred vision, and headaches. She has a high-school education, is married and has children, but has never held a full-time job. In 2010 she underwent brain surgery to remove the cyst. Although an MRI following the operation showed that the cyst had been removed and the site of the operation in the brain was healing normally, and her vertigo and vision problems had been resolved, within weeks she was complaining about pain and numbness in her head. She had declined suggested treatments and had continued her hobby of long-distance running. After a hearing before an administrative law judge in 2011, her application was rejected. The rejection upheld by the district court and the Seventh Circuit. The administrative law judge was entitled to find that the plaintiff, although she may well suffer from chronic pain, is capable of full-time employment and therefore not totally disabled. View "Mitze v. Colvin" on Justia Law

Pursuant to written plea agreements, defendants Yolanda Sosa and Adrian Velazquez pled guilty to conspiracy to commit healthcare fraud. For a five month period in 2011, Defendants met with a "cooperating doctor" and paid the doctor for prescriptions that Defendants could use to fraudulently bill Medicare. Specifically, Defendants provided the cooperating doctor with Medicare beneficiary information and paid the doctor thousands of dollars to write prescriptions for expensive medications that were not actually given to any patients. The doctor never saw or evaluated the patients, and instead wrote the prescriptions for whatever medications Defendants requested. Defendants gave the fraudulent prescriptions to various pharmacies, which submitted false claims to Medicare based on the prescriptions. As a result, Medicare paid the pharmacies approximately $753,430 based on the false claims. The pharmacies paid Defendants over $60,000 for obtaining the fraudulent prescriptions. Defendants appealed two forfeiture orders entered by the district court after it imposed joint-and-several restitution against them, specifically challenging the restitution amount and the forfeiture of two cars. After careful review of the record and the parties' briefs, and with the benefit of oral argument, the Eleventh Circuit found no reversible error and affirmed the district court. View "United States v. Velazquez" on Justia Law

Providers of “habilitation services” under Idaho’s Medicaid plan are reimbursed by the state Department of Health and Welfare. Section 30(A) of the Medicaid Act requires Idaho’s plan to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguard[ing] against unnecessary utilization of . . . care and services,” 42 U.S.C. 1396a(a)(30)(A). Providers of habilitation services claimed that Idaho reimbursed them at rates lower than section 30(A) permits. The district court entered summary judgment for the providers. The Ninth Circuit affirmed, concluding that the Supremacy Clause gave the providers an implied right of action, under which they could seek an injunction requiring compliance. The Supreme Court reversed, concluding that there is no private right of action. The Supremacy Clause instructs courts to give federal law priority when state and federal law clash, but it is not the source of any federal rights and does not create a cause of action. The suit cannot proceed in equity. The power of federal courts of equity to enjoin unlawful executive action is subject to express and implied statutory limitations. The express provision of a single remedy for a state’s failure to comply with Medicaid’s requirements, the withholding of Medicaid funds by the Secretary of Health and Human Services, 42 U.S.C. 1396c, and the complexity associated with enforcing section 30(A) combine to establish Congress’s “intent to foreclose” equitable relief. View "Armstrong v. Exceptional Child Ctr., Inc." on Justia Law