Justia Public Benefits Opinion Summaries

The Attorney General for the State of Louisiana brought an action against the defendant pharmaceutical companies alleging, among other things, violations of the Louisiana Medical Assistance Programs Integrity Law (MAPIL). The district court entered a judgment upon the jury's verdict in favor of the Attorney General, finding the defendants' alleged misconduct in marketing certain drugs had violated provisions of MAPIL as it read in November 2003, and awarding civil penalties of $257,679,500.00, $70,000,000.00 in attorney fees, and $3,000,200.00 in costs. The court of appeal affirmed the district court's judgment. After its review, the Supreme Court found the Attorney General failed to establish sufficient facts to prove a cause of action against the defendants under MAPIL because no evidence was presented that any defendant made or attempted to make a fraudulent claim for payment against any Louisiana medical assistance program within the scope of MAPIL. Accordingly, the Court reversed the district court's judgment in favor of the Attorney General.View "Caldwell v. Janssen Pharmaceutical, Inc." on Justia Law

Mrs. Rusick is the surviving spouse of veteran George Rusick, who served on active duty in the U.S. military 1942-1943. In 1983, a Veterans Administration regional office issued a decision continuing a 30-percent rating for Rusick’s service-connected anxiety disorder. With a service-connected hearing loss rated at 40 percent, Rusick’s combined rating was 60 percent. In 1996, the regional office increased the rating for his anxiety disorder to 100 percent. Rusick died in April 2000, with no pending claims for benefits. In May 2000, Mrs. Rusick filed a claim seeking dependency and indemnity compensation (DIC) and accrued benefits. The Department of Veterans Affairs denied both claims and she did not appeal. In September 2006, Mrs. Rusick filed another claim, asserting clear and unmistakable error in that Rusick should have received a 100 percent rating in 1983 because he was unemployable. The Board of Veterans’ Appeals agreed that the regional office’s failure to assign a 100 percent rating in 1983 constituted CUE and that Mrs. Rusick was entitled to DIC benefits under 38 U.S.C. 1318. The regional office implemented the Board’s decision by awarding DIC, but it denied accrued benefits under 38 U.S.C. 5121. The Board, Veterans Court, and the Seventh Circuit affirmed. View "Rusick v. Gibson" on Justia Law

Murphy had a stroke in April 2007. Before leaving the hospital, Murphy was examined by Dr. Mayer, who noted a past history of headaches and diminished fluency in speech. Murphy started seeing a physical therapist but did not complete the program. A year later, Dr. Mayer noted that Murphy still had difficulty speaking and “some significant loss of sensation.” In September 2008, Murphy applied for social security disability benefits. Her application was denied. At a hearing, a vocational expert testified that there were no sedentary jobs in the regional economy for a person who could neither work with the general public nor use her hands more than occasionally for fine manipulation, but that there were a significant number of jobs for a person who had the capacity to do light, unskilled work, but who could only occasionally perform fine hand manipulation. The ALJ ruled that Murphy was not disabled. The Appeals Council adopted that decision. The district court affirmed. The Seventh Circuit reversed and remanded, finding that the ALJ erroneously excluded information about Murphy’s potential inability to perform light work and by not questioning Murphy further about her failure to comply with her home exercise program and the activities she participated in while on vacation. View "Murphy v. Colvin" on Justia Law

Plaintiff filed a motion asking the court to approve the contingency fee arrangement he agreed to with his lawyer, following a successful claim for social security benefits. The magistrate judge determined that a fee in the amount of $11,876.65 was reasonable under 42 U.S.C. 406(b)(1). Plaintiff appealed. The court concluded that the magistrate judge correctly started with the fee agreement, and after determining that the early retirement benefits were not past-due benefits "owed," went on to conclude an independent review of the resulting fee for reasonableness. Accordingly, the court affirmed the fee award because the court agreed with the magistrate judge's interpretation of the contract and found no error in his review of the fee. View "Keller v. Commissioner of Social Security" on Justia Law

Robertson voluntarily enlisted in the Army in 1963.After serving confinement for being absent without leave on two occasions for a total of about 340 days, Robertson was discharged in 1967 under conditions other than honorable, a character of discharge that can foreclose the receipt of veterans’ benefits. He later participated in President Ford’s clemency program, completed alternative service, and received a presidential pardon and a new clemency discharge. Despite his pardon and clemency discharge, the Department of Veterans Affairs has continued to deny Robertson’s claim for veterans’ benefits. The Federal Circuit affirmed, holding that the Department of Veterans Affairs properly considered the misconduct underlying his pardoned offense to deny his application for benefits. Entitlement to veterans’ benefits under the clemency program was meant to be the exception, not the rule. View "Robertson v. Gibson" on Justia Law

Four cases challenged the constitutionality of Senate Bill (SB) 822, which was passed by the 2013 Legislative Assembly during its regular session, and SB 861, passed during a special session in October 2013. Both bills changed certain statutory provisions of the Public Employees Retirement System (PERS) and, in doing so, affected the retirement benefits of some current and former public employees. Central Oregon Irrigation District (the District), an intervenor in these proceedings, filed a motion to disqualify the sitting judges of the Oregon Supreme Court from hearing these cases. The District also filed a separate motion to disqualify the circuit judge appointed by the Supreme Court to serve as a special master for purposes of conducting evidentiary proceedings and preparing recommended findings of fact. Because disqualification would leave petitioners without a tribunal to decide their claims, and in light of the legislature's express grant of jurisdiction to the Supreme Court to decide challenges to the 2013 PERS legislation, the Court concluded that the rule of necessity applied and that the members of Court were not disqualified from deciding these cases because of any interest in the proceeding. Further, the application of the rule of necessity in these circumstances was not a denial of due process. Central Oregon Irrigation District's motions to disqualify the members of the Supreme Court and the Special Master on this matter was denied. View "Moro v. Oregon" on Justia Law

Arnold and Vesta Melby were trustors of separate irrevocable trusts. Both Arnold and Vesta received Medicaid benefits. After the Melbys’ deaths, the Iowa Department of Human Services notified Arnold’s estate that it would seek reimbursement for all Medicaid expenses it had paid on behalf of Arnold and Vesta. The Department then filed an application in the estate seeking a judgment declaring the Melbys had interests in the corpus of their trusts that should be counted as assets available for repayment of the Department’s Medicaid claim. The district court concluded (1) the Melbys’ interests in the trusts were limited to their right to receive the net income from the trusts’ assets, and (2) the Department’s right to recover the Medicaid payments could be enforced against such income, but not against the corpus of the trusts. The Supreme Court reversed, holding (1) the Department’s right to recover Medicaid payments under the facts of this case extended beyond the Melbys’ net income interests; and (2) the district court erred in determining the scope of medical assistance for which recovery was authorized by the general assembly. Remanded.View "In re Estate of Melby" on Justia Law

On October 11, 2013, the Ohio Department of Medicaid (Department) submitted an application to the Ohio Controlling Board (Board) for an increase in its appropriation authority from the accounts holding federal Medicaid funds. The Board approved the Department's request on October 21, 2013, the effect of which was to provide medical services to Group VIII members under the Patient Protection and Affordable Care Act. The following day, Relators filed a request for writ of mandamus. Relators claimed that the Board violated Ohio Rev. Code 127.17, which provides that the Board shall take no action which does not carry out the legislative intent of the general assembly, by approving the Department's request for increased appropriation authority for the Hospital Care Assurance Match Fund. The Supreme Court denied the writ, concluding that Relators failed to establish a clear legal right to the requested relief and a clear legal duty on the part of the Board to undo the authorization of the expenditure of additional federal funds to provide medical insurance for Group VIII members.View "State ex rel. Cleveland Right to Life v. State of Ohio Controlling Bd." on Justia Law

Two Chicago firefighters suffered duty-related injuries in the 1980s and later died. Their widows each received an ordinary widow’s pension from the Retirement Board of the Firemen’s Annuity and Retirement Benefit Fund of Chicago. The two widows were later awarded annuities available to widows of firemen who died in the line of duty, retroactive to the date of death of each spouse, with interest, because the injuries were permanent and had prevented them from ever returning to active duty. The widows claimed that the calculation of their annuities (based on the current salary of the position last held by the deceased) should include duty availability pay, which is generally intended to compensate firefighters for being available for duty. This type of compensation was created in the 1990s, after these firemen’s accidents, and neither ever received it. Their argument, based on Pension Code language added in 2004, was rejected by the Board and the trial court. The appellate court reversed. The Illinois Supreme Court reinstated the denial. If duty availability pay may be used for pension calculation, it must be pay that was actually received by the firemen.View "Hooker v. Ret. Bd. of the Firemen's Annuity & Benefit Fund of Chicago" on Justia Law

The worker was injured in a 2006 automobile accident near Cordova, where he was working temporarily for Venture. Cordova is 200 miles from Springfield, where he lived and where his plumbers’ and pipefitters’ union was. He was living a motel 30 miles from the worksite with a coworker, also from Springfield, who was driving when the accident occurred. An arbitrator denied his workers’ compensation claim. The Workers’ Compensation Commission reversed; the trial court set aside the Commission’s finding. The Workers’ Compensation Division of the Appellate Court granted relief to the worker. The Illinois Supreme Court reversed, holding that the worker was not a “traveling employee” and could not be compensated. An injury incurred by an employee in going to or returning from the place of employment is not compensable, because it is not arising out of or in the course of employment, unless the worker can be categorized as a “traveling employee.” The employer did not direct the worker to accept the position at the Cordova location; he accepted it with full knowledge of the commute involved. His course or method of travel was not determined by the demands and exigencies of the job. He was not reimbursed for travel time or expenses or told what route to take.View "The Venture-Newberg Perini Stone v. IL Workers' Compensation Comm'n" on Justia Law