Justia Public Benefits Opinion Summaries

In this case the Supreme Court was asked to decide whether a charitable hospital may pursue payment for medical care provided to a Medicaid-eligible patient by filing a lien against a settlement between the patient and an insurance company covering the liability of a tortfeasor responsible for the patient's injuries. To answer the question, the Court balanced the complex state and federal legal framework surrounding Medicaid with Wis. Stat. 779.80 (hospital lien statute). The Court concluded that the soundest harmonization of the two permitted the liens at issue here. In so doing, the Court reversed the court of appeals, which reversed the circuit court's reasoning that the hospital was authorized to either file the liens or bill Medicaid.View "Gister v. Am. Family Mut. Ins. Co." on Justia Law

Plaintiff-Appellant John Dilley appealed the grant of summary judgment in favor of Defendant-Appellee City of Missoula. The district court concluded the City acted within its legal authority when it purchased the Missoula Civic Stadium with tax increment financing (TIF) funds designated for urban renewal. The stadium was originally planned and developed by Play Ball Missoula, Inc. (Play Ball), a volunteer, non-profit corporation organized for the purpose of bringing a minor league baseball team to Missoula. In 2000, Play Ball and the City entered a development agreement that permitted Play Ball to finance and construct a stadium on blighted City property and later convey the facility to the City. Plaintiff, acting pro se, filed suit prior to the City's acquisition of the stadium, alleging the planned purchase using TIF funds was an "illegal payoff of private enterprise debt." On appeal, Plaintiff argued that the district court erroneously failed to specify which provision under Title 7, Chapter 15, Part 42 of the Montana Code that permitted the "payoff." He also argued that the City could not make such an expenditure of TIF funds simply because the practice was not prohibited by statute. Finding that the City's use of TIF money to acquire the stadium was a proper exercise of its urban renewal posers, the Supreme Court affirmed the grant of summary judgment in the City's favor. View "Dilley v. City of Missoula" on Justia Law

The New York City Off-Track Betting Corporation (NYC OTB) was a public benefit corporation charged with operating an off-track pari-mutuel betting system within the City. Later, NYC OTB filed for bankruptcy and shut down. The City's Corporation Counsel then announced that NYC OTB retirees would lose coverage under the City's health insurance and welfare benefit plans because the Corporation was no longer able to reimburse the City. A union representing NYC OTB employees and retirees and others (collectively, Plaintiffs) brought suit against the State and City, seeking a judgment declaring that the failure of the State and City to fund, and the termination of retiree health insurance and supplemental benefits, violated the City Administrative Code and other express and implied obligations. Supreme Court rejected the four theories advanced by Plaintiffs to support State or City liability for NYC OTB retiree health benefits. The appellate division affirmed. The Court of Appeals affirmed, holding (1) Plaintiffs did not demonstrate a likelihood of success on the merits of their claim against the City; and (2) because NYC OTB had a legal identity separate from the State, Plaintiffs stated no viable theory under which the State could be held liable in this case.View "Roberts v. Paterson" on Justia Law

The State Department of Labor and Industry appealed a district court's order that reversed the Department's decision regarding Petitioner Sheila Callahan & Friends, Inc. (SC&F). SC&F, a radio broadcasting company entered into a one-year contract with Joni Mielke. During the term of employment, SC&F evaluated Mielke as being an excellent radio personality and announcer but as underperforming other responsibilities because she either did not want to do them or preferred announcing-related duties. Mielke elected not to renew her contract with SC&F, and on an exit interview form, Mielke indicated her reason for leaving was that she "quit." After Mielke left her employment with SC&F, she was hired by another radio station. After a brief employment with this subsequent employer, she was laid off and filed for unemployment benefits in October 2009. The Department of Labor sent a Notice of Chargeability Determination to SC&F assessing a pro rata share of the costs of Mielke’s unemployment insurance benefits to SC&F’s experience rating account. The Department administratively determined that Mielke was employed for SC&F on a contract basis during her base period of employment and that SC&F’s account was chargeable for a portion of benefits drawn by Mielke. SC&F requested a redetermination, arguing that Mielke had voluntarily left her employment. The Department issued a Redetermination affirming the initial Determination. An administrative hearing was then conducted by telephone; the hearing officer determined that Mielke neither voluntarily quit nor was discharged for misconduct and affirmed the decision to charge SC&F’s account. On appeal, the Department argued the District Court improperly failed to defer to the Board’s findings of facts. Upon review, the Supreme Court concluded that the error of the Board was primarily premised upon application of legal standards, in the nature of a conclusion of law. Given the inapplicability of the imputation rules to the situation here, the District Court properly concluded that the evidence did not support the Board’s determination that Mielke’s work separation was involuntary. View "Sheila Callahan & Friends, Inc. v. Montana" on Justia Law

The State brought a civil action against Pharmacia Corporation, alleging that the company reported inflated drug prices to Wisconsin Medicaid. A jury found Pharmacia liable for violating the Deceptive Trade Practices Act (DTPA) and the Medicaid fraud statute. The jury awarded the State $2 million for the DTPA claim and $7 million for the Medicaid fraud claim. The jury also determined that Pharmacia committed 1,440,000 separate violations of the Medicaid fraud statute. In post-trial proceedings, the circuit court reduced the number of violations to 4,578. Both parties appealed. The court of appeals certified three issues to the Supreme Court. The Court affirmed the circuit court's judgment on the issues and remanded to the court of appeals, holding (1) the State was entitled to a jury trial on its Medicaid fraud claim; (2) the jury did not impermissibly speculate in determining the damage award; and (3) the circuit court properly reduced the number of violations found by the jury.View "State v. Abbott Labs." on Justia Law

Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded.View "In re E.B." on Justia Law

The State appealed the dismissal of its complaint against seventeen pharmaceutical companies, which the State alleged defrauded Utah's Medicaid program by reporting inflated drug prices. In its complaint, the State pursued two causes of action, violation of the Utah False Claims Act (UFCA) and fraudulent misrepresentation. The district court dismissed the claims based on three alternative grounds. The Supreme Court reversed in part and affirmed in part, holding (1) although the State's complaint was insufficiently particular under the appropriate Utah R. Civ. P. 9(b) standard for claims alleging a widespread scheme to commit fraud and submit false claims, it was in the interest of justice to grant the State leave to amend its complaint under the new standard; (2) the district court erred in dismissing the State's claims under Utah R. Civ. P. 12(b)(6) because the State alleged all the elements of its causes of action; and (3) the district court properly applied the one-year statute of limitations to the State's UFCA cause of action and its dismissal of those claims alleged to have arises before April 30, 2006. Remanded.View "State v. Apotex Corp." on Justia Law

Petitioner, J.S., was a thirteen-year-old boy who suffered from cerebral policy. Through his mother, J.S. submitted an authorization request for a power wheelchair with fifty-five accessories to the respondent, the state department of health and human resources (DHHR), which administers the Medicaid program in West Virginia. DHHR denied Petitioner's request on the basis that it exceeded the Medicaid policy of providing only the most economical equipment to meet a recipient's basic health care needs. The DHHR board of review upheld the denial. The circuit court upheld the decision. The Supreme Court reversed, holding that the circuit court applied an erroneous standard of review to the decision of the DHHR board of review. Remanded to the circuit court with direction to make an independent review of both the law and the facts of this case.View "J.S. v. Hardy" on Justia Law

Plaintiff's son, Hayden, was involved in a near-drowning accident in which he suffered severe permanent injuries. Plaintiff subsequently sought coverage for the cost of his treatment from Wasatch Crest Mutual Insurance, under which Hayden was insured. Wasatch Crest was later declared insolvent, and Plaintiff filed a claim against the Wasatch Crest estate. The liquidator of the estate denied Plaintiff's claim, concluding that Wasatch Crest had properly terminated coverage under the language of the plan. The Supreme Court reversed, interpreting the plan in favor of coverage. Plaintiff resubmitted her claim for medical expenses to the liquidator for payment under the Utah Insurers Rehabilitation and Liquidation Act. One year later, Plaintiff filed a motion for summary judgment with the district court. The liquidator subsequently issued a second amended notice of determination denying Plaintiff's claim on the merits. The district court then denied Plaintiff's motion for summary judgment, as Plaintiff had not yet challenged the second amended notice of determination and could do so under the Liquidation Act. Plaintiff appealed the district court's order. The Supreme Court dismissed the appeal because Plaintiff did not appeal from a final judgment and had not satisfied any of the exceptions to the final judgment rule.View "Mellor v. Wasatch Crest Mut. Ins." on Justia Law

The Employment Appeal Board (Board) denied Willie Hall's application for unemployment insurance benefits. Hall filed a petition for judicial review. The district court affirmed the decision of the Board and assessed costs against Hall. The court of appeals affirmed. The Supreme Court reversed the portion of the judgment as it related to court costs, holding (1) pursuant to Iowa Code 96.15(2), any individual claiming benefits shall not be charged fees of any kind, including court costs, in a proceeding under the statute by a court or an officer of the court; and (2) therefore, the district court erred by requiring that Hall pay court costs. View "Hall v. Employment Appeal Bd." on Justia Law