Justia Public Benefits Opinion Summaries

After the court reversed and remanded for an award of social security disability benefits to plaintiff, plaintiff moved for an award of attorney's fees and costs under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The court concluded that the district court abused its discretion in denying the fees where the government's underlying action was not substantially justified in this case. Accordingly, the court reversed the district court's denial of plaintiff's motion and remanded for an award of fees and costs. View "Meier v. Colvin" on Justia Law

Gentiva, a provider of home healthcare services, contended that the Secretary violated the Medicare statute, 42 U.S.C. 1395ddd(f)(3), by delegating to an outside contractor the authority to determine whether Gentiva's Medicare reimbursement claims exhibited a "sustained or high level of payment error." The court affirmed the district court's decision to defer, under Chevron deference, to the Secretary's reasonable interpretation of section 1395ddd(f)(3). The court also agreed with the district court that section 1395ddd(f)(3) precluded the court from reviewing the merits of the "sustained or high level of payment error" determination. Accordingly, the court affirmed the judgment in its entirety. View "Gentiva Healthcare Corp. v. Sebelius" on Justia Law

Plaintiff appealed the denial of her application for Social Security disability benefits, disability insurance benefits, and supplemental security income. The court concluded that substantial evidence supported the ALJ's determination that plaintiff's doctor's opinion was inconsistent with the treatment record and thus not entitled to controlling weight; substantial evidence supported the ALJ's determination that plaintiff's impairments did not meet or equal a medical listing; because the residual functioning capacity (RFC) finding was supported by substantial evidence, it was proper for the ALJ to consider testimony of a vocational expert that was premised on the RFC; and the ALJ did not err in determining plaintiff's credibility. Accordingly, the court affirmed the district court's affirmance of the denial of benefits. View "Myers v. Astrue" on Justia Law

Oaks, a nursing facility, initiated contempt proceedings against the government because the government failed to abide by the district court's order enjoining the government from acting in accordance with a Notice of Termination relative to Oak's Medicare and Medicaid Provider Agreement. The court vacated the finding of contempt and reversed the judgment of the district court, concluding that the government complied with the injunction by delaying effectuation of the termination notice. View "Oaks of Mid City Resident Council v. Sebelius, et al." on Justia Law

Louis Burden, a Vietnam veteran, served on active duty in the Army from 1948 until 1968. He married Michele in a ceremonial marriage in April, 2004. Two months later, Burden died. In August 2004, Michele applied for dependency and indemnity compensation. A VA regional office denied her claim because she had not been married to Burden for at least one year prior to his death, 38 U.S.C. 1102(a). Michele asserted that she and Burden had been living in a common law marriage for five years prior to his death. The board acknowledged that she had provided some evidence to support her claim, but concluded that it did not constitute the “clear and convincing proof” required to establish a valid common law marriage under Alabama law. The Veterans Court and the Federal Circuit upheld the denial. State law, including state law evidentiary burdens, applies in determining the validity of a purported common law marriage View "Burden v. Shinseki" on Justia Law

After Hermann Hospital merged with Memorial Hospital System, creating the Memorial Herman Hospital System (MHHS), the Administrator denied MHHS's request for a Medicare loss payment under 42 C.F.R. 413.134(l). The court joined all other circuits that have ruled on the issue by holding that statutory mergers must be bona fide sales in order to be eligible for a depreciation adjustment under 42 U.S.C. 413.134(l). The court found that substantial evidence supported the Administrator's conclusion that the merger at issue failed to constitute a bona fide sale and, therefore, affirmed the judgment of the district court. View "Memorial Hermann Hospital v. Sebelius" on Justia Law

Defendants, brothers Mathew and Timothy, appealed their convictions related to their participation in Social Security fraud. The court concluded that the government presented sufficient evidence for a reasonable jury to find beyond a reasonable doubt that Mathew knowingly participated in a conspiracy to defraud the United States and that he intended to steal government property; the court rejected Mathew's challenges to his theft of government property conviction by arguing that the government failed to establish that the Social Security funds Timothy received were a "thing of value of the United States;" the government also presented sufficient evidence to support Timothy's convictions; and Timothy's sentence was not unreasonable where the district court considered 18 U.S.C. 3553(a) factors and did not clearly err in weighing them. Accordingly, the court affirmed the convictions and Timothy's sentence. View "United States v. Shirley" on Justia Law

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

States participating in Medicaid in a managed care environment are required to make, at least every fourth month, supplemental “wraparound” payments to federally-qualified health centers (FQHCs) equal to the difference between a rate set by statute multiplied by the number of Medicaid patient encounters, and the amount paid to FQHCs by managed care organizations (MCOs) for all Medicaid-covered patient encounters, 42 U.S.C.1396. Concerned that gaps in FQHC claim verification led to overpayments, the New Jersey Department of Human Services changed its calculation: instead of basing wraparound payments solely on the number of Medicaid encounters and total MCO receipts as self-reported by FQHCs, the state would rely on data reported by MCOs absent receipt of certain additional data from the FQHCs. Because MCOs report only encounters that they have approved and paid, prior MCO payment would be a prerequisite to wraparound reimbursement under the new system. An association of FQHCs sued, claiming that the change violated their due process rights as well as state and federal law, resulting in budget shortfalls. The district court granted the association summary judgment and a preliminary injunction. The Third Circuit affirmed the holding that the requirement that wraparound payments be contingent on prior MCO payment violated the Medicaid statute’s requirement that FQHCs receive timely full wraparound payment for all Medicaid-eligible claims. View "NJ Primary Care Assoc. v. NJ Dep't of Human Servs." on Justia Law

ITT is a for-profit institution with more than 140 locations and offers post-secondary education. Leveski, who worked at the ITT campus, alleged, under the qui tam provisions of the False Claims Act, 31 U.S.C. 3730(b) that ITT knowingly submitted false claims to the Department of Education to receive funds from federal student financial assistance programs under the Higher Education Act, 20 U.S.C. 1001. The district court dismissed for lack of jurisdiction, finding that the allegations had already been publicly disclosed and that Leveski was not the original source of the allegations. The court granted sanctions of $394,998.33 against Leveski's lawyers. The Seventh Circuit reversed, finding the allegations that ITT paid illegal incentive compensation throughout Leveski’s employment as a recruiter and financial aid assistant, sufficiently distinct from prior public disclosures to give the court jurisdiction. The court noted the lack of temporal overlap with allegations by other ITT employees and Leveski’s more detailed allegations. View "Timothy J. Matusheski v. ITT Educational Services, Inc" on Justia Law