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In several cases consolidated for review, the issue common to all was whether the Michigan Department of Health and Human Services could recover from beneficiaries’ estates an amount equivalent to certain Medicaid benefits paid to, or on behalf of, those beneficiaries during their lifetimes. Pursuant to the Michigan Medicaid estate-recovery program (MMERP), DHHS asserted creditor claims in the amount of those benefits against the estates of four deceased beneficiaries. In each case, the estate prevailed in the probate court and DHHS appealed. The Court of Appeals consolidated the appeals and reversed in part, concluding that DHHS could pursue its claims for amounts paid after MMERP’s July 1, 2011 implementation date, but not for amounts paid between that date and the program’s effective date, July 1, 2010. One estate appealed to the Michigan Supreme Court, arguing due process barred DHHS from recovering any amount paid before 2013, when the agency had directly notified the estate’s decedent of MMERP. DHHS applied for leave to appeal in all four cases, arguing that the Court of Appeals had erred in concluding that the agency was not entitled to recover the amounts paid between July 1, 2010, and July 1, 2011. The Supreme Court concluded DHHS was not barred from pursuing estate recovery for amounts paid after July 1, 2010. View "In re Gorney Estate" on Justia Law

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In 2009, Lanigan injured his back at his job and hurt his neck in a car accident; in 2011 he was diagnosed with diabetes. Since then his medical impairments have been complicated by mental illness. Lanigan applied for Supplemental Security Income and Disability Insurance Benefits in 2012 when he was 38 years old. At a hearing, the ALJ asked a vocational expert to assess whether competitive employment would be available to a person: capable of performing low-stress jobs constituting light work if those jobs involve only routine tasks; do not require more than occasional interaction with coworkers or the public; do not involve piece work or a rapid assembly line; is limited to occasional stooping, crouching, kneeling, or crawling; and can be off task up to 10% of the workday in addition to regularly scheduled breaks. The ALJ did not explain the source of the 10% figure. The ALJ found his impairments to be severe but not disabling and denied benefits. The Appeals Council denied review. The district court upheld the ALJ’s decision. The Seventh Circuit remanded for further proceedings because the ALJ misinformed a vocational expert about Lanigan’s residual functional capacity, thus undermining the expert’s testimony that Lanigan could engage in competitive employment. View "Lanigan v. Berryhill" on Justia Law

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Guerrero applied for workers’ compensation benefits after he was injured in the course of his employment as a construction laborer. He received temporary disability benefits: November 18–December 4, 2005, and January 17–June 15, 2006. His entitlement to permanent disability benefits was contested but settled in December 2014. The resulting agreement provided that Guerrero would receive a lump sum in satisfaction of his employer’s obligation to pay permanent disability benefits, less the amount of permanent disability payments his employer had advanced. Guerrero also applied for benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF), the state fund that pays workers’ compensation benefits to certain permanently disabled workers. A Workers’ Compensation ALJ ordered the SIBTF to pay, finding that Guerrero’s preexisting condition combined with the subsequent injury left him totally and permanently disabled. The ALJ fixed the beginning date for SIBTF payments as June 16, 2006, the day after temporary disability payments ceased, rejecting SIBTF’s argument that its obligation should not begin until January 26, 2011 (when Guerrero’s injuries were deemed permanent and stationary). The Workers’ Compensation Appeals Board denied a petition for review. The court of appeal affirmed, finding that under the controlling statutes, SIBTF benefits commence at the time the employer’s obligation to pay permanent disability benefits begins. View "Baker v. Workers Compensation Appeals Board" on Justia Law

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The Eighth Circuit reversed the denial of disability insurance benefits (DIB) and supplemental security income (SSI), holding that substantial evidence was insufficient to support the ALJ's denial of benefits. In this case, the ALJ's residual functional capacity assessment and hypothetical question to the vocational expert (VE) did not contain all impairments supported by substantial evidence in the record, and thus the VE's testimony was not substantial evidence. View "Gann v. Berryhill" on Justia Law

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Plaintiff filed suit under the Individuals with Disabilities Education Act (IDEA), alleging that the school district did not offer her daughter a free appropriate public education (FAPE). On appeal, the school district challenged an award in favor of plaintiff. The Fifth Circuit held, without adopting the characterization that the district court created a new category of IDEA private school student, that the district court's order could not be supported based on a requirement of temporary services for transfer students; plaintiff took a financial gamble of not being reimbursed when she placed her daughter in a private school without first allowing the school district to seek to comply with its obligations under IDEA; and, although the district court failed to recognize the proper private school placement, that failure did not create a penalty beyond what otherwise would be owed. Because the district court erred by holding that the school district was obligated to provide temporary services and by ordering reimbursement of the costs associated with such services, the court reversed in part. The court affirmed the district court's holding that the school district failed to make a timely offer of FAPE, thereby making reimbursement an appropriate form of relief. The court remanded for the district court to determine the amount of reimbursement owed from April 24, 2014, to the end of the school year. View "Dallas Independent School District v. Woody" on Justia Law

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Plaintiffs Chorches and Fabula filed a qui taim suit under the False Claims Act (FCA), 31 U.S.C. 3729 et seq., against AMR, alleging that AMR made false statements and submitted false Medicare and Medicaid claims. Plaintiff Fabula also alleged a retaliation claim. The Second Circuit vacated the district court's dismissal of the claims and held that Chorches has pled the submission of false claims with sufficient particularity under Fed. R. Civ. P. 9(b), as applied in the qui tam context, and that Fabula's refusal to falsify a patient report, under the circumstances of this case, qualified as protected activity. Accordingly, the court remanded for further proceedings. View "Fabula v. American Medical Response, Inc." on Justia Law

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The Ninth Circuit dismissed for lack of jurisdiction relators' appeal of the district court's dismissal of their qui tam suit against UOPX. The panel held that the appeal was untimely because relators' post-judgment motion, although styled as a Fed. R. Civ. P. 59(e) motion, was in substance a motion only to stay the entry of judgment, which did not toll the time to file a notice of appeal. View "United States ex. rel. Hoggett v. University of Phoenix" on Justia Law

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Federal Medicaid funds are not available for state medical expenditures made on behalf of “any individual who is an inmate of a public institution (except as a patient in a medical institution),” 42 U.S.C. 1396d(a)(29)(A). "Inmate of a public institution" means a person who is living in a public institution. However, an individual living in a public institution is not an “inmate of a public institution” if he resides in the public institution “for a temporary period pending other arrangements appropriate to his needs.” Ohio submitted a proposed plan amendment aimed at exploiting this distinction: it sought to classify pretrial detainees under age 19 as noninmates, living in a public institution for only “a temporary period pending other arrangements appropriate to [their] needs,” for whom the state could claim Medicaid reimbursement. The Centers for Medicare and Medicaid Services rejected the amendment, finding that the inmate exclusion recognizes “no difference” between adults and juveniles, or convicted detainees and those awaiting trial. The Sixth Circuit denied a petition for review, agreeing that the involuntary nature of the stay is the determinative factor. The exception does not apply when the individual is involuntarily residing in a public institution awaiting adjudication of a criminal matter. View "Ohio Department of Medicaid v. Price" on Justia Law

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By 2009 Vanprooyen’s physician had prescribed Xanax to treat her panic attacks. She was treated for anxiety, depression, and bipolar disorder. She had a history of addiction. In 2010, Vanprooyen, then age 26, fell down a flight of stairs and suffered a brain hemorrhage. She claimed post-traumatic stress disorder, short-term memory loss, attention-deficit hyperactivity disorder, seizures, and fibromyalgia. She was prescribed medication for pain, migraine headaches, and seizures. Vanprooyen applied for Disability Insurance Benefits and Supplemental Security Income. An administrative law judge found her impairments to be severe but not disabling and denied benefits. The district court upheld the ALJ’s decision. The Seventh Circuit reversed, finding “serious deficiencies” in the ALJ’s analysis, which failed to mention that a state consultative examiner who had given Vanprooyen a mental-status examination concluded that she was unable to manage her own money because of her “emotional adjustment and medical difficulties,” although at least two of the three jobs that the ALJ found that Vanprooyen could do involve handling money. Without explanation, the ALJ gave substantial weight to the opinions of consulting physicians who had never examined Vanprooyen. An ALJ can reject an examining physician’s opinion only for reasons supported by substantial evidence; a contradictory opinion of a non-examining physician does not, alonef, suffice. View "Vanprooyen v. Berryhill" on Justia Law

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Claimants appealed the denial of civil claims under the Settlement Program that was established following the Deepwater Horizon oil spill. Claimants submitted Individual Economic Loss (IEL) claims for lost wages as employees of their architectural firm. The firm had already received a Business and Economic Loss (BEL) award under the Settlement Program. The Fifth Circuit held that the BEL framework, by compensating the business for the owners' lost wages through the fixed-cost designation of their wages, precluded compensating those same owners for the same wages through an IEL claim. Because the Settlement Program did not contemplate the requested compensation, the court affirmed the judgment. View "In Re: Deepwater Horizon" on Justia Law