Justia Public Benefits Opinion Summaries

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Immigrants have historically been eligible for various public benefits and the receipt of those benefits, with limited exceptions did not jeopardize the immigrant’s chances of becoming a lawful permanent resident or citizen. The Department of Homeland Security (DHS) issued a new rule, intended to prevent immigrants whom the Executive Branch deems likely to receive any amount of public assistance, from entering the country or adjusting their status. The rule purports to implement the “public charge” provision of 8 U.S.C. 1182(a)(4). The Seventh Circuit affirmed a preliminary injunction against the rule’s enforcement in favor of Cook County, Illinois. The county had standing because the law threatened immediate financial harm because it would cause immigrants to forego preventative health care. The interests of the county are among those protected or regulated by federal law. There is “abundant evidence” supporting the county’s interpretation of the “public charge provision” as being triggered only by long-term primary dependence and that provision does not provide DHS unfettered discretion. The rule is unlikely to survive “arbitrary and capricious” review; it is unclear how immigration officials are to make “public charge” predictions. Cook County lacks legal remedies for the harms imposed by the rule. View "Cook County v. Wolf" on Justia Law

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Ehnert was placed at WPP by Staffmark as a temporary general laborer. It was understood that Ehnert would be considered for hire as a WPP employee. Ehnert suffered from various medical conditions but never requested accommodations. On May 23, 2012—the last day of his work placement—Ehnert was informed that he would not be hired by WPP. Ehnert completed applied for social security disability insurance (SSDI) benefits, representing that he had been unable to work due to a “disabling condition” since May 21, 2012. An ALJ granted Ehnert benefits. Ehnert then sued WPP and Staffmark, alleging discrimination on the basis of disability and age, under the Americans with Disabilities Act, the Pennsylvania Human Relations Act, and the Age Discrimination in Employment Act. The Third Circuit affirmed summary judgment for the defendants. Ehnert was unable to establish a prima facie case of discrimination because a necessary element was lacking for his ADA and PHRA claims--that he was otherwise qualified to perform the essential functions of the job as of the date WPP informed him that he would not be hired. Ehnert’s statements regarding his disability for SSDI purposes preclude his subsequent claim that, for the purposes of the ADA and the PHRA, he was “qualified” for the position; Ehnert failed to advance a reasonable explanation that reconciles those positions. View "Ehnert v. Washington Penn Plastic Co Inc." on Justia Law

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The First Circuit affirmed the district court's judgment reversing the magistrate's order that had quashed an administrative subpoena duces tecum as to the recordings of certain telephone conversations, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that an employer's interception of the telephone calls was intentional. When investigating whether Patient Services, inc. (PSI) had engaged in an illegal kickback scheme, the Government issued an administrative subpoena duces tecum to PSI for all recorded conversations of PSI officers and employees. This appeal concerned conversations that were recorded on the extension of Karen Middlebrooks. Middlebrooks's telephone conversations were recorded while she was working in PSI's call center on the second floor where calls were regularly recorded. At issue was whether PSI intentionally continued recording Middebrooks's calls after her transfer to the third floor, where calls were not regularly recorded, in violation of Title III of the Omnibus Crime Control and Safe Streets Act. The magistrate judge ruled that the recordings violated Title III. The district court reversed. The First Circuit affirmed, holding that the magistrate judge clearly erred in finding that Appellants met their burden of proving that PSI's interception of calls from Middlebrooks's extension after her move to the third floor was intentional. View "In re HIPAA Subpoena" on Justia Law

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The Supreme Court affirmed the district court's judgment affirming a state agency's denial of Medicaid eligibility after J.S., a noncitizen who was admitted into the bridge to independence program (B2I), reached age nineteen, holding that the statutes and regulations cited by J.S. did not authorize her participation despite her immigration status and age. B2I, Nebraska's extended foster care program, was created by the Young Adult Bridge to Independence Act (YABI), Neb. Rev. Stat. 43-4501 to 43-4514. J.S., a citizen of El Salvador who fled to Nebraska as a minor, was adjudicated in juvenile court and placed into foster care. Upon turning nineteen years old, J.S. was accepted into B2I but was denied Medicaid coverage after her nineteenth birthday. The Nebraska Department of Health and Human Services (DHHS) upheld the denial of Medicaid benefits. At issue on appeal was whether J.S. could receive Medicaid under B2I. The district court concluded that because the Nebraska Legislature did not affirmatively provide for unlawful aliens to receive Medicaid benefits under B2I, J.S. was not entitled to Medicaid benefits. The Supreme Court affirmed, holding that the district court did not err in determining that J.S. was not eligible for Medicaid. View "J.S. v. Nebraska Department of Health & Human Services" on Justia Law

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Holloway, the qui tam relator, sued Heartland Hospice and related entities under the False Claims Act (FCA), 31 U.S.C. 3729-3733, for orchestrating a corporate-wide scheme to submit false claims for payments from Medicare and Medicaid to cover hospice care. Heartland allegedly enrolled patients in hospice when they were not terminally ill and kept them there, even when employees like Holloway urged their release and allegedly paid bonuses for the recruitment of hospice patients. Heartland argued that Holloway is not a genuine whistleblower, that her claims are drawn from prior allegations against Heartland so that her qui tam action is prohibited by the FCA’s public-disclosure bar. In the alternative, Heartland argued that Holloway has not satisfied the FCA’s heightened pleading standard for allegations of fraud or the limited exception to that standard. The Sixth Circuit affirmed the dismissal of Holloway’s action as barred in light of prior public disclosures. Even if South Carolina complaints, dismissed in 2008, were focused on a single hospice facility, the allegations against Heartland as a whole were sufficiently general and alike to those alleged here such that the government was put on notice of the corporate-wide conduct alleged in this case. Holloway’s claims are barred by the pre-amendment public-disclosure bar. View "Holloway v. Heartland Hospice, Inc." on Justia Law

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The Eighth Circuit reversed the district court's order affirming the ALJ's denial of plaintiff's application for disability benefits. The court held that the ALJ's error in failing to provide good reason for giving plaintiff's treating psychiatrist's opinion limited weight was not harmless error. In this case, the failure to comply with SSA regulations is more than a drafting issue, it is legal error. Furthermore, the court cannot determine whether the ALJ would have reached the same decision denying benefits, even if the ALJ had followed the proper procedure for considering and explaining the value of the psychiatrist's opinion. Accordingly, the court remanded for further administrative proceedings and for reconsideration of plaintiff's claims. View "Lucus v. Saul" on Justia Law

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Petitioner John Halaseh petitioned the Colorado Supreme Court to review a court of appeals' remand order to his underlying appeal, which directed the district court to enter four convictions for class 4 felony theft in place of the single conviction of class 3 felony theft that was reflected in the charge and jury verdict. The appellate court reversed the class 3 felony on grounds that when the statutory authorization for aggregating separate acts of theft was properly applied, there was insufficient evidence to support a single conviction for theft of $20,000 or more. It also found, however, that there was sufficient evidence to support four separate convictions for aggregated thefts with values qualifying as class 4 felonies, and that substituting these four class 4 felony convictions for the vacated class 3 felony conviction was necessary to fulfill what it understood to be its obligation to maximize the effect of the jury’s verdict. The Supreme Court disapproved of the appellate court's judgment, finding no theft offense required the aggregation of two or more separate instances of theft, whether that aggregation were to be based on commission within a period of six months or on commission as a single course of conduct, was a lesser included offense of the class 3 felony of which Halaseh was actually charged and convicted. Further, no such offense was implicitly found by the jury, and therefore none could be entered in lieu of the reversed conviction without depriving the defendant of his right to a jury trial. The matter was remanded for further proceedings. View "Halaseh v. Colorado" on Justia Law

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Methodist Specialty Care Center was the only nursing facility for the severely disabled (NFSD) in Mississippi. NFSDs generally incur higher costs than other nursing facilities, and because of this, Methodist received a percentage adjustment to its new-bed-value (NBV) calculation when the Mississippi Division of Medicaid (DOM) determined how much it should reimburse Methodist for its property costs through the DOM’s fair-rental system. A NBV was intended to reflect what it would cost to put a new bed into service in a nursing facility today. Methodist had received a NBV adjustment of 328.178 percent added to the standard NBV every year since it opened in 2004 until State Plan Amendment (SPA) 15-004 was enacted. During the 2014 Regular Session, the Mississippi Legislature passed House Bill 1275, which authorized the DOM to update and revise several provisions within the State Plan; one such amendment changed Methodist's adjustment rate, and made the facility experience a substantial decrease in its NBV, while all other nursing facilities in the state received increases. Methodist appealed the DOM’s changes to its NBV that were enacted in SPA 15-004. After a hearing, an Administrative Hearing Officer (AHO) upheld the decreased percentage adjustment to Methodist’s NBV, but also determined the DOM had miscalculated Methodist’s NBV adjustment. The DOM had planned to calculate Methodist’s adjustment as 175 percent of the base NBV, but the AHO found that Methodist’s adjusted NBV should be calculated in the same manner as it was calculated preamendment - by taking 175 percent of the standard NBV and adding that value to the standard NBV. Methodist still felt aggrieved because its NBV adjustment rate had not been restored to the preamendment rate. Methodist appealed the DOM’s final decision to the Chancery Court. When the chancellor affirmed the DOM’s final decision, Methodist appealed to the Mississippi Supreme Court. After review, the Supreme Court found the DOM’s final decision was supported by substantial evidence, was not arbitrary or capricious, did not violate Methodist’s constitutional or statutory rights and that the DOM was acting within its power in reaching and adopting its final decision. View "Methodist Specialty Care Center v. Mississippi Division of Medicaid" on Justia Law

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Justice, employed as a workers’ compensation claims adjuster since 1991, fell at work in 2011 and injured her left knee. She later developed problems in her right knee, which was found to be a compensable consequence of the first injury. In 2012-2013 Justice had total bilateral knee replacement. Dr. Anderson, an orthopedic surgeon, testified that there was significant preinjury degeneration in both knees, that knee replacement was not required because of the meniscus tear, and that the fall “hasten[ed]” the need for knee replacement by “lighting up the underlying pathology.” Anderson apportioned 50 percent of the bilateral knee disability to the nonindustrial, preexisting degeneration. The workers’ compensation judge determined that Justice had sustained permanent partial disability of 48 percent, worth $59,110.00, stating that “the need for these surgeries was at least partially non-industrial. … the surgeries appear to have significantly increased [Justice’s] ability to walk and engage in weight-bearing activities. The judge stated that before the 2017 Hikida decision, he would have awarded permanent disability with 50% apportionment but that Hikida precluded apportionment. The Appeals Board affirmed. The court of appeal annulled the decision. Justice's permanent disability should have been apportioned between industrial and nonindustrial causes. Hikida, in which a medical treatment resulted in a new compensable consequential injury, is distinguishable. Here, there was unrebutted substantial medical evidence that Justice’s permanent disability was caused, in part, by preexisting pathology. Apportionment was required. Whether or not the workplace injury “directly caused” the need for surgery, the apportionment statutes demand that the disability be sorted among direct and indirect causal factors. View "County of Santa Clara v. Workers' Compensation Appeals Board" on Justia Law

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In 2012, Lozano gave birth to a baby. While still hospitalized, Lozano received a tetanus-diphtheria-acellular-pertussis (Tdap) vaccination. Two weeks later, Lozano reported a low-grade fever, body aches, and breast tenderness. Lozano’s symptoms persisted through visits to her physician and the emergency room. She developed abdominal pain, difficulty urinating, weakness, loss of balance, vision changes, neck pain, headache, vomiting, and dizziness. A brain MRI suggested that Lozano possibly had multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), or vasculitis. Lozano’s symptoms improved with steroid treatment, following a working diagnosis of MS. After several months, a repeat MRI “showed dramatic improvement, suggesting that ADEM was a more likely etiology, which was confirmed through later serological findings.” Lozano’s doctors opine that ADEM is the likely explanation for her symptoms. Lozano sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa. Lozano’s expert opined that Lozano’s ADEM was the result of her receipt of the Tdap vaccine. The special master granted Lozano’s petition, finding that her expert’s testimony and the supporting medical literature demonstrated that the Tdap vaccine can cause autoimmune diseases such as ADEM and that Lozano offered preponderant evidence of a proximate temporal relationship between the vaccine and her injury. The Claims Court and Federal Circuit upheld the award of a lump-sum payment of $1,199,216.86, finding that the decision was neither an abuse of discretion nor contrary to law and that the fact-findings were neither arbitrary nor capricious. View "Lozano v. Secretary of Health and Human Services" on Justia Law