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An educational agency does not commit a per se violation of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1414, by not specifying the anticipated school where special education services will be delivered within a child's individualized education program. The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought on behalf of a student under the IDEA. The panel held that the IDEA did not require identification of the anticipated school where special education services would be delivered in light of the student's planned move to a new school district. Therefore, the student was not denied a free appropriate public education because of a purported procedural error. View "Rachel H. v. Department of Education, State of Hawaii" on Justia Law

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An employee continued to work for over ten years after a job-related knee injury but had multiple surgeries on her injured knee. Over time, her employer made several permanent partial impairment payments, and she was eventually determined to be permanently and totally disabled because of the work injury. She began to receive Social Security disability at about the same time she was classified as permanently and totally disabled for workers’ compensation. Her employer asked the Alaska Workers’ Compensation Board to allow two offsets to its payment of permanent total disability (PTD) compensation: one related to Social Security disability benefits and one related to the earlier permanent partial impairment (PPI) payments. The Board established a Social Security offset and permitted the employer to deduct the amount of previously paid PPI. The employee appealed to the Alaska Workers’ Compensation Appeals Commission, arguing that the Board had improperly applied one of its regulations in allowing the PPI offset and had incorrectly calculated the amount of the Social Security offset. She also brought a civil suit against the State challenging the validity of the regulation. The State intervened in the Commission appeal; the lawsuit was dismissed. The Commission reversed the Board’s calculation of the Social Security offset and affirmed the Board’s order permitting the PPI offset. The employer appealed the Commission’s Social Security offset decision to the Alaska Supreme Court, and the employee cross- appealed the PPI offset. The Court affirmed that part of the Commission’s decision reversing the Board’s calculation of the Social Security disability offset and reversed that part of the Commission’s decision permitting an offset for permanent partial impairment benefits. The case was remanded back to the Commission for further proceedings. View "Alaska Airlines, Inc. v. Darrow" on Justia Law

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New York's intestacy law, as it existed in 2013 at the time of the agency's final determination, did not permit children conceived posthumously to inherit via intestacy. In this case, plaintiff had conceived twins via in vitro fertilization eleven years after her husband, the donor spouse, died. Plaintiff filed applications for child's survivors' benefits, based on her husband's earnings history, with the Social Security Administration. The Second Circuit held that, under the applicable provisions of New York's Estates, Powers and Trusts Law (EPTL) in effect at and prior to the time of the agency's final decision, the twins were not entitled to inherit from the decedent in intestacy. Accordingly, the court affirmed the district court's denial of benefits. View "MacNeil v. Berryhill" on Justia Law

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A claimant must, at a minimum, raise the issue of the accuracy of the vocational expert's estimates at some point during administrative proceedings to preserve the challenge on appeal in federal district court. The Ninth Circuit affirmed the denial of plaintiff's application for disability insurance benefits. In this case, the ALJ's residual functional capacity determination was supported by substantial evidence and there was no inconsistency between the opinions of two physicians regarding his capability for interaction with colleagues. Furthermore, plaintiff waived his challenge to the vocational expert's job numbers where he did not suggest that the vocational expert's job estimates might be unreliable at any point during administrative proceedings. View "Shaibi v. Berryhill" on Justia Law

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Rosewood is a skilled nursing facility, 42 U.S.C. 1395i-3(a), participating in Medicare and Medicaid as a provider. The Secretary of Health and Human Services, which enforces the statutory and regulatory provisions governing nursing homes operating in the Medicare/Medicaid network, assessed a civil monetary penalty against Rosewood on the grounds that it had failed to protect a resident from abuse, failed to timely report or to investigate thoroughly allegations of abuse, and failed to implement its internal policies on abuse, neglect, and misappropriation of property. The Centers for Medicare and Medicaid Services (CMS) determined that these deficiencies placed residents in “immediate jeopardy.” An Administrative Law Judge and the Department Appeals Board affirmed the $6,050 per day penalty imposed by CMS. The Seventh Circuit affirmed. Substantial evidence supports the Agency’s findings. The court noted three specific examples of noncompliance and concluded that there was a systemic failure to implement Rosewood’s policies aimed at conforming to federal regulations View "Rosewood Care Center of Swansea v. Price" on Justia Law

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Gazelle served in the U.S. Army, 1962-1965, and incurred service-connected disabilities. He receives compensation for: degenerative disc disease and joint disease of the cervical spine rated at 20 percent; degenerative disc disease and spondylosis of the thoracolumbar spine rated at 20 percent; left upper extremity radiculopathy rated at 10 percent; left lower extremity radiculopathy rated at percent; and post-traumatic stress disorder. In 2009, the VA increased Gazelle’s disability rating for his service-connected PTSD to 100 percent. Gazelle filed a Notice of Disagreement, alleging the VA failed to award him additional special monthly compensation under 38 U.S.C. 1114(s)(1). In 2011, Gazelle was denied entitlement to special monthly compensation because he did not have additional service-connected “disabilities . . . independently ratable as [60 percent] or more disabling.” Instead of adding together Gazelle’s additional service-connected disabilities at their respective amounts, the VA calculated the independent additional rating via the combined ratings table pursuant to 38 C.F.R. 4.25 (2010), which resulted in a combined rating of 50 percent. In 2014, the Board affirmed. The Veterans Court and Federal Circuit affirmed, holding that consistent with the plain meaning of subsection 1114(s), the Board appropriately applied the combined ratings table to determine eligibility for special monthly compensation benefits. View "Gazelle v. Shulkin" on Justia Law

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Prime Hospitals provide inpatient services under the Medicare program, submitting payment claims to private contractors, who make initial reimbursement determinations. Prime alleged that many short-stay claims were subject to post-payment review and denied. Prime appealed through the Medicare appeal process. Prime alleged short-stay claims audits were part of a larger initiative that substantially increased claim denials and that the Center for Medicare & Medicaid Services (CMS) was overwhelmed by the number of appeals. CMS began offering partial payment (68 percent) in exchange for dismissal of appeals. Prime alleged that it executed CMS's administrative settlement agreement so that CMS was contractually required to pay their 5,079 Medicare appeals ($23,205,245). CMS ultimately refused to allow the Prime to participate because it was aware of ongoing False Claims Act cases or investigations involving the facilities. Prime alleged that the settlement agreement did not authorize that exclusion. The district court denied a motion to dismiss Prime’s suit but transferred it to the Court of Federal Claims. The Federal Circuit affirmed in part. The breach of contract claim is fundamentally a suit to enforce a contract and does not arise under the Medicare Act, so the Claims Court has exclusive jurisdiction under the Tucker Act, 28 U.S.C. 1491. That court does not have jurisdiction, however, over Prime’s alternative claims seeking declaratory, injunctive, and mandamus relief from an alleged secret and illegal policy to prevent and delay Prime from exhausting administrative remedies. View "Alvarado Hospital, LLC v. Cochran" 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 insurance benefits and supplemental security income. The court held that the ALJ erred in relying on his own inferences about what plaintiff's medical providers meant when they noted in her medical records that she was in "no acute distress" and had "normal movement of all extremities" to determine her residual functioning capacity. The court explained that remand was necessary so the ALJ may conduct further inquiry as to what relevance plaintiff's being in "no acute distress" and having "normal movement of all extremities" has in terms of plaintiff's ability to function in the workplace. View "Combs v. Berryhill" on Justia Law

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The Ninth Circuit reversed the district court's decision affirming the Commissioner's denial of plaintiff's application for disability insurance benefits and supplemental security income benefits. The panel held that the ALJ committed legal error when she failed to provide legally sufficient reasons to discount the opinions of examining psychologist Dr. Hart, and when she failed to provide germane reasons to discount the opinions of treating nurse practitioner Dr. Sorrell; the ALJ's error in discounting these opinions permeated her hypothetical to the vocational expert regarding the availability of a significant number of jobs in the national economy that plaintiff could perform; and therefore the panel remanded for an award of benefits. View "Popa v. Berryhill" on Justia Law

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The Hospitals challenged HHS's implementation of a Medicare outlier-payment program in the late 1990s and early 2000s. The Hospitals contend that HHS violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by failing to identify and appropriately respond to flaws in its methodology that enabled certain "turbo-charging" hospitals to manipulate the system and receive excessive payments at the expense of non-turbo-charging hospitals, including the Hospitals. The DC Circuit held that District Hospital Partners, L.P. v. Burwell, 786 F.3d 46 (D.C. Cir. 2015), controlled to the extent that the Hospitals repeated challenges decided in that case. In regard to the remaining challenges, the court affirmed the district court's denials of the Hospitals' motions to supplement the record and to amend their complaint, and its decision that HHS acted reasonably in a manner consistent with the Medicare Act in fiscal years (FYs) 1997 through 2003, and 2007. However, because HHS inadequately explained aspects of the calculations for FYs 2004 through 2006, the court reversed summary judgment in that regard and remanded for further proceedings. View "Banner Health v. Price" on Justia Law