Justia Public Benefits Opinion Summaries

Pupo first applied for supplemental security income (SSI) in June 2011, alleging that she was unable to work due to depression, body tremors, and high blood pressure. Her initial application was denied, but, in 2015, her case was remanded for further proceedings pursuant to sentence four of 42 U.S.C. 405(g). The district court affirmed the subsequent denial of Pupo’s application.The Fifth Circuit reversed and remanded. The decision is not supported by substantial evidence; the ALJ erred by not addressing one of Pupo’s medical diagnoses, her incontinence when assessing her residual functional capacity and the Appeals Council erred by not considering the new medical evidence submitted by Pupo following the ALJ’s denial of her SSI claim. Pupo submitted medical records showing that she had surgery because of her stress urinary incontinence nine days before the ALJ issued his decision. The ALJ did not err in failing to consider Pupo’s borderline age situation because he did not apply the grids mechanically but instead relied on testimony due to Pupo’s non-exertional limitations. View "Pupo v. Commissioner, Social Security Administration" on Justia Law

Family Rehab brought a procedural due process claim arguing that it is entitled to third step review before recoupment of Medicare overpayments. The district court granted summary judgment in favor of Family Rehab, and entered a permanent injunction barring HHS from recouping the disputed funds until the completion of third step review under 42 C.F.R. 405.1036(c)–(d).However, in reaching its decision, the district court did not have the benefit of the Fifth Circuit's decision in Sahara Health Care Inc. v. Azar, 975 F.3d 523 (5th Cir. 2020), in which the court rejected a similar due process claim under nearly identical facts. In this case, Family Rehab's claims all involve documentation issues that do not require cross-examination and credibility determinations. The court explained that Family Rehab's claims could have been resolved in the first two steps of administrative review by producing the relevant documents. Accordingly, the court reversed the district court's judgment. View "Family Rehabilitation, Inc. v. Becerra" on Justia Law

Plaintiffs, tenants living in substandard conditions in a "Section 8" housing project, filed suit seeking to compel HUD to provide relocation assistance vouchers. The Fifth Circuit held that, because 24 C.F.R. 886.323(e) mandates that HUD provide relocation assistance, its alleged decision not to provide relocation vouchers to plaintiffs is not a decision committed to agency discretion by law and is therefore reviewable. Furthermore, the agency's inaction here constitutes a final agency action because it prevents or unreasonably delays the tenants from receiving the relief to which they are entitled by law. Therefore, the district court has jurisdiction over plaintiffs' Administrative Procedure Act (APA) and Fair Housing Act (FHA) claims and erred in dismissing those claims.However, the court agreed with the district court that plaintiffs failed to state a claim for which relief can be granted on their Fifth Amendment equal protection claim. In this case, plaintiffs failed to state a plausible claim of intentional race discrimination. Accordingly, the court reversed in part, affirmed in part, and remanded for further proceedings. View "Hawkins v. United States Department of Housing and Urban Development" on Justia Law

Owsley. a nurse for Care Connection, a company providing home healthcare to Medicare patients, alleged that she observed, firsthand, documents showing that her employer had used fraudulent data from Fazzi to submit inflated claims for payment to the federal and Indiana state governments. She sued both companies under the False Claims Act, 31 U.S.C. 3729(a)(1)(A), (B), (C), (G), and an Indiana statute.The Sixth Circuit affirmed the dismissal of the suit. Owsley’s complaint provided few details that would allow the defendants to identify any specific claims—of the hundreds or likely thousands they presumably submitted—that she thinks were fraudulent, and did not meet the requirements of Civil Rule 9(b). While Owsley’s allegations describe, in detail, a fraudulent scheme: Fazzi fraudulently upcoded patient data, which Care then used to submit inflated requests for anticipated Medicare payments, that information does not amount to an allegation of “particular identified claims” submitted pursuant to the fraudulent scheme. View "Owsley v. Fazzi Associates., Inc." on Justia Law

Philbrook served in the Army, 2000-2004, then was awarded disability compensation for PTSD. In 2011, Philbrook stipulated to a judgment of “guilty except for insanity” in connection with a felony. He was ordered into the custody of the Oregon State Hospital “under the jurisdiction of the Psychiatric Security Review Board . . . for care, custody, and treatment for a maximum period not to exceed 20 years.” Philbrook then applied for total disability based on individual unemployability (TDIU).A VA regional office concluded that Philbrook’s PTSD did not entitle him to TDIU because it did not preclude gainful employment. The Board of Veterans’ Appeals denied TDIU “as a matter of law”; 38 U.S.C. 5313(c), precludes the assignment of a TDIU rating for any period “during which the veteran is incarcerated in a Federal, State, local, or other penal institution or correctional facility for conviction of a felony.” The Veterans Court affirmed.The Federal Circuit reversed. Philbrook was not confined in a “penal institution or correctional facility”; he was committed to a mental institution, “a hospital for people with mental or emotional problems.” The term “correctional facility” cannot encompass a hospital that treats civil patients, and a hospital cannot be a correctional facility for some patients and not others. View "Philbrook v. McDonough" on Justia Law

The Ninth Circuit reversed the district court's decision affirming the ALJ's 2019 decision denying claimant's application for social security disability benefits. The panel concluded that, although the ALJ's conclusion that claimant was not disabled at the time of the hearing was supported by substantial evidence, the ALJ did not adequately consider claimant's symptoms over time. The panel explained that the ALJ's failure to consider these changes over time impacted both her assessment of claimant's credibility and her analysis of the medical opinions. Therefore, on remand, the ALJ shall consider whether claimant was disabled and thus entitled to benefits, for some qualifying, earlier portion of his alleged disability period. View "Smith v. Kijakazi" on Justia Law

This case arose from the cancellation of long-term-care Medicaid benefits for two claimants when an Oklahoma agency concluded that the claimants’ resources exceeded the regulatory cap for eligibility. One claimant, Idabelle Schnoebelen died, mooting her claim. The eligibility of the other claimant, Nelta Rose, turned on whether her resources included a 2018 promissory note. In 2017 and 2018, Rose loaned money to her daughter-in-law in exchange for three promissory notes. The daughter-in-law provided the first two promissory notes in 2017 (before Rose applied for Medicaid benefits). The Oklahoma Department of Human Services initially approved Rose for Medicaid, declining to regard the 2017 promissory notes as resources. In 2018, the daughter-in-law provided the third promissory note. But the Department of Human Services concluded that the 2018 promissory note: (1) was a resource because the payment to the daughter-in-law did not constitute a bona fide loan; and (2) was a deferral that turned the 2017 promissory notes into resources. The extra resources put Rose over the eligibility limit for Medicaid, so the Department of Human Services cancelled Rose’s benefits. A district court concluded that the agency’s conclusion did not conflict with federal law. In the Tenth Circuit's view, however, a reasonable factfinder could disagree. Summary judgment was reversed and the matter remanded for further proceedings. View "Baker, et al. v. Brown, et al." on Justia Law

Wade filed her claim for Social Security Disability Insurance benefits and Supplemental Security Income in 2015. An ALJ denied Wade’s claim in 2017, finding her not disabled. Following an unsuccessful administrative appeal, Wade filed suit, seeking leave to proceed in forma pauperis (IFP). The district court granted Wade’s IFP motion and, in 2020, entered judgment in the Commissioner’s favor. Wade proceeded IFP with her appeal. The Ninth Circuit found that the ALJ erred, reversed the order affirming the denial of benefits, and remanded for further administrative review. Wade then submitted a bill of appellate costs, seeking $169.65 from the government for copies of briefs and excerpts of record.The Ninth Circuit denied the request. A party who proceeds IFP and prevails on appeal is not entitled to recover taxable costs from the United States, 28 U.S.C. 1915(f)(1); “judgment may be rendered for costs at the conclusion of the suit or action as in other proceedings, but the United States shall not be liable for any of the costs thus incurred.” View "Wade v. Kijakazi" on Justia Law

Alliance alleged that County and City policies and inaction have created a dangerous environment in the Skid Row area, claiming that the County violated its mandatory duty to provide medically necessary care and that the municipalities have facilitated public nuisance violations by failing to clear encampments, violated disability access laws by failing to clear sidewalks of encampments, and violated constitutional rights by providing disparate services to those within the Skid Row area and by enacting policies resulting in a state-created danger to area residents and businesses. The district court issued a preliminary injunction, ordering the escrow of $1 billion to address homelessness, offers of shelter to all unhoused individuals in Skid Row within 180 days, and numerous reports. The court found that structural racism was behind Los Angeles’s homelessness crisis and its disproportionate impact on the Black community.The Ninth Circuit vacated. The plaintiffs lacked standing on all but their ADA claim; no claims were based on racial discrimination. The district court impermissibly resorted to independent research and extra-record evidence. There was no allegation that any individual plaintiff was Black nor that there was a special relationship between the City and unhoused residents nor that any individual plaintiff was deprived of medically necessary care or general assistance. Two plaintiffs who use wheelchairs and cannot traverse Skid Row sidewalks because of homeless encampments had standing to bring ADA claims but had not shown a likelihood of success on the merits. View "LA Alliance for Human Rights v. County of Los Angeles" on Justia Law

Plaintiff appeals the district court's order affirming the ALJ's denial of his application for supplemental security income (SSI) benefits, pursuant to 42 U.S.C. 1383(c). Plaintiff contends that the ALJ erred by ruling that he could perform a job with level 3 reasoning after finding that his residual functional capacity limited him to simple, routine, and repetitive tasks, and by basing the number of available jobs on unreliable vocational expert testimony.The Eleventh Circuit joined the Fourth, Ninth, and Tenth Circuits and held that there is an apparent conflict between a limitation to simple, routine, and repetitive tasks and the demands of level 3 reasoning. Because the ALJ did not address that apparent conflict—as required by precedent—and because the court cannot say that the error was harmless, the court reversed and remanded for further proceedings. View "Viverette v. Commissioner of Social Security" on Justia Law