Justia Public Benefits Opinion Summaries

Wisconsin provides transportation to private-school students, limited to only one school “affiliated or operated by a single sponsoring group” within any given attendance area. The state superintendent decided that St. Augustine, a freestanding entity that describes itself as Catholic but independent of the church’s hierarchy, is “affiliated with or operated by” the same sponsoring group as St. Gabriel, which is run by the Catholic Archdiocese.In 2018, the Seventh Circuit rejected a suit by St. Augustine. The Supreme Court vacated and remanded for further consideration in light of intervening precedent. The Seventh Circuit then certified to the Wisconsin Supreme Court the question of how to determine “affiliation” under state law. That court responded: [I]n determining whether schools are “affiliated with the same religious denomination” [i.e., the same sponsoring group] pursuant to Wis. Stat. 121.51, the Superintendent is not limited to consideration of a school’s corporate documents exclusively. In conducting a neutral and secular inquiry, the Superintendent may also consider the professions of the school with regard to the school’s self-identification and affiliation, but the Superintendent may not conduct any investigation or surveillance with respect to the school’s religious beliefs, practices, or teachings.The Seventh Circuit then reversed. The Superintendent’s decision was not justified by neutral and secular considerations, but necessarily and exclusively rested on a doctrinal determination that both schools were part of a single sponsoring group—the Roman Catholic church—because their religious beliefs, practices, or teachings were similar enough. View "St. Augustine School v. Underly" on Justia Law

The Supreme Court held that Corpus Christi pharmacist John McNeill, who participated in a Medicaid drug program run by the Texas Health and Human Services Commission, was entitled to an administrative contested case hearing as to his challenge to the results of a program audit by the Commission.After the Commission audited McNeill, the auditor determined that McNeill had been overpaid by $69,911. McNeill requested a hearing, after which the Commission issued a final notice that reduced the overpayment amount to $64,549. McNeill thrice requested a contested case hearing before the State Office of Administrative Hearings. The Commission denied each request. McNeill sued the Commission, its commissioner, and its inspector general, seeking a declaration that he was entitled to a contested case hearing. The trial court granted the Commission's plea to the jurisdiction based on sovereign immunity and dismissed the complaint. The court of appeals reversed. The Supreme Court reversed, holding (1) McNeill's appeal was timely; and (2) the Commission's inspector general acted ultra vires in failing to perform her ministerial duty to provide McNeill a contested-case hearing under Tex. Gov't Code 531.1201, and the inspector general was not entitled to sovereign immunity. View "Phillips v. McNeill" on Justia Law

The Fifth Circuit affirmed the denial of social security disability benefits to plaintiff, concluding that the ALJ's residual function capacity (RFC) determination was supported by substantial evidence. The court also concluded that a consultive exam was not required where the ALJ's decision was based upon substantial evidence in a sufficiently developed record. Finally, the court concluded that plaintiff's remaining arguments were waived because he failed to raise them in the district court. View "Webster v. Kijakazi" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the trial court concluding that the Town of Fairfield may require James Gallagher and his wife to enroll in medicare but may also reimburse the costs of their Medicare Part B premiums, holding that the Town was not required to reimburse the Gallaghers for their Medicare premium costs.In 1985, when federal law did not permit municipal employees to participate in the Medicare system, the Town and its police union entered into a collective bargaining agreement providing that upon members who retired early, such as James, due to disability and their eligible dependents would be entitled to Town-paid private health insurance. An intervening change in federal law permitted retirees, such as James, to enroll in Medicare upon reaching the age of sixty-five. At issue was whether the Town was permitted to terminate James's private health insurance, provide him with comparable Town-paid Medicare supplemental insurance, and require that he bear the costs of his Medicare premium. The Supreme Court held that the trial court (1) properly concluded that the Town may require the Gallaghers to enroll in Medicare; but (2) erred in concluding that the Town must also reimburse the costs of the Gallaghers' Medicare premium costs. View "Gallagher v. Fairfield" on Justia Law

Plaintiff and her now-adult son K.S., a former high school student with a specific learning disability, filed suit under the Individuals with Disabilities in Education Act (IDEA), alleging that the school district neither provided K.S. with a free appropriate public education (FAPE) nor complied with procedural safeguards meant to ensure such.The Fifth Circuit affirmed the district court's decision affirming two administrative decisions concluding that the school district did not violate the IDEA's substantive and procedural requirements. The court reviewed the voluminous record and the magistrate judge's thorough report that the district court adopted, discerning no reversible error in the district court's holding that: (1) the school district did not violate its obligation to identify and evaluate K.S. as a student with a suspected disability; (2) the individualized education programs and transition plan created for K.S. complied with IDEA's substantive requirements; and (3) the school district's procedural foot-faults in failing to include K.S. for the first manifestation determination review and failing to consider certain relevant information were not actionable. View "H v. Riesel Independent School District" on Justia Law

In 2008, following a diagnosis of multiple sclerosis (MS), Karantsalis sued the city under the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 by failing to make its facilities and infrastructure accessible to individuals with disabilities. He later voluntarily dismissed the lawsuit, believing that he lacked constitutional standing because his symptoms were mild and did not prevent him from accessing and using the city’s programs or services. By 2019, Karantsalis’s MS and his symptoms had progressed dramatically: he had started falling, developed a limp, and needed a disabled parking permit. His neurologist had prescribed a wheelchair.He again sued the city under the ADA and Rehabilitation Act alleging the sidewalks, municipal gymnasium, and parking at public facilities were inaccessible. The district court dismissed the case with prejudice, holding that it was barred by the four-year statute of limitations, which was triggered before or during 2008 when Karantsalis became aware of his MS diagnosis. The Eleventh Circuit reversed. From the face of his complaint, Karantsalis’s injury did not occur until at least 2017. Karantsalis could not have sued before he lost his mobility and his ready access to and use of the city’s public services. View "Karantsalis v. City of Miami Springs" on Justia Law

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