Justia Public Benefits Opinion Summaries

The Fifth Circuit affirmed the district court's denial of a parent's motion for summary judgment against the school district for alleged procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA). The court held that the district court did not err in finding that the parent failed to meet her burden of showing that the school district violated the procedural requirements of the IDEA. In this case, none of the incidents the parent claimed amounted to a procedural violation and the court was not convinced that the student was denied a free and appropriate public education.The court also held that there were no substantive IDEA violations. The court was satisfied that the school district took the necessary steps to ensure that the student was being properly serviced under this individualized education plan, despite his absences. Accordingly, the court affirmed the district court's grant of the school district's motion for summary judgment. View "A. A. v. Northside Independent School District" on Justia Law

The Supreme Court affirmed the judgment of the trial court enjoining the application of Arizona statutes authorizing the recording of liens against third-party tortfeasors to allow hospitals to recover health care costs for Medicaid patients beyond the amounts provided by Medicaid, holding that the statues are preempted to the extent hospitals utilize them against third-party tortfeasors for "balance billing" to recover costs beyond Medicaid reimbursement.Plaintiffs were patients who were treated at defendant hospitals under the state's contract provider for the federal Medicaid program, which negotiates reimbursement rates with hospitals. Defendants recorded liens against the third-party tortfeasors who caused the patients' injuries in order to recover the remainder of their fees exceeding Medicaid reimbursement. Plaintiff brought this class action challenging the liens, arguing that Ariz. Rev. Stat. 33-931(A) and 36-2903.01(G)(4) (the lien statutes) were preempted by federal Medicaid law. The trial court enjoined application of the lien statutes. The Supreme Court affirmed, holding (1) Plaintiffs had a private right of action to challenge the lien statutes; and (2) the lien statutes are unconstitutional as applied. View "Ansley v. Banner Health Network" on Justia Law

The Eighth Circuit affirmed the denial of social security disability benefits to plaintiff, holding that substantial evidence supported the ALJ's residual functional capacity (RFC). The court held that the ALJ's finding that plaintiff can perform frequent but not constant grasping, handling, and fingering with her right arm is supported by substantial evidence. View "Pemberton v. Saul" on Justia Law

In 2011, K.G., age 48, received an influenza vaccination in advance of knee replacement surgery. Over the next several months, she experienced increasingly severe nerve pain in her hands, arms, feet, and legs; she succumbed to alcoholism, spent months in the hospital, and developed amnesia. In 2014, an Iowa state court declared K.G. incapable of caring for herself and, against K.G.’s will, appointed K.G.’s sister as her guardian. K.G. regained her mental faculties by May 2016. She then retained an attorney who filed her claim under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-1. A Special Master held that equitable tolling was not available during the period that K.G.’s sister acted as K.G.’s guardian and dismissed K.G.’s claim as not timely filed within the three-year statute of limitations. The Federal Circuit vacated. Equitable tolling is available in Vaccine Act cases and the appointment of a legal guardian is only one factor a court should consider when deciding whether equitable tolling is appropriate in a particular case. K.G. was not required to argue the legally irrelevant question of whether she personally was diligent while she was mentally competent and she preserved her argument that her legal representative exercised reasonable diligence under the circumstances. The Special Master erred in adopting a per se rule. View "K.G. v. Secretary of Health and Human Services" on Justia Law

Arthur Noreja appeals the denial of his claim for disability benefits. Noreja filed his disability claim in March 2012. In July 2013, following a hearing, an ALJ issued a detailed written order – exceeding 13 pages with single spacing – in which she denied Noreja’s claim. The ALJ found Noreja had several severe impairments, including “arthritis of the left upper extremity and right lower extremity,” “cognitive disorder,” and “headaches.” Nevertheless, the ALJ determined that these impairments (or a combination of the impairments) did not warrant relief. The ALJ found that Noreja had the residual functional capacity (“RFC”) to do “medium” work, subject to various limitations, and that there were “jobs that exist in significant numbers in the national economy” which Noreja could perform. The Appeals Council disagreed with the ALJ’s assessment, and remanded with direction for further proceedings. Once more, however, the ALJ determined that Noreja did not have “an impairment or combination of impairments” that warranted relief, reiterated that Noreja had the RFC to do "medium" work, subject to various limitations, and that there were jobs in existence "in significant numbers" which Noreja could perform. The ALJ did not obtain a new consultative mental examination before issuing her May 2016 decision, but she procured additional evidence regarding Noreja’s impairments. On appeal of the second ALJ decision, Noreja alleged the ALJ failed to follow an instruction in the Appeals Council's remand order. The Tenth Circuit held: (1) it had jurisdiction to determine whether an alleged ALJ violation of an Appeals Council order warranted reversal; but (2) the Court's “usual” review standards remained in force, meaning that the alleged violation was material only if it showed the ALJ meaningfully failed to apply the correct legal standards, or the denial of benefits was unsupported by substantial evidence; and (3) applying those standards here, the ALJ’s denial of Noreja’s application had to be affirmed. View "Noreja v. Commissioner, SSA" on Justia Law

Care Alternatives provides hospice care to New Jersey patients, employing “interdisciplinary teams” of registered nurses, chaplains, social workers, home health aides, and therapists working alongside independent physicians who serve as hospice medical directors. Former Alternatives employees filed suit under the False Claims Act, 31 U.S.C. 3729–3733 alleging that Alternatives admitted patients who were ineligible for hospice care and directed its employees to improperly alter those patients’ Medicare certifications to reflect eligibility. They retained an expert, who opined in his report that, based on the records of the 47 patients he examined, the patients were inappropriately certified for hospice care 35 percent of the time. Alternatives’ expert testified that a reasonable physician would have found all of those patients hospice-eligible. The district court determined that a mere difference of opinion between experts regarding the accuracy of the prognosis was insufficient to create a triable dispute of fact as to the element of falsity and required that the plaintiffs provide evidence of an objective falsehood. Upon finding they had not adduced such evidence, the court granted Alternatives summary judgment. The Third Circuit vacated, rejecting the objective falsehood requirement for FCA falsity. The plaintiffs’ expert testimony created a genuine dispute of material fact as to falsity. View "Druding v. Care Alternatives" on Justia Law

Under the GI Bill, the VA provides monetary benefits to veterans enrolled in “approved” “course[s] of education,” 38 U.S.C. 3483. Approval must be provided by the state approving agency (SAA) for the state where the educational institution is located. For online courses, the educational institution must obtain approval from the SAA where the institution’s “main campus” is located. The VA may discontinue educational assistance, after following certain procedures, if this requirement is not met. Ashford is a for-profit educational institution that provides online courses to veterans and others. In November 2017, the VA sent a Cure Letter to Ashford stating that Ashford’s online courses were not approved by the correct SAA, expressing its “inten[t] to suspend payment of educational assistance and suspend approval of new enrollments and re-enrollments [for Ashford’s online programs] in 60 days unless corrective action is taken.” The Letter noted the availability of a hearing before the Committee on Educational Allowances. Ashford sought review, contending that the Cure Letter “announces” new “rules” and that 38 U.S.C. 502 provided the court with jurisdiction to review those alleged rules. The Federal Circuit dismissed the petition, finding that the Cure Letter is not rulemaking or any other reviewable action; it is also not a final agency action under the Administrative Procedure Act. View "Ashford University, LLC v. Secretary of Veterans Affairs" on Justia Law

Strand served in the Navy for roughly 19-1/2 years until he was discharged under other than honorable conditions for firing a gun at his estranged wife. Strand was convicted in state court of three felonies. After his release from prison, Strand sought “corrections” to his service records, including a six-month credit so that he would have 20 years of service and be eligible for military retirement benefits. The Board for Correction of Naval Records recommended granting Strand’s request, citing his “overall record … of satisfactory service [including receiving numerous medals,].” The Secretary of the Navy rejected the Board’s recommendation, citing the seriousness of Strand’s convictions, the Navy’s core values, its practice in similar cases, and Strand’s supposed “long-standing history" of domestic violence issues. On remand, the Secretary also noted two early “counseling/warning” entries on Strand’s record and that Strand had already received “appropriate relief” in upgrading his service characterization to “General Under Honorable Conditions.” The Claims Court found the denial arbitrary.The Federal Circuit reinstated the denial. The Secretary reviewed the same record as the Board and drew a different, but supported, conclusion. Where a military officer has not unduly influenced the decision, a service secretary may reject the recommendation of a records correction board, even if supported by the record, if the rejection is not arbitrary or capricious, unsupported by substantial evidence, or otherwise contrary to the law. View "Strand v. United States" on Justia Law

Plaintiffs filed suit under the Individuals with Disabilities Education Act (IDEA), bringing a due process challenge to the school district's individualized education plan (IEP) and school placement before the Missouri Administrative Hearing Commission. The Commission affirmed the plan and placement, denying reimbursement. The district court reversed the Commission but limited the reimbursement award based on equitable considerations.The Eighth Circuit held that the school district violated the IDEA and the district court erred in limiting the award. As a preliminary matter, the court held that the school district's jurisdictional challenge was without merit; the school district's mootness challenge also failed; and the district court properly placed the burden on plaintiffs in the proceeding before it and correctly stated the standard of review on appeal.On the merits, the court held that the school district denied plaintiffs' son a free and appropriate education as required by the IDEA when it placed him at a school without direct occupational therapy or a sensory diet plan in place to address his autism-related issues. The court also held that an award limitation based on improvements to the school was inappropriate and inconsistent with the purposes of the IDEA because the school district failed to give any notice to plaintiffs. Furthermore, limiting an award based on improvements not communicated to plaintiffs was inconsistent with the IDEA's purpose. Accordingly, the court reversed the district court's limitation of tuition reimbursement and awarded full tuition reimbursement. View "D. L. v. St. Louis City School District" on Justia Law

The Supreme Judicial Court vacated the judgment of the superior court vacating a Department of Health and Human Services hearing officer's decision requiring AngleZ Behavioral Health Services to pay $392,603.31 in MaineCare reimbursements because of billing errors, holding that the superior court erred by finding that the Department did not submit proper evidence in support of some of its recoupment claims.After auditing the claims submitted by AngleZ between February 13, 2013 and July 20, 2013 The Department issued a notice of violation applying an error rate to all of AngleZ's claims during that time period. The Department ultimately sought a total recoupment of $392,603.31. A hearing officer concluded that the Department was correct in seeking 392,603.31 in recoupment, and the Department's acting commissioner adopted the recommendation. The superior court vacated the Commissioner's decision, concluding that the hearing officer's decision was not supported by substantial evidence. The Supreme Judicial Court vacated the superior court's judgment, holding that the hearing officer's decision was supported by substantial evidence and was neither arbitrary nor capricious. View "AngleZ Behavioral Health Services v. Department of Health and Human Services" on Justia Law