Articles Posted in Health Law

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The 2013 Public Employment Labor Relations Act (PELRA) did not infringe on the First Amendment rights of a group of parents who provide home care services to their disabled children. PELRA applied to persons who provide in-home care to disabled Medicaid recipients, and authorized covered employees to organize and to designate by majority vote an exclusive representative to negotiate employment terms with the state. The parents complained that the Act unconstitutionally compelled them to associate with the exclusive negotiating representative. Determining that the parents had Article III standing, the Eighth Circuit affirmed the district court's judgment and held that, under Minnesota State Board for Community Colleges v. Knight, the current version of PELRA allowed the homecare providers to form their own advocacy groups independent of the exclusive representative, and it did not require any provider to join the union. Therefore, the state did not impinge on the parents' right not to associate by recognizing an exclusive negotiating representative. View "Bierman v. Dayton" on Justia Law

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The Eighth Circuit granted Bussen's petition for review of the MSHA's issuance of a citation to Bussen. In this case, the Secretary claimed that Bussen violated federal regulation 30 C.F.R. 56.15005, which requires the use of certain fall-protection equipment at surface metal and nonmetal mines when working where there is a danger of falling. The court held that there was no evidence to support a conclusion that any miner approached the highwall edge when moving the pump cart or were otherwise working without safety belts and lines where there was a danger of falling. Therefore, substantial evidence did not support the ALJ's finding that Bussen violated section 56.15005. View "Bussen Quarries, Inc. v. Acosta" on Justia Law

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The Eighth Circuit affirmed the district court's grant of judgment on the pleadings to the Med and Avectus in a class action suit alleging that both federal and Arkansas Medicaid laws prohibited the Med from directly billing Medicaid beneficiaries. The court held that federal law did not bar the Med from attempting recovery from plaintiff or a liable third party because the Med had opted not to bill and to accept payment from Arkansas Medicaid. The court also held that, like the federal provisions, the Arkansas Medicaid statutes do not prohibit a medical provider from foregoing Medicaid’s guaranteed payment for covered services and opting instead to bill the patient or liable third parties directly. View "Robinett v. Shelby County Healthcare Corp." on Justia Law

Posted in: Health Law

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Act 900, Arkansas Code Annotated 17-92-507, an amendment to the state's then-existing maximum allowable cost (MAC) law that governed the conduct of pharmacy benefits managers, was preempted by the Employee Retirement Income Security Act (ERISA) and Medicare Part D statutes. The Eighth Circuit affirmed the district court's ERISA ruling in this case, but reversed the Medicare Part D ruling. The court remanded for entry of judgment for PCMA. View "Pharmaceutical Care Management v. Rutledge" on Justia Law

Posted in: ERISA, Health Law

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After plaintiff's son was denied coverage related to gender reassignment services and surgery, plaintiff filed suit against Essentia and the health insurance plan's third party administrator for sex based discrimination in violation of Title VII of the Civil Rights Act of 1964, the Minnesota Human Rights Act (MHRA), and the Affordable Care Act (ACA). The Eighth Circuit held that plaintiff was not discriminated against on the basis of her own sex, and the protections of Title VII and the MHRA do not extend to discrimination based on her son's sex. Therefore, the court affirmed as to this issue. The court reversed the district court's dismissal of plaintiff's ACA claim based on lack of Article III standing, holding that plaintiff has alleged an injury cognizable under Article III because she contends that defendants' discriminatory conduct denied her the benefits of her insurance policy and forced her to pay out of pocket for some of her son's prescribed medication. View "Tovar v. Essentia Health" on Justia Law

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Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-33, alleging that his former employer, AAKC, violated the FCA by submitting claims for Medicare reimbursement of anesthesia services at the “Medical Direction” rate. Relator alleged that, because AAKC anesthesiologists were not present in the operating room during patients’ “emergence” from anesthesia, and therefore AAKC did not comply with the Medicare conditions of payment for submitting such claims. The district court granted AAKC summary judgment. The court granted the United States leave to appear as amicus curiae supporting neither party. The court concluded that, because the agency had not clarified an obvious ambiguity in its Step Three regulation for decades, AAKC’s failure to obtain a legal opinion or prior CMS approval cannot support a finding of recklessness. The court also concluded that the district court did not abuse its discretion in refusing to consider a new theory first articulated in relator's summary judgment papers. Finally, the court rejected relator's claim that AAKC violated 42 C.F.R. 415.110(b). Accordingly, the court affirmed the judgment. View "Donegan v. Anesthesia Assoc." on Justia Law

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SEARK, operator of two hospice-care facilities, voluntarily entered into a provider agreement with the Secretary of Health and Human Services to receive Medicare reimbursement pursuant to the Medicare Act, 42 U.S.C. 1395c, 1395f(a)(7), 1395cc. The Act annually caps Medicare reimbursement. SEARK filed suit after the Secretary sent it seven demands for repayment, arguing that the cap violates the Takings Clause of the Fifth Amendment. The district court concluded that SEARK’s voluntary participation in the Medicare program precludes a takings claim. The court concluded that SEARK has not met its burden to prove the demands for repayment based on the statutory cap are a taking where the reimbursement cap allocates the government's capacity to subsidize healthcare; SEARK presented no evidence to suggest the cap makes it impossible to profitably engage in their business; and SEARK voluntarily chose to participate in the Medicare hospice program. Accordingly, the court affirmed the judgment. View "Southeast Arkansas Hospice v. Burwell" on Justia Law

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Plaintiffs, six homecare providers, filed suit challenging Minnesota's Individual Providers of Direct Support Services Representation Act, Minn. Stat. 179A.54, 179A.06. The Act allows homecare providers for Medicaid program participants to unionize. The court concluded that the district court properly dismissed plaintiffs' Supremacy Clause claim because the National Labor Relations Act (NLRA), 29 U.S.C. 152, does not preempt Minnesota's regulation of domestic service workers; plaintiffs' state preemption argument against the SEIU failed because even if the state laws conflict irreconcilably, the law passed most recently by the legislature controls and thus the Act trumps the older statute's definition of "employees;" the district court properly dismissed the providers' tortious interference claim against the state defendants because federal courts are unable to order state officials to conform their conduct to state law; and the district court properly dismissed plaintiffs' Contract Clause claims where plaintiffs did not have authority to negotiate compensation or benefits terms with program participants. Accordingly, the court affirmed the judgment. View "Greene v. Dayton" on Justia Law

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The Departments of Health and Human Services (HHS), Labor (DOL), and Treasury appealed a preliminary injunction that enjoins the government from enforcing the contraceptive mandate provisions of the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg-13(a)(4), and its implementing regulations against nonprofit religious organizations that offer healthcare coverage to their employees. The district court’s order also enjoined the government from enforcing the challenged provisions against “any insurance provider (including insurance issuers and third-party administrators) offering health insurance to” the organizations. The Eighth Circuit affirmed, stating that by coercing the organizations to participate in the contraceptive mandate and accommodation process under threat ofsevere monetary penalty, the government has substantially burdened their exercise of religion. Even assuming that the government’s interests in safeguarding public health and ensuring equal access to health care for women are compelling,the contraceptive mandate and accommodation process likely are not the least restrictive means of furthering those interests. View "Dordt College v. Burwell" on Justia Law

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Smiley, a resident of Monroe County, Arkansas, was severely injured when a vehicle driven by Medford, a resident of Woodruff County, struck Smiley’s vehicle. The accident occurred in Monroe County. Smiley was transported to the Med, a medical center in Memphis, Tennessee, where he received care before dying from his injuries. Under the Tennessee Hospital Lien Act, the Med filed a lien for the unpaid balance of over $355,000 in Tennessee and mailed copies to the attorneys for Smiley’s estate. After negotiating with Medford’s insurer, the administratrix for Smiley’s estate petitioned the probate court to authorize a settlement of $700,000. That court noted that no medical liens had been filed in Monroe County and that the Med’s lien was void and unenforceable in Arkansas as the Med did not follow the requirements of the Arkansas Medical, Nursing, Hospital, and Ambulance Service Lien Act. None of the settlement proceeds were paid to the Med, which filed suit in federal court, claiming impairment of its hospital lien. The court granted summary judgment, concluding that Arkansas law applied and would not permit the Med to recover. The Eighth Circuit vacated. The district court failed to identify the elements of a hospital lien impairment action. Viewed as a claim for damages for lien impairment, significant issues remain unaddressed. View "Shelby Cnty. Health Care Corp v. So. Farm Bureau Cas. Ins. Co." on Justia Law

Posted in: Health Law