Articles Posted in 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

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In 1997, after his third DWI arrest, Scheffler’s driving privileges were cancelled. Scheffler successfully completed a one-year abstinence-only program, and in 1998, was issued a driver’s license with the restriction that he abstain from use of alcohol. After a 1999 cancellation of his license, Scheffler was completed a three-year rehabilitation program and received a restricted license in 2002. In 2010, Scheffler was arrested for DWI and, to obtain a new restricted license, had to either complete a six-year rehabilitation program or submit to an Ignition Interlock Program. Scheffler sued, claiming Americans with Disability Act violations based on perceived alcoholism. The district court dismissed. The Eighth Circuit affirmed. ADA defines a disabled person as having a physical or mental impairment that substantially limits one or more major life activities, having a record of such an impairment, or being regarded as having such an impairment, 42 U.S.C. 12102(1). Alcoholism may qualify when it limits a major life activity. Scheffler did not claim to actually be an alcoholic or that alcoholism limits a major life activity. DWI does not, alone, establish that he is an alcoholic. There was no allegation that Scheffler has ever been diagnosed as an alcoholic or that Scheffler suffers from a substantial limitation to a major life activity. View "Scheffler v. Dohman" on Justia Law

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The Patient Protection and Affordable Care Act (ACA) creates “navigators,” to assist consumers in purchasing health insurance from exchanges, 42 U.S.C. 18031(i), and authorizes the Department of Health and Human Services to establish standards for navigators and exchanges. HHS regulations recognize: federal navigators, certified application counselors (CACs), and non-navigator assistance personnel. They conduct many of the same activities, but federal navigators have more extensive duties. Plaintiffs, federally-certified counselor designated organizations, employ CACs. The federal government established a Missouri Federally Facilitated Exchange. The Health Insurance Marketplace Innovation Act (HIMIA), Mo. Rev. Stat. 376.2000, regulates “person[s] that, for compensation, provide[] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange.” Regulatory provisions dictate what state navigators and cannot do. Plaintiffs challenged: the definition of state navigators; three substantive provisions; and penalty provisions. The district court granted a preliminary injunction, finding that the ACA preempted HIMIA. The Eighth Circuit affirmed in part, finding likelihood of success in challenges to HIMIA requirements that: state navigators refrain from providing information about health insurance plans not offered by the exchange; that in some circumstances, the navigator must advise consultation with a licensed insurance producer regarding private coverage; and that CACs provide information about different health insurance plans and clarify the distinctions. The court vacated the preliminary injunction, holding that ACA does not entirely preempt HIMIA. View "St. Louis Effort For AIDS v. Huff" on Justia Law

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Nurse Dalton was terminated from her supervisory position at the ManorCare skilled nursing facility. Dalton alleged interference with her statutory rights under the Family and Medical Leave Act (FMLA), 29 U.S.C. 2601, and discrimination based on her Chronic Kidney Disease disability in violation of the Iowa Civil Rights Act, Iowa Code Ch. 216, and the Americans with Disabilities Act, 42 U.S.C. 12101. ManorCare claimed that nurses that Dalton supervised had complained about her job performance and that Dalton had received a Third/Final Written Warning for violating Major/Type B Work Rules, citing inappropriate negative comments about her work at the nurses’ station, where patients could overhear; failure to notify staff members she had cancelled a meeting; and taking an extended lunch break and failing to attend patient care conferences. There were also problems with attendance and late reports. Dalton understood that any further performance-related issue could result in termination. The district court dismissed all claims. The Eighth Circuit affirmed. Dalton’s termination was the end of an on-going, unrelated disciplinary process. View "Dalton v. Manor Care of West Des Moines, LLC" on Justia Law

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Johnson began working for U.S. Steel in 2004. On May 12 2011, he left work, complaining of a headache, and went to a clinic where a physician’s assistant indicated that he had high blood pressure. The next day he provided a note that was deemed insufficient by his employer. His regular physician later indicated that Johnson's blood pressure was normal. Emails, memoranda, and letters indicate that Johnson was suspended on May 16 and then terminated for altering, falsifying, or forging the work excuse. U.S. Steel never provided him with notice of his FMLA rights and obligations. Nor was such notice included in the employee handbook. Johnson filed suit under the Family and Medical Leave Act (FMLA), 29 U.S.C. 2601-2654, alleging that U.S. Steel retaliated against him for taking protected FMLA leave, failed to reinstate him after a period of protected leave, and otherwise unlawfully interfered with his FMLA rights. The district court entered summary judgment for the employer. The Eighth Circuit affirmed. Johnson did not demonstrate how any alleged technical violations could have prejudiced him if his condition was not a serious health condition and did not qualify him for FMLA leave in the first place. View "Johnson v. Wheeling Mach. Prods." on Justia Law