Articles Posted in Health 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

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From 1995-2009, Johnson worked for CRE. In the last three years, Johnson worked from home, 8 hours a day at a computer. Johnson was covered under CRE’s United disability insurance policy. In 1999, Johnson was diagnosed with fibromyalgia. In 2004, she underwent neck surgery for nerve injuries. On the day she resigned, Johnson visited MacDonald, her primary care physician, who diagnosed anxiety, depression, fibromyalgia, and chronic pain. Johnson completed a short-term disability form. MacDonald completed an Attending Physician’s Statement. United denied the application. Based on the recommendations of its doctor, United denied Johnson’s appeal. Johnson sought long-term disability benefits. MacDonald completed a Physician’s Statement that imposed multiple limitations. United denied the claim. Johnson appealed. United referred Johnson’s file and medical records to Boscardin, an orthopedic surgeon, who determined that, although Johnson experienced chronic pain in her neck and spine, Johnson’s complaints were not supported by “conclusive, objective evidence.” McClellan, Johnson’s surgeon, responded that he “[o]verall” agreed with Boscardin. United denied the appeal. Johnson sued under ERISA. The district court granted Johnson summary judgment, finding that United failed to consider Johnson’s condition as a whole. The Eighth Circuit reversed, finding the denial supported by substantial evidence. View "Johnson v. United of Omaha Life Ins. Co." on Justia Law

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Todd, born in 1963, was a high school graduate, and worked primarily as a laborer, often for temporary services. Todd’s last employment before seeking disability benefits ended in April 2007 because the temporary job was completed. Todd claimed inability to work due to anxiety, cramping in his feet, and difficulty breathing. Until his death in July 2009, Todd was treated for major depressive disorder, alcoholism, alcohol dependence, emphysema, and generalized anxiety disorder. Todd also experienced tremors of unknown etiology. An ALJ decided: Todd had not engaged in substantial gainful activity since April 14, 2007; Todd suffered from emphysema, tremors, an affective disorder, an anxiety disorder, and alcohol dependence; Todd did not have an impairment or combination of impairments so severe as to meet or equal the criteria of a listed impairment; Todd had the residual functional capacity to perform light work and was capable of performing his past relevant work as a laborer; and Todd was “not under a disability.” The district court agreed. Although the ALJ improperly weighed the medical professionals’ opinions, the error was harmless because substantial evidence supported a finding that Todd’s limitations would not be disabling if he stopped using alcohol. The Eighth Circuit affirmed. View "Bernard v. Colvin" on Justia Law

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The court reversed the district court's dismissal of plaintiff's claim for relief under the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb-1(a) to (c), and vacated the dismissal of plaintiffs' remaining claims. The court concluded that, in light of Burwell v. Hobby Lobby Stores, Inc., plaintiffs' complaint submitted a facially plausible claim for relief under the Act.View "O'Brien, Jr., et al. v. Dept. of HHS, et al." on Justia Law

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Annex, Stuart Lind, and Tom Janas filed suit challenging HHS' contraceptive mandate under the Religioous Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb-1(a). Lind, a controlling shareholder of Annex, opposed insurance coverage of contraceptives for Annex's employees. The district court denied Annex and Lind's motion for a preliminary injunction respecting the contraceptive mandate's enforcement. The court concluded that Janas lacks standing to appeal because he did not join the preliminary injunction motion which forms the basis of the appeal; the mandate does not apply to Annex because Annex has fewer than fifty full-time employees and has no government-imposed obligation to offer health insurance of any kind; the only alleged injury is that independent third parties - private health insurance companies not involved in this case - are unable to sell Annex a health insurance plan that excludes healthcare inconsistent with Lind's religious relief; and, ultimately, it is unclear whether Annex's alleged injury is caused by the government defendants and redressable by the federal courts. Accordingly, the court vacated the district court's denial and remanded for the district court to conduct more fact-finding to determine whether subject matter jurisdiction exists. View "Annex Medical, Inc., et al. v. Sebelius, et al." on Justia Law

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Plaintiff, an orthopedic surgeon and former consultant at Stryker, filed suit alleging that Stryker and I-Flow violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by marketing their pain pumps to encourage the placement of pain pumps directly into patients' joint spaces after orthopedic procedures. The court concluded that the district court did not err in concluding that plaintiff's allegations had been publicly disclosed and that plaintiff was not excepted under section 3730(e)(4)(B) as an "original source" of the information. The court rejected plaintiff's claim of procedural error and affirmed the district court's dismissal of the claims under section 3730(e)(4)(A). View "Paulos v. Stryker Corp., et al." on Justia Law

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Plaintiff, her husband, and their jointly owned company filed suit under 42 U.S.C. 1983 against two employees of the Department (Hansen and Watkins), alleging violations of their due process rights. Plaintiffs argued, inter alia, that the Department failed to provide plaintiff with actual notice of her placement on the disqualification list and deprived all the plaintiffs of due process. The court could find no authority or "general constitutional rule" requiring Hansen and Watkins to provide plaintiff final oral notice or request written confirmation of her termination in addition to the notice and opportunity for hearing they had already provided. Therefore, the court concluded that placing plaintiff on the disqualification list was not a deprivation of due process rights. Accordingly, Hansen and Watkins were entitled to qualified immunity on the individual capacity claims against them. Plaintiff's remaining claim was without merit. The court affirmed the judgment of the district court. View "Foster, et al. v. MO Dept. of Health and Senior Servs., et al." on Justia Law

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Relators brought a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A) and (B), alleging that the Mayo Foundation and others billed Medicare for surgical pathology services it did not provide. The government intervened and the parties settled. Relators then filed a Second Amended Complaint asserting additional claims. On appeal, relators challenged the district court's dismissal of their additional claim that Mayo fraudulently billed for services it did not provide whenever it prepared and read a permanent tissue slide but did not prepare a separate written report of that service. As a preliminary issue, the court concluded that relators satisfied their burden of showing that the public disclosure bar did not deprive the court of jurisdiction over relators' claim. On the merits, the court concluded that nowhere in the Medicare regulations or in the American Medical Association Codebook has the court found a requirement that physicians using the CPT codes for surgical pathology services must prepare the additional written reports that relators claimed Mayo fraudulently failed to provide. Accordingly, the court affirmed the judgment of the district court. View "Ketroser, et al. v. Mayo Foundation, et al." on Justia Law