Justia U.S. D.C. Circuit Court of Appeals Opinion Summaries

Articles Posted in Health Law

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In 1973, two Kalamazoo, Michigan hospitals formed a consortium to manage their health education programs and to train interns and residents. In the 1980s, they joined Michigan State University to form the Michigan State University Kalamazoo Center for Medical Studies (KCMS). KCMS administered graduate medical programs for residency programs for the hospitals. The hospitals agreed to incur “joint and equal responsibility for providing [KCMS] with sufficient financing to carry out its programs as negotiated on a yearly basis.” KCMS also received patient-care revenue, support from Michigan State University, and funds from contracts and grants. The hospitals sought reimbursement on their Medicare cost reports (42 U.S.C. 1395ww(h)) during fiscal years 2000–2004 for costs incurred for residents’ training at KCMS’s nonhospital clinics. The Centers for Medicare and Medicaid Services found that the hospitals failed to show they incurred all or substantially all of the costs of their residency programs and that they failed to comply with a requirement of a written agreement detailing the financing of their offsite programs. The district court and D.C. Circuit affirmed the denials of reimbursement, rejecting an argument that the “written agreement” requirement was satisfied by a collection of documents executed over the years. None of the documents met the regulatory criteria. View "Borgess Medical Center v. Burwell" on Justia Law

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In order to determine how much federal funding goes to each hospital for providing care, the Secretary of HHS makes certain “estimates” as required by the Affordable Care Act, 42 U.S.C. 1395ww(r). Tampa General filed suit arguing that the Secretary’s reliance on “obsolete” data rather than “the most recent data available” violated federal law. The district court dismissed the hospital’s claim for lack of subject matter jurisdiction, holding that section 1395ww(r)(3), which precludes judicial review of the Secretary’s “estimate” of a hospital’s amount of uncompensated care, bars review of the Secretary’s choice of data used in determining that estimate. The court agreed and held that the bar on judicial review of the Secretary's estimates precludes review of the underlying data and affirmed that section 1395ww(r)(3) bars Tampa General’s challenge. View "Florida Health Sciences v. Secretary of DHHS" on Justia Law

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The Public Health Service Act (PHSA), 42 U.S.C. 201, establishes coverage requirements for all health insurance plans except those it deems “excepted benefits.” The Patient Protection and Affordable Care Act (ACA), 26 U.S.C. 5000A(a), updated the PHSA’s coverage requirements and mandated that all applicable individuals maintain “minimum essential coverage.” The ACA left intact and incorporated the PHSA’s rules regarding excepted benefits. In May 2014, HHS announced its plan “to amend the criteria for fixed indemnity insurance to be treated as an excepted benefit” in the individual health insurance market. On top of the requirements codified in the PHSA, HHS added another. To be an “excepted benefit,” the plan may be “provided only to individuals who have . . . minimum essential coverage.” Several providers challenged the rule as an impermissible interpretation of the PHSA, and after a hearing, the district court permanently enjoined HHS’s enforcement of the rule under Chevron Step One. The court affirmed the district court's permanent injunction because HHS lacked authority to demand more of fixed indemnity providers than Congress required. View "Central United Life Ins. v. Burwell" on Justia Law

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West Virginia filed suit challenging the President’s determination not to enforce certain controversial provisions of the Affordable Care Act, 42 U.S.C. 300gg-22(a)(1), for a transitional period. That decision, implemented by a letter from the Secretary of the Department of Health and Human Services, left the responsibility to enforce or not to enforce these provisions to the States, and West Virginia objects to being put in that position. The district court concluded that West Virginia lacked standing. The court agreed, rejecting the State's claim that requiring the States to assume the political responsibility of deciding whether or not to implement a federal statute supposedly creates an injury-in-fact. The court concluded that there is simply no support for this extraordinary claim. The court stated that the State's injury is nothing more than the political discomfort in having the responsibility to determine whether to enforce or not – and thereby annoying some West Virginia citizens whatever way it decides. And no court has ever recognized political discomfort as an injury-in-fact. Even assuming that the administration’s action created a theoretical breach of State sovereignty, West Virginia nevertheless lacks a concrete injury-in-fact. Finally, the court rejected West Virginia's argument that any party, whether or not a governmental entity, has standing to challenge a delegation from the government to carry out a governmental responsibility. Accordingly, the court affirmed the judgment. View "State of West Virginia v. HHS" on Justia Law

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Appellants filed suit alleging that their health insurance premiums increased by 57% at the end of 2014 because of the Affordable Care Act (ACA), 26 U.S.C. 5000A(a)-(c). Appellants contend that in late 2013, HHS unlawfully implemented two policies: a “Transitional Policy,” which permitted health insurance companies to temporarily continue providing health insurance plans that do not comply with ACA requirements; and a “Hardship Exemption,” which permitted some individuals whose policies were cancelled for noncompliance to avoid the penalty under the individual mandate. The court affirmed the district court's determination that appellants lack standing because they have failed to demonstrate that the Transitional Policy caused appellants’ insurer, Blue Cross, to increase the premium for their health care plan specifically. Additionally, any alleged injury to appellants from the Transitional Policy stemmed not from the Policy itself, which HHS applied evenhandedly, but from Blue Cross’s decision not to take advantage of the Policy. Accordingly, appellants also lack standing to bring their equal protection challenge. View "American Freedom Law Center v. Obama" on Justia Law
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The Authority faced a funding shortfall for at least the period immediately after its opening in 2014. To cover the shortfall, the Authority, with emergency authorization from the District’s Council, levied a charge on all insurance policies above a certain premium threshold sold by health carriers in the District. American Council raised statutory and constitutional challenges to that charge and the district court rejected Council's arguments, dismissing the complaint for failure to state a claim. The court agreed with the District that the district court lacked jurisdiction to hear this case because the charge levied by the Authority was a tax rather than a fee. Therefore, the court vacated the district court's judgment for lack of jurisdiction and remanded with instructions to dismiss the case for lack of jurisdiction because the assessment is a tax. View "American Council of Life Ins. v. District of Columbia Health" on Justia Law

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Plaintiffs seek a writ of mandamus compelling the Secretary to act within Congress's prescribed specific time frames, 42 U.S.C. 1395ff, for the Secretary to reach decisions on various stages of administrative appeals of Medicare reimbursement claim denials. The district court concluded that mandamus relief was unwarranted. The court concluded that the statute imposes a clear duty on the Secretary to comply with the statutory deadlines, that the statute gives the Association a corresponding right to demand that compliance, and that escalation—the only proposed alternative remedy—is inadequate in the circumstances of this case. Because the Association has demonstrated that the threshold requirements for mandamus jurisdiction are met, and because the Secretary’s other jurisdictional arguments fail, the court reversed the district court’s dismissal for lack of jurisdiction. On remand, the district court should determine whether “compelling equitable grounds” now exist to issue a writ of mandamus. View "American Hospital Ass'n v. Burwell" on Justia Law

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The Hospital challenged the method used by the Secretary to calculate its reimbursement for services it provided during 2003 and 2004 - the two years after statutory caps on reimbursements for psychiatric hospitals expired but before psychiatric hospitals were moved to a prospective-payment system. The court affirmed the district court's denial of the hospital's motion for summary judgment and grant of HHS's cross-motion for summary judgment because HHS’s interpretation was not only reasonable but also the best interpretation of the controlling statute, 42 U.S.C. 1395ww, and regulation, 42 C.F.R. 413.40. View "Washington Regional Medicorp v. Burwell" on Justia Law

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Plaintiff, as the personal representative of Curtis Suggs, filed suit against the District, Symbral, and others, under 42 U.S.C. 1983, federal law regulating community residential facilities, and the common law. Suggs died while residing in a group home operated by Symbral, a District contractor. The District appealed the district court's grant of summary judgment to plaintiff on the section 1983 claims and negligence claims, and against Symbral and Defendants Leon and Yvonne Mohammed, as well as appealed the district court's denial of the District's post-trial motion. After reviewing the record and considering the parties' arguments, the court concluded that the district court did not err in entering summary judgment against the District on plaintiff’s section 1983 claim, and the court affirmed that portion of the decision on review. The court reversed the district court’s grant of summary judgment to plaintiff on his negligence and statutory claims, concluding that those claims are barred under D.C. Code 12-309. Because the district court abused its discretion by excluding causation evidence, the court vacated the damages and remand for reconsideration. View "Harvey v. Mohammed" on Justia Law

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Plaintiff filed suit challenging the religious exemption in the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, as an unconstitutional establishment of religion. Plaintiff also argued that the Administration’s decision to temporarily suspend enforcement of some of the Act’s requirements for a transitional period deprived him of the equal protection of the laws. The district court granted the government's motion to dismiss and held that plaintiff lacked standing to bring either claim. The court agreed with the district court that plaintiff lacks standing to assert his equal protection claim because nothing in the transitional policy requires him to buy insurance. In this case, plaintiff's inability to maintain his old plan was the independent choice of his insurer. The court concluded, however, that plaintiff did have standing to bring his Establishment Clause challenge. On the merits, the court concluded that the claim fails because the qualifications for exemption are not drawn on sectarian lines. Rather, they simply sort out which faiths have a proven track record of adequately meeting the statutory goals. Moreover, the exemption promotes the Establishment Clause’s concerns by ensuring that those without religious objections do not bear the financial risk and price of care for those who exempt themselves from the tax. As configured by this specific statutory framework, that is an objective, non-sectarian basis for cabining the exemption’s reach. View "Cutler v. HHS" on Justia Law