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

A private health insurer that participates in the Medicare Advantage program consolidated two of its contracts in 2024. One of the pre-existing contracts (“consumed contract”) had provided a Special Needs Plan (SNP) and received a star rating for that measure in 2023, while the other (“surviving contract”) did not. After consolidation, the insurer’s new contract offered an SNP for 2025. The Centers for Medicare and Medicaid Services (CMS) calculates star ratings for consolidated contracts by taking the enrollment-weighted mean of measure scores from the consumed and surviving contracts. Initially, CMS excluded the consumed contract’s SNP data for the 2025 star rating, but after the insurer’s request, CMS included the data, resulting in the same overall rating as before.The insurer challenged this calculation in the United States District Court for the District of Columbia, arguing that including the consumed contract’s SNP data violated the statute, regulations, and agency guidance, and that CMS failed to adequately explain a change in calculation methodology. The district court granted summary judgment in favor of CMS, finding that the agency’s actions complied with applicable law and guidance, and that no further explanation for the calculation was required.On appeal, the United States Court of Appeals for the District of Columbia Circuit affirmed the district court’s judgment. The appellate court held that CMS properly applied its regulations and guidance by including the consumed contract’s SNP measure score in the calculation. The court also found that the methodology provided accurate information to beneficiaries, as required by statute, and that CMS did not make a policy change triggering a requirement for further explanation. The district court’s entry of summary judgment in favor of CMS was affirmed. View "HMO Louisiana, Inc. v. Department of Health and Human Services" on Justia Law

Michael C. Baxley served in the Army beginning in 1974. After various instances of misconduct, he was identified as a drug abuser and entered the Army’s rehabilitation program. In 1975, he was designated a rehabilitation program failure, and subsequent further misconduct led to a recommendation for discharge. During his discharge proceedings, evidence of his rehabilitation failure was introduced, and he was discharged “under other than honorable conditions.” Years later, his discharge status was upgraded to “under honorable conditions (general),” but without “honorable” status, he was unable to access certain veterans benefits. In 2018, following a VA determination of a service-connected mental health condition, Baxley requested the Army Board for Correction of Military Records to upgrade his discharge to “honorable,” arguing that exempt evidence was improperly used against him and that relevant Army guidance regarding mental health conditions was not followed.The United States District Court for the District of Columbia reviewed the Board’s denial of Baxley’s request and granted summary judgment to the Board. The court found no violation of the Army’s Exemption Policy and concluded that the Board adequately considered the Army guidance for discharge upgrades related to mental health conditions (the Kurta Memorandum).On appeal, the United States Court of Appeals for the District of Columbia Circuit reviewed the administrative action de novo. The Court held that the Board’s decision regarding the Exemption Policy was arbitrary and capricious because it failed to meaningfully assess whether evidence of Baxley’s rehabilitation failure was developed as a direct or indirect result of protected communications during his rehabilitation program, as the policy requires. Therefore, the Court reversed the District Court’s grant of summary judgment on this issue, vacated the Board’s decision, and remanded for further proceedings. However, the Court affirmed the District Court’s grant of summary judgment regarding the Kurta Memorandum, finding the Board’s consideration sufficient and not arbitrary or capricious. View "Baxley v. Driscoll" on Justia Law

A pharmaceutical company, together with a healthcare research organization and a kidney patient advocacy group, challenged regulatory actions by the Centers for Medicare & Medicaid Services (CMS) concerning the Medicare payment system for end-stage renal disease (ESRD). The dispute arose after CMS included oral-only drugs, specifically XPHOZAH—a drug manufactured by the company for treating hyperphosphatemia in dialysis patients—within the bundled payment for renal dialysis services under Medicare, effective January 1, 2025. Previously, such oral drugs were reimbursed separately under Medicare Part D.The plaintiffs filed suit in the United States District Court for the District of Columbia, contesting both the inclusion of oral-only drugs in the bundled payment regulation and the specific identification of XPHOZAH as a renal dialysis service. They asserted these actions were arbitrary, exceeded statutory authority, and violated the Administrative Procedure Act. CMS moved to dismiss the complaint, arguing that federal law expressly bars judicial review of the Secretary’s “identification of renal dialysis services included in the bundled payment.” The district court agreed, finding that both the regulation and the identification of XPHOZAH fell within the statutory bar to judicial review because they constituted “identifications” as defined by the statute and were within the agency’s delegated authority. The court dismissed the action for lack of jurisdiction.On appeal, the United States Court of Appeals for the District of Columbia Circuit reviewed the district court’s dismissal de novo. The appellate court affirmed, holding that the relevant statute, 42 U.S.C. § 1395rr(b)(14)(G), clearly precludes judicial review of the Secretary’s identification of renal dialysis services, including oral-only drugs and XPHOZAH. The court found that CMS acted within its statutory authority, and therefore, further judicial review was barred. The district court’s dismissal was affirmed. View "Ardelyx, Inc. v. Kennedy" on Justia Law

Norwich Pharmaceuticals sought to market a generic version of Xifaxan, a drug invented by Salix Pharmaceuticals for treating irritable bowel syndrome with diarrhea and hepatic encephalopathy. Norwich submitted an Abbreviated New Drug Application (ANDA) to the FDA, identified as number 214369. Salix believed this ANDA infringed its patents and sued Norwich in the United States District Court for the District of Delaware. That court found Norwich’s ANDA infringed Salix’s patents related to hepatic encephalopathy, while the patents for irritable bowel syndrome were invalid as obvious. The court’s final judgment barred FDA approval of Norwich’s ’369 ANDA until Salix’s hepatic encephalopathy patents expired in October 2029.Following the judgment, Norwich amended its ’369 ANDA to remove the indication for hepatic encephalopathy and requested the Delaware District Court modify its judgment to allow immediate FDA approval of the amended ANDA. The court denied this motion, reasoning that Norwich could not change its ANDA after final judgment to circumvent the prior ruling. Norwich appealed to the United States Court of Appeals for the Federal Circuit, which agreed the judgment restricted approval of the entire ANDA, including non-infringing indications, until 2029, and affirmed the Delaware District Court’s decision.After the FDA declined to grant final approval of Norwich’s amended ANDA, instead issuing only tentative approval, Norwich sued in the United States District Court for the District of Columbia, arguing the FDA acted arbitrarily and capriciously. The court granted summary judgment to the FDA and Salix. On appeal, the United States Court of Appeals for the District of Columbia Circuit held that the Delaware District Court’s judgment applied to Norwich’s ANDA as amended, so the FDA correctly delayed final approval until October 2029. The appellate court affirmed the district court’s judgment. View "Norwich Pharmaceuticals, Inc. v. Kennedy" on Justia Law

The case concerns a challenge by several states and industry groups to a 2024 rule by the Environmental Protection Agency (EPA) that revised the National Ambient Air Quality Standards (NAAQS) for fine particulate matter (PM2.5), lowering the annual standard from 12 µg/m³ to 9 µg/m³. The revision followed new scientific assessments and a unanimous recommendation from the Clean Air Scientific Advisory Committee (CASAC) that the prior standard was inadequate to protect public health. Petitioners argued that the EPA lacked statutory authority to promulgate the new rule, that the decision-making process was improperly influenced by environmental justice considerations, and that the EPA acted arbitrarily and capriciously under the Clean Air Act.Previously, in 2020, the prior EPA Administrator chose to retain the 12 µg/m³ standard, citing scientific uncertainties and a divided CASAC. That decision was challenged but held in abeyance after a change in administration. The Biden-appointed EPA Administrator initiated a review, which led to the 2024 revision. After a further change in administration, the EPA itself moved to vacate the 2024 rule, now agreeing with challengers that the agency had exceeded its authority and failed to consider costs.The United States Court of Appeals for the District of Columbia Circuit reviewed the 2024 rule and the EPA’s motion to vacate. The court held that the EPA had statutory authority to revise the NAAQS outside the five-year review cycle without performing a “thorough review” of all criteria, that the agency was not required to consider costs or attainability when revising or setting the standard, and that the decision was not arbitrary or capricious. The court denied both the petitions for review and the EPA’s motion for vacatur, upholding the 2024 rule. View "Commonwealth of Kentucky v. EPA" on Justia Law

A former State Department employee and his family alleged that two law enforcement officers from the State Department arrived unannounced at their home in Virginia, banged on the door, and engaged in aggressive behavior. One officer, previously known to have harassed the employee at work, cursed and shouted at him, grabbed him by the wrist in front of his family, and pointed his fingers in the shape of a gun at the employee’s young son, pretending to shoot and calling him a racial slur. The family claimed they were traumatized by the encounter, with children crying, experiencing nightmares, and the in-laws suffering insomnia and depression.The United States District Court for the District of Columbia dismissed the family’s claim of common law assault under the Federal Tort Claims Act (FTCA), applying Virginia law. The district court concluded that while the officer’s conduct was threatening, it did not plausibly place any family member in reasonable apprehension of imminent physical harm—an essential element for assault under Virginia law. The court stayed other FTCA claims pending Department of Labor review, then dismissed them for lack of jurisdiction when the plaintiff declined to seek a ruling under the Federal Employees Compensation Act.On appeal, the United States Court of Appeals for the District of Columbia Circuit reviewed de novo the dismissal of the family’s FTCA assault claim. The appellate court held that the facts alleged, if true, plausibly established all elements of assault under Virginia law: overt acts intended to cause harmful or offensive contact or apprehension thereof, and reasonable apprehension of imminent contact, including through the doctrine of transferred intent. The court reversed the district court’s dismissal and remanded for further proceedings, holding the family’s claim could proceed. View "He v. Rubio" on Justia Law

At an oil and gas wellsite in Texas, a contractor, TCP Specialists, LLC, provided wireline services alongside other companies that managed the well’s pressure and equipment. During a maintenance operation, a pressurized pipe ruptured while the well was being depressurized, causing fatal injuries to two workers and serious injury to a TCP employee. Although TCP did not control the depressurization or supply the faulty pipe, its employees were standing near the wellhead at the time of the accident. The Department of Labor alleged that TCP exposed its employees to known hazards by not establishing a buffer zone around the well during depressurization.An administrative law judge (ALJ) of the Occupational Safety and Health Review Commission held a hearing and found that TCP had violated the General Duty Clause of the Occupational Safety and Health Act. The ALJ determined that TCP had control over its employees’ proximity to the hazard and that a buffer zone would have been a feasible and effective abatement measure. The ALJ concluded that TCP failed to implement adequate safety policies and upheld the citation, imposing a penalty. The full Commission declined to review the ALJ’s decision, making it a final order.The United States Court of Appeals for the District of Columbia Circuit reviewed TCP’s petition and denied it. The court held that the hazard was properly defined by reference to the physical agents (the frac stack and pressurized piping) and that TCP had control over its employees’ exposure to that hazard. The court found substantial evidence supported the ALJ’s conclusions regarding the feasibility and effectiveness of a buffer zone, and rejected TCP’s constitutional and procedural arguments. The order upholding the citation and penalty was affirmed. View "TCP Specialists, LLC v. Secretary of Labor" on Justia Law

The appellant submitted a whistleblower application to the Internal Revenue Service (IRS) alleging that two taxpayers had underpaid taxes from 2004 to 2012 and requested that the IRS also consider similar conduct for 2013 through 2017 when determining any award. The IRS had already begun investigating much of the reported conduct and ultimately collected proceeds from the taxpayers. However, the IRS’s Whistleblower Office denied the claim, reasoning that the information provided was either previously known or “tainted”—meaning it was unlawfully obtained or privileged—and asserted it did not rely on this information when auditing the later years.After receiving this denial, the appellant sought review in the United States Tax Court. The appellant requested to supplement the administrative record or conduct discovery regarding the audits for 2013 through 2017, arguing that the record did not adequately show whether her information was used. The Tax Court denied these requests, citing procedural deficiencies in how discovery was sought, and granted summary judgment to the IRS, finding the administrative record sufficient to support the IRS’s determination.The United States Court of Appeals for the District of Columbia Circuit reviewed the case. The court held that the IRS’s rationale for denying the whistleblower award for tax years 2013 through 2017 was not supported by the administrative record, which was largely silent regarding those years. The court concluded that the IRS’s decision was arbitrary and capricious because it did not reasonably investigate or explain whether the whistleblower’s application contributed to the audits for those years. The court reversed the Tax Court’s decision and remanded the case for further proceedings consistent with its opinion. View "Trongone v. Cmsnr. IRS" on Justia Law

The appellant, an experienced foreign currency exchange (FX) trader, claimed he uncovered manipulation in the FX market after noticing a sharp drop in the values of several currencies relative to the Swiss franc in 2011. He believed this was due to collusion among market makers and shared his suspicions with various regulators, including the Commodity Futures Trading Commission (CFTC). His allegations focused on conduct by a retail trading platform, Oanda, and mentioned possible involvement by banks but did not name any specific institutions. Two years later, media reports surfaced about large banks rigging FX benchmark rates, prompting the CFTC to investigate and eventually reach settlements with several banks for manipulating benchmark rates.The CFTC initially investigated the appellant’s allegations against Oanda but found no evidence of wrongdoing and closed the case without action. The CFTC’s later enforcement actions against major banks were initiated after media coverage revealed benchmark-rate manipulation schemes, not because of the appellant’s information. After the settlements were announced, the appellant applied for a whistleblower award, arguing his tips had led to these enforcement actions. The CFTC’s Whistleblower Office and Claims Review Staff recommended denial, finding his tips were not the original source of the information leading to the enforcement actions. The appellant sought reconsideration and, after a delay, petitioned for mandamus relief in the United States Court of Appeals for the District of Columbia Circuit, which was rendered moot when the Commission issued final orders denying his application.The United States Court of Appeals for the District of Columbia Circuit reviewed the CFTC’s denial for arbitrariness or capriciousness. The court found that the appellant’s tips did not lead to or significantly contribute to the enforcement actions against the banks, nor was he the original or derivative source of the information used. The court affirmed the CFTC’s orders denying the whistleblower award. View "Kitchen v. Commodity Futures Trading Commission" on Justia Law

A railroad company operating in Massachusetts sought to acquire a 155-acre parcel in the town of Hopedale to build a new transloading facility. The land had been classified as forest land under Massachusetts General Law Chapter 61, which gives municipalities a right of first refusal to purchase such land if the owner wishes to sell or convert it to another use. After an initial notice of intent to sell was deemed deficient by the town, the seller withdrew the notice. Without issuing a new notice, the seller then transferred beneficial ownership of the property to the railroad company through a transaction that attempted to circumvent the town’s rights. Hopedale asserted its rights under Chapter 61 and filed suit in Massachusetts Land Court to enforce its right of first refusal and prevent further site work by the railroad.After a failed settlement agreement—subsequently invalidated by the Massachusetts Superior Court and with state litigation ongoing—the railroad company petitioned the Surface Transportation Board for a declaratory order that the Interstate Commerce Commission Termination Act (ICCTA) preempted the town’s rights under Chapter 61. The Surface Transportation Board denied the petition, finding that Chapter 61 was a generally applicable property law not categorically preempted by ICCTA, and that the railroad had not established a valid property interest in the land. The Board also concluded that the town’s actions did not unreasonably burden or interfere with rail transportation.The United States Court of Appeals for the District of Columbia Circuit reviewed the Board’s order. It held that ICCTA does not preempt Chapter 61’s right-of-first-refusal provisions, as they are generally applicable state property laws and do not directly regulate railroad operations. The court further found that, without a settled property interest, the railroad’s as-applied preemption arguments failed. The court denied the railroad’s petition for review and affirmed the Board’s order. View "Grafton & Upton Railroad Company v. Surface Transportation Board" on Justia Law