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

Plaintiff brought this qui tam suit alleging that the District of Columbia and its schools violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by submitting a Medicaid reimbursement claim without maintaining adequate supporting documents. The district court dismissed the case, relying on the court's precedent in United States ex rel. Findley v. FPC-Boron Employees' Club. Because the court concluded that the Supreme Court had implicitly overruled Findley in Rockwell International Corp. v. United States, the court reversed. View "Davis v. DC" on Justia Law

States both appealed the district court's grants of summary judgment in favor of HHS, which upheld HHS's disallowance of certain Medicaid claims for Federal Financial Participation (FFP) as ineligible for "medical assistance" under the "Institution for Mental Diseases" (IMD) exclusion set forth in section 1905(a) of 42 U.S.C. 1396 et seq. (Medicaid Statute). Because HHS correctly concluded that the disputed claims were not eligible for FFP under the plain language of the IMD exclusion and the under-21 exception, the court affirmed the judgment of the district court. View "Virginia Dept. of Medical Assist. Svcs. v. HHS, et al." on Justia Law

Dayton was served with a citation alleging over 100 willful violations of the Occupational Safety and Health Act, 29 U.S.C. 654. Dayton contested the citation and by 1997, its appeal was before the Occupational Safety and Health Review Commission. Twelve years later, the Commission issued an order affirming nearly all of the violations and assessed a penalty. Dayton asked the court to set aside the order because of the Commission's delay. The court declined, holding that the delay alone was not enough to set aside the order. The court held, however, that the Commission lacked substantial supporting evidence for its finding that Dayton's violations were willful. Accordingly, the court vacated that portion of the Commission's order and remanded for the Commission to reassess the nature of Dayton's violations and recalculate the appropriate penalty. The court affirmed the Commission's order in all other respects. View "Dayton Tire v. Secretary of Labor" on Justia Law

Plaintiffs opposed the use of vaccines that contain thimerosal, a mercury-based preservative, and believed that vaccines containing mercury harm young children and pregnant women. Plaintiffs filed an action alleging that the FDA, by allowing thimerosal-preserved vaccines, violated its statutory duty to ensure the safety of vaccines. Plaintiffs asked for a court order requiring the FDA to prohibit the administration of vaccines containing more than a trace level of thimerosal to young children and pregnant women and sought to force the FDA to remove thimerosal-preserved vaccines from the market. The district court dismissed the suit for lack of standing. The court concluded that plaintiffs were not required to receive thimerosal-preserved vaccines; they could readily obtain thimerosal-free vaccines; they did not have standing to challenge the FDA's decision to allow other people to receive the vaccines; and plaintiffs could advocate that the Legislative and Executive Branches ban the vaccines. But because plaintiffs were suffering no cognizable injury as a result of the FDA's decision to allow the vaccine, their lawsuit was not a proper subject for the Judiciary. Accordingly, the court affirmed the judgment of the district court. View "Coalition for Mercury-Free Drugs, et al. v. Sebelius, et al." on Justia Law

This case arose when plaintiffs filed a class action complaint under 42 U.S.C. 1983, alleging that the District was violating the Medicaid Act, 42 U.S.C. 1396 et seq. Since 1993, a consent decree has governed how the District provides "early and periodic screening, diagnostic, and treatment services" under the Act. The District has now asked the district court to vacate that decree on two grounds: that an intervening Supreme Court decision has made clear that plaintiffs lack a private right of action to enforce the Medicaid Act, and that in any event, the District has come into compliance with the requirements of the Act. Because the court concluded that the district court's rejection of one of the District's two arguments did not constitute an order "refusing to dissolve [an] injunction[]" within the meaning 28 U.S.C. 1292(a)(1), the court dismissed the appeal for lack of jurisdiction. View "Salazar, et al. v. DC, et al." on Justia Law

Plaintiffs sued the Government, seeking to disclaim their legal entitlement to Medicare Part A benefits for hospitalization costs. Plaintiffs wanted to disclaim their legal entitlement to such benefits because their private insurers limited coverage for patients who were entitled to Medicare Part A benefits. Plaintiffs preferred to receive coverage from their private insurers rather than from the Government. The district court granted summary judgment for the Government because there was no statutory authority for those who were over 65 or older and receiving Social Security benefits to disclaim their legal entitlement to Medicare Part A benefits. The court understood plaintiffs' frustration with their insurance coverage. But based on the law, the court affirmed the judgment of the district court. View "Hall, et al. v. Sebelius, et al." on Justia Law

Appellants, manufacturers, distributors, and users of ear candles, along with organizations that advocate the use of holistic health remedies like ear candles, challenged warning letters the FDA issued to several manufacturers, advising that the agency considered their candles to be adulterated and misbranded medical devices. The district court dismissed appellants' complaint on the ground, among others, that the warning letters did not constitute final agency action. The court affirmed the district court's order to dismiss for failure to state a claim because the warning letters, even as supplemented by the FDA's website and appellants' conversations with FDA officials, did not constitute final agency action and therefore, appellants' complaint was not cognizable under the Administrative Procedures Act (APA), 5 U.S.C. 500 et seq. View "Holistic Candlers and Consumer, et al. v. FDA, et al." on Justia Law

An association of doctor-owned equipment providers challenged regulations issued by the Secretary that effectively prevented its members from obtaining Medicare reimbursement for their services. The district court dismissed the complaint for lack of subject matter jurisdiction. The court concluded that under the particular circumstances of this case, the Shalala v. Illinois Council on Long Term Care, Inc. exception applied and the association could invoke the district court's federal question jurisdiction without first seeking administrative review under the Medicare Act, 42 U.S.C. 405(h). View "Council For Urological Interests v. Sebelius, et al." on Justia Law

This case arose when the Board found petitioner had acted unlawfully by unilaterally reducing the hours of its full-time respiratory department employees. The Board ordered petitioner to rescind the hours reduction, bargain with the labor union representing the affected employees, and make whole any employee for any loss of earnings and other benefits suffered (2004 Order). An ALJ subsequently determined that petitioner owed 13 current and former employees roughly $105,000 in backpay to compensate them for the unlawful hour reduction and the Board adopted the ALJ's findings without elaboration, ordering petitioner to pay (2011 Order). Petitioner appealed the 2011 Order and the Board cross-applied for enforcement. The court granted in part the Board's cross-application for enforcement with respect to all issues except the matter relating to interim earnings. The Board did not err in applying a backpay remedy to those employees hired into the bargaining unit after petitioner unlawfully reduced the employees' hours; and the Board correctly held the Union's failure to communicate with petitioner did not toll the employer's liability, because petitioner had not rescinded the unlawful unilateral reduction in hours when it sought to negotiate with the Union. However, the Board did not adequately explain its failure to consider interim earnings when calculating the backpay award. Therefore, the court vacated the Board's backpay computation and remanded so the Board could amplify its position on interim earnings. View "Deming Hospital Corp. v. NLRB" on Justia Law

Appellant, which sought review under the Administrative Procedures Act (APA), 5 U.S.C. 500 et seq., claimed that the Secretary's delegee failed to disapprove appellant's reimbursement request within 60 working days, as required by the Medicare Act, 42 U.S.C. 1395rr(b)(7), because the delegee did not notify appellant of its asserted disapproval within the 60-day time period. Appellant appealed the district court's grant of summary judgment to the Secretary. The court concluded that the notification of appellant within 60 days was not necessary for the disapproval to be effective and therefore affirmed the judgment of the district court. View "Gundersen Lutheran Med. Center v. Sebelius" on Justia Law