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

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

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

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

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

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

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

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

This case arose from the Secretary’s decision in 2005 to change the boundaries of the geographic areas used to compute regional wage indices. A group of hospitals challenged the Secretary's decision to include wage data from Southcoast campuses outside the Boston-Quincy area in calculating the index for that area for fiscal years 2006 and 2007. The court concluded that the Secretary's treatment of Southcoast hewed to the existing administrative treatment of such multi-campus hospital groups; there were substantial informational and operational obstacles to implementing a different computational method quickly in 2006 or retroactively; appellants admit that the temporary effect of Southcoast’s multi-campus data on the wage index was a “one-off” occurrence arising from “unusual circumstances” that apparently did not affect any other multi-campus hospital group’s treatment; and nothing in the Medicare Act, 42 U.S.C. 1395 et seq., or established principles of administrative review mandate that the Secretary individually tailor one hospital’s reporting treatment to fit appellants' preferred computational outcome. Accordingly, the court affirmed the judgment. View "Anna Jacques Hospital v. Burwell" on Justia Law

Grossmont and four other California hospitals sought reimbursement under the Medicare program for so-called “bad claims.” Payment was denied because the claims were submitted to Medicare without first being submitted to the State of California for a determination of any payment responsibility it may have for the claims. The court concluded that Grossmont has failed to preserve its challenge that the mandatory state determination policy violates the bad debt moratorium; Grossmont also failed to preserve its claim that the Secretary’s effort to limit the alternative documentation policy must be rejected because it is a change in policy that must be adopted in a notice and comment rule; and, as applied in this case, the Secretary’s state determination requirement was not arbitrary or capricious. The court need not decide whether the Secretary acts arbitrarily and capriciously if she refuses to allow claims as bad debt if a recalcitrant state refuses to issue state determinations of payment responsibility despite reasonably diligent efforts to obtain them. Finally, the Secretary's conclusion that the hold harmless provision, in Joint Signature Memorandum 370 (JSM 370), does not apply is supported by substantial evidence and is not arbitrary or capricious. Accordingly, the court affirmed the judgment. View "Grossmont Hosp. Corp. v. Burwell" on Justia Law

The Secretary issued regulations that effectively prohibit physicians who lease medical equipment to hospitals from referring their Medicare patients to these same hospitals for outpatient care involving that equipment. The association challenged the regulations as exceeding the Secretary's statutory authority and violating the Administrative Procedure Act (APA), 5 U.S.C. 500 et seq., and the Regulatory Flexibility Act (RFA), 5 U.S.C. 601-612. The district court granted summary judgment in favor of the Secretary. Although one majority agrees with the district court that the statute is ambiguous as to the regulation of leases that charge on a per-use basis, a different majority concludes that the Secretary’s explanation for prohibiting these leases is unreasonable; the court unanimously concludes that the Secretary’s interpretation of the statute to apply to the physician-groups performing the procedures is reasonable, and that the Secretary complied with the RFA; and therefore, the court affirmed in part, reversed in part, and remanded to the district court with instructions to remand the regulation relating to leases charging by use to the Secretary for further proceedings. View "Council for Urological Interests v. Burwell" on Justia Law