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

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

Appellant sued to recover $373.00 in expenses he incurred from the alleged unlawful levy of his social security benefits under 26 U.S.C. 7433. The district court concluded that appellant's suit was untimely because he did not bring suit within two years of when he had a "reasonable opportunity to discover all essential elements of a possible cause of action." The court agreed and affirmed, holding that the two-year statute of limitations on appellant's cause of action began to run no later than June 2005 after he received notice of the levy on his benefits. Because appellant did not sue until December 2008, more than three years after he received notice of the levy, his claim was time-barred. View "Keohane v. United States" 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

In a 2008 administrative appeal, the Secretary of Health and Human Services ruled that a Medicare beneficiary enrolled in Medicare Part C still qualified as a person "entitled to benefits" under Medicare Part A. As a result, Beverly Hospital received a smaller reimbursement from the Secretary for services it provided to low-income Medicare beneficiaries during fiscal years 1999-2002. The district court granted summary judgment for Beverly Hospital on the ground that the Secretary's interpretation violated the plain language of the Medicare statute. The court held that the statute did not unambiguously foreclose the Secretary's intepretation. The court, nonetheless, affirmed the district court on the alternative ground that the Secretary must be held to the interpretation that guided her approach to reimbursement calculations during fiscal years 1999-2002, an interpretation that differed from the view she now advanced. Under her previous approach, the hospital would have prevailed on its claim for a larger reimbursement. View "Northeast Hospital Corp. v. Sebelius" on Justia Law

Appellant challenged a judgment of the district court affirming the Social Security Administration's (SSA) denial of his application for disability benefits. Appellant contended that the ALJ did not properly apply the "treating physician rule" in evaluating his application and further argued that new evidence had come to light that warranted a remand to the agency. The court held that the ALJ did not, as required by the treating physician rule, explain his reasons for rejecting the opinion of appellant's treating physician. The court also held that a letter from the Board of Medicine validating appellant's complaint, as well as a judicial determination that a physician's report contained a false representation, qualified as new evidence within the meaning of 42. U.S.C. 405(g). Therefore, the court reversed the judgment of the district court and remanded for further proceedings.

Appellant filed suit in the district court when the Commissioner of the Social Security Administration (SSA) denied his application for disability benefits. At issue was whether the district court had authority to permit additional evidence to be taken on remand where the SSA asked the district court to remand the case so the agency could supplement the record and the district court obliged. The court held that because the district court misunderstood the full reach of its remedial authority, the court vacated the judgment and remanded the matter to the district court to consider the issue anew.

The District of Columbia filed this suit to recover its attorneys' fees from a lawyer who brought an administrative complaint against the District on behalf of a student with special educational needs under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400(d)(1)(A). At issue was whether the District was a "prevailing party" under the IDEA in this suit. The court held that the facts in this case followed closely in the wake of the court's precedent in District of Columbia v. Straus where that court held that the district was not a "prevailing party" where its own change of position was what had mooted the dispute, causing the case to be dismissed. Therefore, the court held that the District, in this case, was not a "prevailing party" where the District of Columbia Public Schools (DCPS) authorized an independent comprehensive psychological evaluation for the student, which mooted the only issue before the hearing officer. Accordingly, the district court's grant of summary judgment ordering the lawyer to pay attorneys' fees was reversed.

This case stemmed from the discovery in an unrelated case that the Center for Medicare & Medicaid Services ("CMS") had paid hospitals less than they were due because it had miscalculated the disproportionate share hospital ("DSH") payment. Appellants, a group of hospitals that received DSH payments, filed claims with the Provider Reimbursement Review Board ("PRRB") seeking full payments for the fiscal years 1987-1994. At issue was whether the district court lacked jurisdiction in the matter and whether the Medicare statute, 42 U.S.C. 1395oo(a), allowed for equitable tolling. The court held that a decision by the PRRB denying jurisdiction was a final decision subject to judicial review by the district court. The court also held that, given the factors emphasized in United States v. Brockamp did not apply to the facts presented, and without any other reasons for rebutting the presumption of equitable tolling, the court found that equitable tolling was available under 1395oo(a). The court noted that whether tolling was appropriate in this particular case, however, was a different question for the district court to answer on remand. The court also rejected appellants' alternative arguments and therefore, reversed and remanded for further proceedings.

This case involved cost-saving tools that Congress had devised for Medicare payments to cancer hospitals and specifically concerned Medicare reimbursements paid to one cancer hospital, appellant, in 2000 and 2001. The first issue on appeal related to the cancer hospitals' inpatient costs where appellant requested an increase to its target amount in 2000 and 2001 due to the high cost of certain new cancer drugs and where the Department of Health and Human Services ("HHS") denied that request. Appellant argued that it did not receive proper notice of the new net financial impact requirement and thus did not have a fair opportunity to satisfy the requirement at the administrative hearing. The court agreed and held that appellant did not receive timely notice of the requirement and, on remand to HHS, must be given an opportunity to satisfy it. The second issued on appeal concerned cancer hospitals' outpatient costs where appellant contended that HHS misapplied the statutory formula that provided hospitals a fraction of their reasonable costs and undercompensated appellant. The court rejected appellant's arguments and affirmed summary judgment in favor of HHS.

Forsyth Memorial Hospital, Inc. and other providers (collectively "appellants") appealed the district court's grant of summary judgment in favor of the Secretary of Health and Human Services ("HHS") upholding the denial of their reimbursement claims arising from the merger of Presbyterian Health Services Corporation ("Presbyterian") and Carolina Medicorp, Inc. ("Carolina"). At issue was whether the denial of the reimbursement claims was arbitrary and capricious, an abuse of discretion, contrary to law, or unsupported by substantial evidence. The court affirmed the denial of the reimbursement claims and held that the district court properly concluded that it was neither arbitrary and capricious nor contrary to law for the Administrator of the Centers for Medicare & Medicaid Services ("Administrator") to find that appellants were not entitled to reimbursement where, in the merger between Carolina and Presbyterian, no bona fide sale took place and the parties were related.