Justia U.S. 5th Circuit Court of Appeals Opinion Summaries

Wal-Mart petitions for review of the decision of the Commission finding that the company failed to comply with 29 C.F.R. 1910.132(d)(1), which requires the company to perform a hazard assessment of its distribution center. The court concluded that the regulation, the preamble, and the non-mandatory appendix fail to resolve the ambiguity as to whether Wal-Mart may use its Searcy hazard assessment as the hazard assessment for the allegedly identical New Braunfels location. In such circumstances, the court gives substantial deference to an agency’s interpretation of its own regulation. While section 1910.132(d)(1) may not require an employer to conduct a full-fledged hazard assessment of all identical workplaces, it is reasonable to interpret section 1910.132(d)(1) to require an employer to confirm that workplaces are indeed identical before a hazard assessment for one workplace can qualify as the hazard assessment for another location. Therefore, the court agreed with the Commission’s conclusion that the Secretary’s interpretation of section 1910.132(d)(1) is reasonable. However, because Wal-Mart lacked adequate notice of that interpretation, the court vacated the citation and the related penalty. View "Wal-Mart Distrib. Center v. OSHC" on Justia Law

Chapter 1301 of the Texas Insurance Code requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties. HCSC filed suit seeking a declaratory judgment against Methodist, seeking a declaration that Chapter 1301 does not apply to HCSC as the administrator of particular health plans, and the Federal Employee Health Benefits Act of 1959 (FEHBA), 5 U.S.C. 8901, et seq., preempts application of the statute to its administration of claims under the Federal Employees Health Benefits Program (FEHBP). The district court granted summary judgment to HCSC. The court held that Chapter 1301 is not applicable to BCBSTX’s activities as administrator of the self-funded plans or state government plans, nor to those activities that it performs as administrator of claims under the BlueCard program. The court also held that FEHBA preempts Chapter 1301’s application to the claims processed by BCBSTX under FEHBP plans. Accordingly, the court affirmed the judgment. View "Health Care Serv. Corp. v. Methodist Hospitals" on Justia Law

Plaintiffs, religious organizations, filed suit under the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb to 2000bb-4, challenging a requirement that they either offer their employees health insurance that covers certain contraceptive services or submit a form or notification declaring their religious opposition to that coverage. The district court enjoined the government from enforcing the requirement. The court concluded that the acts plaintiffs are required to perform do not involve providing or facilitating access to contraceptives, and plaintiffs have no right under RFRA to challenge the independent conduct of third parties. Because plaintiffs have not shown that the regulations substantially burden their religious exercise or, in University of Dallas, have not demonstrated a substantial likelihood of doing so, the court need not reach the strict-scrutiny prong or the other requirements for an injunction. Accordingly, the court reversed the judgment of the district court. View "East Texas Baptist Univ. v. Burwell" on Justia Law

The issue before the Fifth Circuit in this case centered on the Origination Clause, and two provisions of the Patient Protection and Affordable Care Act (ACA): the “individual mandate,” which imposed a penalty on non-exempt individuals who lacked qualifying health insurance; and the “employer mandate,” which imposed a tax on certain employers who failed to offer “affordable” health insurance to their employees and their employees’ dependents. The plaintiffs were Steven Hotze, M.D., and his employer, Braidwood Management, Inc. The district court held that the ACA was enacted in conformance with the Origination Clause, and thus dismissed plaintiffs’ complaint on its merits. The Fifth Circuit never reached the merits, and found it unnecessary to address the arguments relating to the Origination Clause. Instead, the Court concluded that the district court lacked subject-matter jurisdiction to entertain the complaint, because Hotze failed adequately to allege an injury that would give him standing to challenge the individual mandate and because Braidwood’s challenge to the employer mandate was barred by the Anti-Injunction Act as a suit seeking to enjoin the collection of a federal tax. Accordingly, the Fifth Circuit vacated the district court’s judgment and remanded this case with instructions to dismiss for lack of subject-matter jurisdiction. View "Hotze v. Burwell" on Justia Law

Medical provider North Cypress Medical Center Operating Co., Ltd. and North Cypress Medical Center Operating Co. GP, LLC (collectively, “North Cypress” or “the hospital”) sued Cigna Healthcare, Connecticut General Life Insurance Company, and Cigna Healthcare of Texas, Inc. (collectively, “Cigna”) for breach of healthcare plans administered or insured by Cigna. North Cypress argued that Cigna failed to comply with plan terms and underpaid for covered services. Cigna counter-claimed, arguing that it paid more than was owed; that North Cypress as an out-of-network provider did not charge the patients for coinsurance, but billed Cigna as if it had. The district court dismissed North Cypress’s ERISA claims for want of standing and Cigna’s ERISA claims as time barred. Finally, the district court granted summary judgment against North Cypress’s breach of contract claims, concluding there was no breach. North Cypress appealed and Cigna cross-appealed. The Eleventh Circuit, after review, affirmed in part, reversed in part, and remanded for further proceedings. In holding that North Cypress had standing to bring ERISA claims, the Court removed the grounds for the district court’s preemption ruling. The parties did not brief the issue of whether the "Discount Agreement" claims would survive un-preempted. Accordingly, the Court vacated the grant of summary judgment and remanded so that the district court could consider the question of preemption in light of our ruling on standing. The Court affirmed the remainder of the district court’s judgment. View "North Cypress Medical Center, et al v. Cigna Health" on Justia Law

Wal-Mart rented space to optometrists using a standard lease agreement requiring optometrists to make representations in their leases of the projected number of hours their offices would remain open. A jury found Wal-Mart liable for setting or attempting to influence office hours of an optometrist in violation of the Texas Optometry Act. Tex. Occ. Code 351.408. The district court subsequently remitted the jury's award of almost $4 million in civil penalties and plaintiffs accepted remittitur. Wal-Mart appealed. The court affirmed the district court's judgment regarding Wal-Mart's liability; reversed and vacated the district court's judgment regarding damages where the district court erred in applying Chapter 41's, Tex. Civ. Prac. & Rem. Code 41.001(5), lower damage cap exception; and remanded.View "Forte, et al. v. Wal-Mart Stores, Inc." on Justia Law

Relators filed suit under the False Claims Act (FCA), 31 U.S.C. 3729-3733, alleging that appellants committed numerous FCA violations concerning improper incentives for patient referrals. Assuming arguendo that qualified immunity is an available defense, the court held on the merits that appellants are not entitled to qualified immunity against these FCA claims where relators sufficiently pleaded that appellants violated the FCA and the courses of conduct allegedly taken by appellants were objectively unreasonable in light of clearly established law. Accordingly, the court affirmed the district court's denial of appellants' motion to dismiss.View "United States ex rel Parikh" on Justia Law

Plaintiffs filed suit challenging Mississippi's H.B. 1390, which requires that all physicians associated with the abortion facility must have admitting privileges at a local hospital and staff privileges to replace local hospital on-staff physicians. On appeal, the State challenged the district court's entry of a preliminary injunction enjoining the enforcement of the admitting privileges provision of H.B. 1390. The provision effectively will close the state's only abortion clinic. The court held that, assuming a rational basis inquiry is a necessary step in deciding the constitutionality of an abortion regulation, H.B. 1930 satisfied rational basis review; Gaines v. Canada instructs the court to consider the effects of H.B. 1390 only within Mississippi in conducting an undue burden analysis; JWHO, the only licensed abortion clinic in the state, has demonstrated a substantial likelihood of success on its claim that H.B. 1390's admission privileges requirement imposes an undue burden on a woman's right to choose an abortion in Mississippi and is unconstitutional as applied to plaintiffs; and, to the extent the preliminary injunction enjoined enforcement of H.B. 1390 against parties other than plaintiffs, it was overly broad and was modified to apply only to the parties in this case. Accordingly, the court affirmed the judgment of the district court with modifications. View "Jackson Women's Health Org., et al. v. Currier, et al." on Justia Law

Plaintiffs, Medicaid beneficiaries with near total disabilities, filed suit after being denied coverage for ceiling lifts under a categorical exclusion in the state's implementing Medicaid regulations. The district court granted summary judgment for the state. The court concluded that, under binding precedent, plaintiffs have an implied private cause of action under the Supremacy Clause to pursue their challenge; the state must comply with the requirements of the Medicaid Act, 42 U.S.C. 1396 et seq., but the Act does not preempt the state's categorical exclusions; and therefore, the court affirmed the grant of summary judgment and denied the motion to vacate. View "Detgen, et al. v. Janek" on Justia Law

Planned Parenthood filed suit against the State for declaratory judgment and to enjoin provisions of 2013 Texas House Bill No. 2 (H.B. 2). H.B. 2 pertains to the regulation of surgical abortions and abortion-inducing drugs. Two provisions of H.B.2 were at issue: first, the requirement that a physician performing or inducing an abortion have admitting privileges at a hospital no more than thirty miles from the location where the abortion is provided; and second, the limitations on the use of abortion-inducing drugs to a protocol authorized by the FDA. The district court held that parts of both provisions were unconstitutional and granted, in substantial part, the requested injunctive relief. A motions panel of this court granted a stay pending appeal, and the Supreme Court upheld the stay. As a preliminary matter, the court concluded that the physician-plaintiffs had standing on behalf of their patients, as well as standing to assert their own rights. The court concluded that the district court applied the wrong legal standards under rational basis review and erred in finding that the admitting-privileges requirement amounts to an undue burden for a large fraction of women that it affects. The court also concluded that the district court erred in holding that H.B. 2's rejection of the off-label protocol from fifty to sixty-three days LMP (last menstrual period) facially imposes an undue burden on the abortion rights of certain women. Accordingly, the court reversed and rendered judgment for the State, except that the admitting privileges requirement may not be enforced against abortion providers who timely applied for admitting privileges under the statute but are awaiting a response from the hospital. View "Planned Parenthood, et al. v. Abbott, et al." on Justia Law