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

Dr. Narang and Moparty were convicted of Conspiracy to Commit Health Care Fraud, 18 U.S.C. 1349; Health Care Fraud, section 1347, and Engaging in Monetary Transactions in Property Derived from Specified Unlawful Activity, section 1957. Narang is an internist who practiced at his Texas self-owned clinic, North Cypress. Moparty co-owned Red Oak Hospital and served as an administrator for Trinity Health Network, which provided staffing and administrative services to health care entities. Narang ordered unnecessary medical tests for patients and then authorized Moparty to bill for these tests at the higher hospital rate even though these patients were seen and treated at Narang’s North Cypress office. The indictment alleged that this scheme resulted in fraudulent billing of over $20 million to Blue Cross Blue Shield, Aetna, and Cigna. Those companies paid Moparty at least $3.2 million in reimbursement for those claims which he allegedly split with Narang through a series of financial transactions.The court sentenced Moparty to 108 months and Narang to 121 months of imprisonment, with joint and several liability for $2,621,999.04 in restitution. The Fifth Circuit affirmed, rejecting challenges to the sufficiency of the evidence and finding that, although the government made repeated errors, those errors did not warrant reversal. View "United States v. Moparty" on Justia Law

The Fifth Circuit, en banc, vacated the district court's permanent injunction declaring Senate Bill 8 (SB8), which prohibits a particular type of dilation and evacuation (D&E) abortion method, facially unconstitutional.The district court held that SB8 imposes an undue burden on a large fraction of women, primarily because it determined that SB8 amounted to a ban on all D&E abortions. However, viewing SB8 through a binary framework—that either D&Es can be done only by live dismemberment or else women cannot receive abortions in the second trimester—is to accept a false dichotomy. Rather, the en banc court concluded that the record shows that doctors can safely perform D&Es and comply with SB8 using methods that are already in widespread use. The en banc court also concluded that the district court, in permanently enjoining SB8, committed numerous, reversible legal and factual errors: applying the wrong test to assess SB8, disregarding and misreading the Supreme Court's precedents in Planned Parenthood of Southeastern Pennsylvania v. Casey and Gonzales v. Carhart, and bungling the large-fraction analysis. Because remanding to the district court would be futile as the record permits only one conclusion, the en banc court concluded that plaintiffs have failed to carry their heavy burden of proving that SB8 would impose an undue burden on a large fraction of women. View "Whole Woman's Health v. Paxton" on Justia Law

Shortly after COVID-19 struck the Wallace Pack Unit, plaintiffs filed suit seeking injunctive relief on behalf of three certified classes of inmate for violations of the Eighth Amendment, the Americans with Disabilities Act (ADA), and the Rehabilitation Act. Specifically, plaintiffs alleged that defendants acted with deliberate indifference to their health and safety in violation of the Eighth Amendment in light of the dangers of COVID-19 for a geriatric prison population, and that defendants violated the ADA and Rehabilitation Act by failing to accommodate for specific risks to wheelchair-bound and other mobility-impaired inmates.On April 16, 2020, the district court entered a preliminary injunction which was stayed by the Fifth Circuit on April 22 and then vacated on June 5. On September 29, 2020, the district court issued a permanent injunction, concluding that plaintiffs did not need to exhaust administrative remedies; defendants were deliberately indifferent; and defendants violated the ADA and the Rehabilitation Act.The Fifth Circuit reversed the district court's permanent injunction and rendered judgment for defendants. The court concluded that the prison officials were not deliberately indifferent based on a lack of a systemic approach. After considering Policy B-14.52, its unwritten additions, and its administration, the court explained that the record does not support a finding of deliberate indifference in the way the officials considered and adopted a response to COVID-19. The court also concluded that the prison officials were not deliberately indifferent based on a failure to abide by basic public health guidance regarding testing, social distancing, mask use, handwashing, sanitation, and cleaning. Finally, the court concluded that the mobility-impaired inmates failed to establish their prima facie ADA claim, and consequently their Rehabilitation Act claim. View "Valentine v. Collier" on Justia Law

The Fifth Circuit withdrew its prior opinion and substituted the following opinion.The States filed suit against the United States, raising constitutional challenges to Section 9010 of the Affordable Care Act (ACA), as well as statutory and constitutional challenges to an HHS administrative rule (Certification Rule).As a preliminary matter, the Fifth Circuit affirmed the district court's ruling that the States had standing. The court reversed the district court's ruling that the States' Administrative Procedure Act (APA) claims were not time-barred and dismissed those claims for lack of jurisdiction. On the merits, the court held that the Certification Rule and Section 9010 are constitutional and lawful. As a result, the court explained that there can be no equitable disgorgement, regardless of whether such a remedy would be otherwise appropriate. Accordingly, the court affirmed the district court's judgment on the Section 9010 claims and reversed the district court's judgment that the Certification Rule violated the nondelegation doctrine. Therefore, the court rendered judgment in favor of the United States. Because the court held that neither the Certification Rule nor Section 9010 are unlawful, the court vacated the district court's grant of equitable disgorgement to the States. View "Texas v. United States" on Justia Law

Shah, a board-certified pediatric anesthesiology specialist, joined STAR, which became the exclusive provider of anesthesia services at several San Antonio-area acute-care hospitals, including NCB. BHS guaranteed STAR $500,000 in collections for pediatric anesthesia services provided at NCB. In 2012, STAR became the exclusive provider of anesthesia services at four BHS hospitals. Shah was not a party to the 2012 agreement, nor was he named in the pediatric income guarantee but he continued to practice as a STAR pediatric anesthesiologist, becoming the primary beneficiary of STAR’s guaranteed collections. In 2016, STAR and BHS amended the 2012 agreement, eliminating the pediatric income guarantee. The exclusivity provision remained. STAR terminated its relationship with Shah. Shah could no longer provide pediatric anesthesia services at NCB or any other BHS facility included in the exclusivity agreement. Shah requested authorization to provide pediatric anesthesia care at NCB; BHS responded that Shah’s reappointment to the Medical Staff of BHS and his privileges were approved but the exclusivity provision precluded Shah from providing pediatric anesthesia services at six BHS facilities (including NCB). After unsuccessfully suing STAR in Texas state court, Shah sued under the Sherman Act.The Fifth Circuit affirmed summary judgment in favor of the BHS parties. Shah’s definition of the relevant market is insufficient as a matter of law; it does not encompass all interchangeable substitute products because it does not include the two non-BHS facilities that the BHS parties contend serve as viable alternatives to BHS facilities. View "Shah v. VHS San Antonio Partners, LLC" on Justia Law

The en banc court held that 42 U.S.C. 1396a(a)(23) does not give Medicaid patients a right to challenge, under 42 U.S.C. 1983, a State's determination that a health care provider is not "qualified" within the meaning of section 1396a(a)(23). The en banc court vacated the preliminary injunction issued by the district court prohibiting the termination of the Providers' Medicaid provider agreements.The Providers provide family planning and other health services to Medicaid patients, and each of the Providers is a member of Planned Parenthood. This case stemmed from a pro-life organization's release of video recordings of conversations at Planned Parenthood (PP) Gulf Coast headquarters. The videos depict two individuals posing as representatives from a fetal tissue procurement company discussing the possibility of a research partnership with PP Gulf Coast. The release of the videos prompted congressional investigations, which ultimately led to the OIG sending each Provider a Notice of Termination of its respective Medicaid provider agreement. The Providers and Individual Plaintiffs filed suit alleging that the terminations violated rights conferred by section 1396a(a)(23) and sought relief under section 1983.The en banc court held that the Individual Plaintiffs may not bring a section 1983 suit to contest the State's determination that the Providers were not "qualified" providers within the meaning of section 1396a(a)(23). The en banc court rested its decision primarily on two independent bases: (1) the Supreme Court's decision in O'Bannon v. Town Court Nursing Center, 447 U.S. 773 (1980), and (2) the text and structure of section 1396a(a)(23), which does not unambiguously provide that a Medicaid patient may contest a State's determination that a particular provider is not "qualified." Rather, the court held that whether a provider is "qualified" within the meaning of section 1396a(a)(23) is a matter to be resolved between the State (or the federal government) and the provider. In so holding, the en banc court overruled Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017), which held that a state agency or actor cannot legitimately find that a Medicaid provider is not "qualified" unless under state or federal law the provider would be unqualified to provide treatment or services to the general public, including Medicaid patients who paid for the care or services with private funds. View "Planned Parenthood of Greater Texas Family Planning and Preventative Health Services, Inc. v. Kauffman" on Justia Law

Plaintiff filed suit challenging the Affordable Care Act (ACA), seeking retrospective and prospective relief for myriad alleged violations of the United States Constitution and the Religious Freedom Restoration Act. The Fifth Circuit declined to reach the merits of plaintiff's claims. The court held that, given the altered legal landscape and the potential effects of plaintiff's request for prospective relief, a mootness analysis must precede the merits. In this case, a year after plaintiff filed his lawsuit, Congress passed and President Trump signed the Tax Cut and Jobs Act, which reduced the shared responsibility payment (imposed on individuals who fail to purchase health insurance) to $0. In the same year, the Department of Health and Human Services created new exemptions to the contraceptive mandate, including an exemption for individuals like plaintiff. These exemptions were enjoined until the Supreme Court's recent decision in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania. Therefore, the court vacated the district court's dismissal of plaintiff's claims and remanded for the district court to conduct a mootness analysis in the first instance. The court also remanded to allow plaintiff to amend his complaint where the parties agreed that the district court incorrectly dismissed plaintiff's claim for retrospective relief. View "Dierlam v. Trump" on Justia Law

Senate Bill 8 -- a statute that requires a woman to undergo an additional and medically unnecessary procedure to cause fetal demise before she may obtain a dilation and evacuation (D&E) abortion, the safest and most common method of second trimester abortions -- imposes an undue burden on a woman's right to obtain an abortion before fetal viability in violation of the Fourteenth Amendment's Due Process clause.The Fifth Circuit affirmed the district court's judgment holding that SB8 is facially unconstitutional and permanently enjoining its enforcement. Applying the undue burden test in Whole Woman's Health v. Hellerstedt, 136 S. Ct. 2292, 2309 (2016), rather than June Medical Services, L.L.C. v. Russo, 140 S. Ct. 2103, 2114 (2020), the court held that SB8's burdens substantially outweigh its benefits and constitutes an undue burden on a woman's right to obtain a previability abortion. Under the statute, the court explained that all women seeking a second trimester abortion starting at 15 weeks LMP would be required to endure a medically unnecessary and invasive additional procedure that provides no health benefit; for most women, the length of the procedure would increase from one day to two, adding to the costs associated with travel, lodging, time away from work, and child care; and SB8 forces abortion providers to act contrary to their medical judgment and the best interest of their patient by conducting a medical procedure that delivers no benefit to the woman. Weighing SB8's significant burdens upon female patients against its nonexistent health benefits and any other limited benefits it may actually confer, the court concluded that it is clear that the law places a "substantial obstacle in the path of a woman seeking" a previability abortion. View "Whole Woman's Health v. Paxton" on Justia Law

The Fifth Circuit affirmed the district court's grant of the government's motion to dismiss Sahara's suit for injunctive relief in a Medicare recoupment case, holding that the government provided Sahara adequate process. Applying the Mathews factors, the court held that the sufficiency of the current procedures and the minimal benefit of the live hearing weighs so strongly against Sahara that its due process claim fails. In this case, Sahara received some procedure, chose to forego additional protections, and cannot demonstrate the additional value of the hearing it requests. The court also held that Sahara failed to state a claim for ultra vires actions under 42 U.S.C. 1395ff. View "Sahara Health Care, Inc. v. Azar" on Justia Law

Federal regulations establish a compensation formula for the payment of certain health care providers—a formula that changes once a year. However, each formula takes effect on January 1 and runs until January 1 of the following year. On January 1, two competing formulas purport to apply, making it unclear which one governs: the new one, or the one from the preceding year.The Fifth Circuit affirmed the district court's grant of summary judgment to the government, holding that the context of the rule makes clear that the court should construe the 2005 rule to give effect to the new formula, and not the formula from the preceding year, when presented with a cost report that begins on January 1. View "Greenbrier Hospital, LLC v. Azar" on Justia Law