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

Plaintiffs, two private citizens and eighteen states, filed suit challenging the individual mandate requirement of the Patient Protection and Affordable Care Act (ACA). The individual mandate required individuals to maintain health insurance coverage and, if individuals did not maintain this coverage, they must make a payment to the IRS called a shared responsibility payment.Plaintiffs argued that the individual mandate was no longer constitutional because: (1) Nat'l Fed'n of Indep. Bus. v. Sebelius, 567 U.S. 519, 538 (2012), rested the individual mandate's constitutionality exclusively on reading the provision as a tax; and (2) a 2017 amendment, which changed the amount of the shared responsibility payment to zero dollars, undermined any ability to characterize the individual mandate as a tax because the provision no longer generates revenue, a requirement for a tax. Plaintiffs further argued that the individual mandate was essential to, and inseverable from, the rest of the ACA and thus the entire ACA must be enjoined.The Fifth Circuit affirmed in part and vacated in part the district court's judgment, holding that there is a live case or controversy because the intervenor-defendant states have standing to appeal and, even if they did not, there remains a live case or controversy between plaintiffs and the federal defendants; plaintiffs have Article III standing to bring this challenge to the ACA because the individual mandate injures both the individual plaintiffs, by requiring them to buy insurance that they do not want, and the state plaintiffs, by increasing their costs of complying with the reporting requirements that accompany the individual mandate; the individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power; and, on the severability question, the court remanded to the district court to provide additional analysis of the provisions of the ACA as they currently exist. View "Texas v. United States" on Justia Law

The Gestational Age Act, a Mississippi law that prohibits abortions, with limited exceptions, after 15 weeks' gestational age is an unconstitutional ban on pre-viability abortions.The Fifth Circuit held that states may regulate abortion procedures prior to viability so long as they do not impose an undue burden on the woman's right, but they may not ban abortions. The court held that the law at issue is a ban on certain pre-viability abortions, which Planned Parenthood of Se. Pa. v. Casey does not tolerate and which presents a situation unlike that in Gonzales v. Carhart. The court explained that, with respect to bans like this one, the Supreme Court's viability framework has already balanced the state's asserted interests and found them wanting: Until viability, it is for the woman, not the state, to weigh any risks to maternal health and to consider personal values and beliefs in deciding whether to have an abortion.The court also held that the district court was within its discretion in limiting discovery of the issue of viability and excluding expert testimony regarding fetal pain perception. Finally, the court upheld the district court's award of permanent injunctive relief. View "Jackson Women's Health Organization v. Dobbs" on Justia Law

After an employee of Excel was killed when a scaffold he was constructing collapsed into Galveston Bay, OSHA conducted an investigation into the incident and issued Excel a number of safety citations. Excel contested the issuance of the citation charging the company with a serious violation of a regulation which required Excel to ensure the presence of a "lifesaving skiff" at all jobsites where employees were required to work over water. The ALJ upheld the Commission's decision declining to conduct further review, and Excel petitioned for review.The Fifth Circuit denied Excel's petition for review, holding that Excel repeatedly failed to preserve the affirmative defense of infeasibility, and the ALJ did not abuse its discretion by determining that it would have been prejudicial to the Secretary to allow Excel to pursue its infeasibility defense. Even if Excel had not abandoned its infeasibility defense, Excel had not met its burden of proving that it was entitled to the defense on the merits. Finally, the court held that the ALJ's conclusion that the absence of a skiff exposed Excel's employees to a substantial probability of death or serious injury was amply supported by the record. View "Excel Modular Scaffold & Leasing Co. v. Occupational Safety and Health Review Commission" on Justia Law

Coleman challenged the Commission's decision that its 18 working-days-late response to a citation notice that had been misplaced in the company's internal mail system demonstrated inexcusable neglect and barred the company from contesting the citations for nearly $70,000.The Fifth Circuit held that the Commission's decision misapplied Federal Rule of Civil Procedure 60(b), which applied under the Commission's own regulations. The court held that the equities weighed in favor of the Company having an opportunity to assert its defenses in OSHA's administrative proceedings. Therefore, the Commission's contrary determination denying relief from the untimely filing was legally in error and an abuse of discretion. Accordingly, the court vacated that decision, remanding for a hearing on the merits of the OSHA violations. View "Coleman Hammons Construction Co. v. Occupational Safety and Health Review Commission" on Justia Law

The Fifth Circuit denied Southern Hens' petition for review of the ALJ's determination that the poultry processing plant committed two violations of occupational safety standards after an employee suffered a serious injury when her hand got caught in a machine's moving parts. The court upheld the ALJ's decision with regard to the lockout violation because Southern Hens lacked the sort of established work rule required for the "unpreventable employee misconduct" defense; upheld that machine-guarding standard and adopted the reasonably predictable standard, holding that there was substantial evidence that employee injury from the hazard was reasonably predictable; and upheld the penalties for the lockout violation and the machine-guarding violation. View "Southern Hens, Inc. v. Occupational Safety and Health Review Commission" on Justia Law

Two Mississippi hospitals filed suit alleging that the government miscalculated their Disproportionate Share Hospital (DSH) payments. In this case, the district court gave substantial deference to the interpretation of HHS, which read that the relevant statute and regulation to exclude from the numerator Mississippi's uncompensated care pool (UCCP) patient days.However, the Fifth Circuit held that HHS's position was foreclosed by the text and structure of the relevant provisions. Therefore, HHS's decision to exclude UCCP patient days from the Medicaid fraction's numerator was not in accordance with law. Accordingly, the court reversed and remanded for further proceedings. View "Forrest General Hospital v. Azar" on Justia Law

The Fifth Circuit affirmed the district court's decision to affirm the revocation of two physicians' Medicare privileges. The court held that the physicians billed for services using their own Medicare National Provider Identifiers without providing direct supervision while traveling outside of the country; the ALJ's summary judgment dismissal of the physicians' claims was supported by substantial evidence; the physicians' constitutional claims were rejected; the court agreed with its sister circuits that have determined that participation in the federal Medicare reimbursement program is not a property interest; and the court deferred to CMS's decision to bar the physicians from re-enrolling in the Medicare program for three years. View "Shah v. Azar" on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment to HHS in an action under the Administrative Procedure Act arising from a demonstration project deviating from the ordinary Medicare reimbursement rules. In this case Texas Tech could keep the additional fees it received for implementing the project only if its care management model achieved cost savings. When the government determined that Texas Tech failed to do so, it demanded return of about $8 million in fees.As a preliminary matter, the court held that the demonstration agreement was not a procurement contract and the HHS Departmental Appeals Board had jurisdiction over this case. On the merits, the court held that it need not resolve whether the Board erred in suggesting that the common law of contracts never informs grant disputes, because, even if it did, the Board made valid findings justifying the rejection of Texas Tech's various contract theories. The court rejected Texas Tech's contention that CMS breached the demonstration agreement by failing to provide an appropriately matched control group; by refusing to allow Texas Tech to access relevant Medicare claims data; and by engaging RTI to evaluate whether differences between the intervention and control groups may have accounted for the apparent lack of cost savings. Finally, the court held that, although the Board did not expressly address two common law contract doctrines -- mistake and impracticability -- it did make findings that doom those two defenses. View "Texas Tech Physicians Assoc. v. US Department of Health and Human Services." on Justia Law

Mathew worked at Parkland Health and Hospital System as a registration specialist and also owned Dallas Home Health Care (DHH). Mathew stole confidential patient information from Parkland and gave it to DHH employees to call the individuals and solicit them as patients. Based on information from a former DHH employee, authorities obtained a search warrant for DHH’s office and determined DHH to be in the possession of approximately 1,300 Parkland patients’ identifying information, including their health insurance claim numbers (HICNs). Mathew pleaded guilty to “knowingly possess[ing] with intent to use unlawfully or transfer unlawfully five or more authentication features, to wit, [HICNs], and the authentication features were or appeared to have been issued by or under the authority of the United States,” 18 U.S.C. 1028(a)(3), (b)(2)(B), (c)(1). The Fifth Circuit vacated his sentence of 30 months’ imprisonment plus $277,957.89 in restitution. The restitution order under the Mandatory Victim Restitution Act, 18 U.S.C. 3663A, was unlawful because it included amounts for Medicare payments that preceded the temporal scope of the offense of conviction. Mathew’s statements at rearraignment cannot serve as the justification for broadening restitution to include conduct not contained in the indictment or factual resume. The court rejected other challenges to the restitution award. View "United States v. Mathew" on Justia Law

Provider Plaintiffs and Individual Plaintiffs filed suit seeking a preliminary injunction against the OIG's decision to terminate the Medicaid provider agreements to Planned Parenthood affiliates throughout the state. The district court held that the Individual Plaintiffs possessed a private right of action under the "qualified-provider" provision of the Medicaid Act and issued a preliminary injunction.The Fifth Circuit held that the district court erred in evaluating the evidence de novo, rather than under the arbitrary and capricious standard, and in applying the reasoning in Planned Parenthood Gulf Coast v. Gee, 862 F.3d 445 (5th Cir. 2017), to its determination of a "qualified" provider in this context. Therefore, the district court erred legally and plaintiffs were unlikely to show a likelihood of success on the merits of their claim. Accordingly, the court vacated the preliminary injunction and remanded for the district court to limit its review to the agency record under an arbitrary-and-capricious standard. View "Planned Parenthood of Greater Texas Family Planning and Preventative Health Services v. Smith" on Justia Law