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

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

After Family Rehabilitation was assessed about $7.6 million for Medicare overpayments, it filed suit for an injunction against recoupment until it received an ALJ hearing. The Fifth Circuit reversed the district court's dismissal for lack of subject matter jurisdiction and remanded in regard to Family Rehabilitation's procedural due process and ultra vires claims. The court held that exhaustion of administrative review was waived because Family Rehabilitation asserted a collateral challenge that could not be remedied after the exhaustion of administrative review. In this case, Family Rehabilitation sought only the suspension of recoupment before a hearing, which was plainly collateral to the result of that hearing, and the combined threats of going out of business and disruption to Medicare patients were sufficient to show that it would suffer irreparable injury. The court affirmed in all other respects. View "Family Rehabilitation, Inc. v. Azar" on Justia Law

After Family Rehabilitation was assessed about $7.6 million for Medicare overpayments, it filed suit for an injunction against recoupment until it received an ALJ hearing. The Fifth Circuit reversed the district court's dismissal for lack of subject matter jurisdiction and remanded in regard to Family Rehabilitation's procedural due process and ultra vires claims. The court held that exhaustion of administrative review was waived because Family Rehabilitation asserted a collateral challenge that could not be remedied after the exhaustion of administrative review. In this case, Family Rehabilitation sought only the suspension of recoupment before a hearing, which was plainly collateral to the result of that hearing, and the combined threats of going out of business and disruption to Medicare patients were sufficient to show that it would suffer irreparable injury. The court affirmed in all other respects. View "Family Rehabilitation, Inc. v. Azar" on Justia Law

Legacy, a Federally Qualified Health Center (FQHC), filed suit against the Commission, alleging that Texas's reimbursement scheme violated the Medicaid Act. The Fifth Circuit reversed the district court's grant of summary judgment for Legacy, holding that the Commission's requirement that Managed Care Organizations (MCOs) fully reimburse FQHCs did not violate the Medicaid Act; Legacy lacked standing to challenge the Commission's lack of a policy that the state directly reimburse an FQHC if it is not fully reimbursed by the MCO; and Legacy was not entitled to reimbursement for the non-emergency, out-of-network services about which it complained. Accordingly, the court remanded with instructions. View "Legacy Community Health Services, Inc. v. Smith" on Justia Law

Legacy, a Federally Qualified Health Center (FQHC), filed suit against the Commission, alleging that Texas's reimbursement scheme violated the Medicaid Act. The Fifth Circuit reversed the district court's grant of summary judgment for Legacy, holding that the Commission's requirement that Managed Care Organizations (MCOs) fully reimburse FQHCs did not violate the Medicaid Act; Legacy lacked standing to challenge the Commission's lack of a policy that the state directly reimburse an FQHC if it is not fully reimbursed by the MCO; and Legacy was not entitled to reimbursement for the non-emergency, out-of-network services about which it complained. Accordingly, the court remanded with instructions. View "Legacy Community Health Services, Inc. v. Smith" on Justia Law

Seymour filed suit challenging DHHS's decision, founded on a manual that defined "primary roads" as numbered federal highways and defined "secondary roads" as non-primary roads, that it was not a critical access hospital. The district court granted summary judgment for DHHS. The court applied deference under Skidmore v. Swift & Co., and concluded that DHHS's approach was neither arbitrary nor unreasoned nor did it rely on irrelevant considerations in attempting to fulfill Congressional intent. In this case, the agency considered, among other things, more than a road's alphanumeric designation, and the agency's premise was that ordinarily, federal highways are likely to be bigger, better-maintained, and more well-traveled than state highways. DHHS's decision reflected the general conclusion that federal highways offer superior conditions than state highways. Accordingly, the court affirmed the judgment. View "Baylor County Hospital District v. Price" on Justia Law

In the underlying action, JCHCC sought to permanently enjoin the Parish from evicting it from two Parish-owned facilities in which JCHCC currently provides medical services to medically underserved populations. The district court granted JCHCC's motion for a preliminary injunction, enjoining the Parish from evicting JCHCC but allowing it to terminate the injunction by establishing that the medical needs of the population currently served by the relevant JCHCC facilities would be met if JCHCC were evicted. The court reversed, concluding that JCHCC has not established a substantial likelihood of success on the merits of the only claim that was properly before the court. In this case, JCHCC failed to establish a likelihood of success on the merits of its Medicaid violation claim where JCHCC does not point to any authority suggesting that every local government in every participating state must provide the relevant medical services, nor does it point to authority establishing that the Parish has any obligation under Louisiana state law to provide such services on behalf of the state. View "Jefferson Community Health Care Centers v. Jefferson Parish Government" on Justia Law

Delek petitions for review of OSHA citations for violations of its process safety management rules, which govern an employer’s responsibility to inspect, and to develop inspection and recording regimes for, machinery that handles large volumes of hazardous chemicals. Item 4 alleges a failure to resolve open findings and recommendations identified during process hazard analyses that occurred in 1994, 1998, 1999, 2004, and 2005—prior to Delek purchasing and taking possession of the refinery. Item 8 alleges an inadequate monitoring and inspection regime for certain equipment involved in process safety management. Item 12 alleges that Delek failed to determine and document a response to the findings of a 2005 compliance audit in a timely manner. Item 12 was also conducted before Delek took possession of the refinery. The court concluded that citations for Items 4 and 12 are barred by the six-month statute of limitations in 29 U.S.C. 658(c). Accordingly, the court vacated those items. The court also concluded that the regulations relevant to the citation for Item 8 are ambiguous and the Secretary's interpretation is reasonable. The court affirmed the citation for Item 8. View "Delek Refining, Ltd. v. OSHC" on Justia Law

West Texas LTC Partners, Inc., doing business as Cedar Manor Nursing & Rehabilitation Center ("Cedar Manor"), appealed a Departmental Appeals Board ("DAB") of the U.S. Department of Health and Human Services ("HHS") decision. In 2013, Cedar Manor was surveyed by the Texas Department of Aging and Disability Services ("DADS"). The surveyor found Cedar Manor out of compliance with three regulations after observing the care provided to two wheelchair-bound residents, Resident #1 and Resident #4. Early the next year, DADS found additional violations of several regulations. The surveys were conducted by a designated state agency on behalf of the Centers for Medicare & Medicaid Services ("CMS") of HHS. The findings were reviewed by CMS, and civil money penalties ("CMPs") or other remedies may be imposed by the Secretary of HHS if the facility was found noncompliant. For the two sets of violations, CMS recommended two CMPs: $6,050 per day for three days, and $350 per day for forty-two days, to run consecutively from the end of an "immediate hazard" penalty. Cedar Manor appealed the findings and CMPs and requested a hearing before an administrative law judge ("ALJ"). CMS moved for summary judgment on all of the violations after the briefing and evidence were submitted. The ALJ granted summary judgment and upheld the CMPs. On de novo review, the DAB affirmed. The Fifth Circuit found that the DAB decision was neither arbitrary and capricious nor unsupported by substantial evidence, it denied Cedar Manor's petition for review. View "West Texas LTC Partners, Inc. v. Dept. of Health & Hum. Svcs." on Justia Law