Articles Posted in Public Benefits

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The Fifth Circuit affirmed the district court's denial of social security disability benefits to plaintiff. The court held that the ALJ's decision not to follow the VA's 100% disability rating determination was supported by substantial evidence where the court considered, but ultimately rejected the VA's findings, in part because the VA relied heavily on a one-time evaluation by a doctor who had not formed a treating relationship with plaintiff. The court explained that reports by two state-agency consultants cut against the VA's determination, and it was emphatically the ALJ's province to weigh the evidence and decide among these competing accounts. The court rejected plaintiff's remaining claims. View "Garcia v. Berryhill" on Justia Law

Posted in: Public Benefits

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Plaintiff filed suit under the Individuals with Disabilities Education Act (IDEA), alleging that the school district did not offer her daughter a free appropriate public education (FAPE). On appeal, the school district challenged an award in favor of plaintiff. The Fifth Circuit held, without adopting the characterization that the district court created a new category of IDEA private school student, that the district court's order could not be supported based on a requirement of temporary services for transfer students; plaintiff took a financial gamble of not being reimbursed when she placed her daughter in a private school without first allowing the school district to seek to comply with its obligations under IDEA; and, although the district court failed to recognize the proper private school placement, that failure did not create a penalty beyond what otherwise would be owed. Because the district court erred by holding that the school district was obligated to provide temporary services and by ordering reimbursement of the costs associated with such services, the court reversed in part. The court affirmed the district court's holding that the school district failed to make a timely offer of FAPE, thereby making reimbursement an appropriate form of relief. The court remanded for the district court to determine the amount of reimbursement owed from April 24, 2014, to the end of the school year. View "Dallas Independent School District v. Woody" on Justia Law

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Claimants appealed the denial of civil claims under the Settlement Program that was established following the Deepwater Horizon oil spill. Claimants submitted Individual Economic Loss (IEL) claims for lost wages as employees of their architectural firm. The firm had already received a Business and Economic Loss (BEL) award under the Settlement Program. The Fifth Circuit held that the BEL framework, by compensating the business for the owners' lost wages through the fixed-cost designation of their wages, precluded compensating those same owners for the same wages through an IEL claim. Because the Settlement Program did not contemplate the requested compensation, the court affirmed the judgment. View "In Re: Deepwater Horizon" on Justia Law

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Maxmed sought judicial review of the Secretary of Health and Human Services' determination that the Medicaid program overpaid Maxmed by almost $800,000 for home health care services rendered to Medicare beneficiaries. The Fifth Circuit held that the failure to record the random numbers used in the sample did not necessarily invalidate the extrapolation methodology; the Secretary did not act arbitrarily and capriciously in rejecting the challenge to the independence of the sampling units; Congress clearly envisioned extrapolation in overpayment determinations involving home health agencies like Maxmed, and the Secretary's reliance on extrapolation as a tool was justified; the district court did not abuse its discretion in denying Maxmed's motion to amend or alter the judgment; and the district court properly rejected Maxmed's due process claim. Accordingly, the court affirmed the district court's grant of summary judgment to the Secretary. View "Maxmed Healthcare, Inc. v. Price" on Justia Law

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Plaintiff suffers from physical, cognitive, and psychological impairments. In this appeal, plaintiff challenged the denial of her social security disability benefits. The court concluded that the ALJ legally erred by rejecting an examining physician's opinion without explanation. In this case, the physician opined that plaintiff could not work any job that entailed standing for longer than 30 minutes or walking farther than 50 years. Accordingly, the court vacated and remanded for the ALJ to consider plaintiff's impairments, taking into account the examining physician's opinion. View "Kneeland v. Berryhill" on Justia Law

Posted in: Public Benefits

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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

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Plaintiff challenged the denial of disability insurance benefits, arguing that the ALJ erred by failing to ask a testifying vocational expert whether her testimony was consistent with the Dictionary of Occupational Titles (DOT), as required by an agency policy interpretation ruling, but nonetheless relying on that testimony. The court concluded that the ALJ's procedural error was harmless and does not warrant reversal. Because plaintiff does not raise any other grounds for reversal, the court affirmed the judgment. View "Graves v. Colvin" on Justia Law

Posted in: Public Benefits

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In response to secretly recorded videos released by the Center for Medical Progress depicting conversations with Planned Parenthood employees elsewhere, LDHH terminated PPGC Louisiana Medicaid provider agreements. PPGC and the Individual Plaintiffs filed suit against LDHH under 42 U.S.C. 1983, alleging violations of 42 U.S.C. 1396a(a)(23) and the First and Fourteenth Amendments of the U.S. Constitution. The Individual Plaintiffs, three women who are Medicaid beneficiaries and who receive medical care from one of PPGC’s Louisiana facilities, seek to continue receiving care from PPGC’s facilities. The Individual Plaintiffs contend that LDHH’s termination action will deprive them of access to the qualified and willing provider of their choice, PPGC, in violation of Medicaid’s free-choice-of-provider provision. The district court entered a preliminary injunction against LDHH’s termination of PPGC’s Medicaid provider agreements. The court held that the Individual Plaintiffs met their burden to show their entitlement to a preliminary injunction; the district court did not abuse its discretion in preliminarily enjoining LDHH’s termination of PPGC’s provider agreements; and thus the court affirmed the district court's preliminary injunction, remanding for further proceedings. View "Planned Parenthood v. Gee" on Justia Law

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Plaintiffs filed suit against the City, arguing that the City's pension reforms violate the Texas Constitution, Tex. Const. art. XVI 66(d). Two district courts ruled in favor of the City. In these consolidated appeals, the court concluded that Section 66 permits prospective changes to the pension plans of the public employees within its reach. In this case, the Pension Reform complies with Section 66 where Section 66 did not turn plaintiffs’ variable-rate cost-of-living adjustment into a one-way ratchet capable only of upward movement. The court rejected claims raised by plaintiffs of Case No. 15-10416, that only the Texas legislature has the City of Dallas v. Trammel "reserved power" to amend pension plans and thus abrogate contractual rights. The court concluded that this argument is foreclosed by Klumb v. Houston Mun. Employees Pension Sys. Finally, the court concluded that the Pension Reform does not violate the United States Constitution’s contracts clause and takings clause where neither clause create property rights and the right to public pension benefits in Texas is subject to legislative power. Accordingly, the court affirmed the district court's judgments. View "Houten, Jr. v. City of Fort Worth" on Justia Law

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Plaintiff, complaining chiefly of neck pain, appealed the denial of his application for disability benefits. The court concluded that the newly submitted evidence - namely, updated treatment records - was not so significant as to require remand to the ALJ for additional consideration; substantial evidence supports the ALJ's determination at step three of the evaluation process that plaintiff did not meet or medically equal Listing 1.04(A); and the ALJ's residual functioning capacity (RFC) finding is supported by substantial evidence where the ALJ found that plaintiff was capable of performing light work with certain limitations. The court agreed with the ALJ's ultimate determination that plaintiff was not disabled and affirmed the judgment. View "Whitehead v. Colvin" on Justia Law

Posted in: Public Benefits