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

UT filed suit against the United States, seeking refund of the Social Security component of FICA taxes it paid with respect to the service of medical residents in 2005. The court affirmed the district court's denial of UT's motion for summary judgment and grant of the United States' motion for summary judgment, concluding that UT's residents are not "students" within the meaning of the student exclusion in Texas's 42 U.S.C. 418 agreement. Section 418 allows states to voluntarily opt-in to the Social Security system by entering into an agreement with the Commissioner of Social Security.View "University of Texas System, et al. v. United States" 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

SHA appealed the district court's grant of summary judgment in favor of plaintiff. The district court concluded that SHA acted arbitrarily and capriciously in terminating plaintiff's rental assistance benefits under the Housing Choice Voucher Program (Section 8) for failure to attend an annual recertification meeting. The court held that plaintiff followed SHA's requirements - including contacting SHA within three days of her receipt of SHA's notice and attempting to reschedule due to her mother's recent death - and that SHA's contrary decision was arbitrary and capricious. Because this conclusion disposed of the case, the court did not address the parties' remaining contentions. Accordingly, the court affirmed the judgment of the district court. View "Cooley v. Housing Auth. of the City of Slidell" on Justia Law

Oaks, a nursing facility, initiated contempt proceedings against the government because the government failed to abide by the district court's order enjoining the government from acting in accordance with a Notice of Termination relative to Oak's Medicare and Medicaid Provider Agreement. The court vacated the finding of contempt and reversed the judgment of the district court, concluding that the government complied with the injunction by delaying effectuation of the termination notice. View "Oaks of Mid City Resident Council v. Sebelius, et al." on Justia Law

After Hermann Hospital merged with Memorial Hospital System, creating the Memorial Herman Hospital System (MHHS), the Administrator denied MHHS's request for a Medicare loss payment under 42 C.F.R. 413.134(l). The court joined all other circuits that have ruled on the issue by holding that statutory mergers must be bona fide sales in order to be eligible for a depreciation adjustment under 42 U.S.C. 413.134(l). The court found that substantial evidence supported the Administrator's conclusion that the merger at issue failed to constitute a bona fide sale and, therefore, affirmed the judgment of the district court. View "Memorial Hermann Hospital v. Sebelius" on Justia Law

Plaintiff appealed the termination of her Medicaid benefits. At issue was the enforceability of a provision of the Medicaid Act, 42 U.S.C. 1396a(a)(8), under 42 U.S.C. 1983. The court concluded that section 1396a(a)(8) created a right enforceable under section 1983, and that exhaustion of Louisiana's procedure for judicial review was not required before a Medicaid claimant filed suit in federal court. Accordingly, the court affirmed the judgment of the district court denying DHH's motion to dismiss because plaintiff's claims were properly before the district court. View "Romano v. Greenstein" on Justia Law

This case involved the interplay between the Medicare Secondary Payer Statute (MSP), 42 U.S.C. 1395y(b), and Texas workers' compensation law. At issue was whether the MSP preempted a state law that required a workers' compensation claimant to obtain preauthorization from the relevant carrier before incurring certain medical expenses. The court held that it did not. The court concluded that Congress intended the MSP to complement, no supplant, state workers' compensation rules. This included the preauthorization requirement that plaintiff failed to meet before he filed suit. The court rejected plaintiff's claim that Medicare's conditional payment for his surgeries - which equated to a determination that his surgeries were medically unnecessary - rendered the state-law preauthorization requirement "moot" because preauthorization likewise depended on a showing of medical necessity. Accordingly, the court affirmed the district court's dismissal of plaintiff's claim for failure to state a claim under Rule 12(b)(6). View "Caldera v. The Ins. Co. of the State of PA" on Justia Law

Southwest appealed the district court's dismissal of its claim regarding the Medicare Part D statute, 42 U.S.C. 1395w-101 et seq., for lack of subject matter jurisdiction. Citing Shalala v. Illinois Council on Long Term Care, Southwest argued that its claim provided a narrow exception to 42 U.S.C. 405(h)'s requirement that required a plaintiff to exhaust administrative remedies before filing a claim in federal court. The court concluded that caselaw interpreting the application of section 405(h) to Medicare claims emphasized that the Illinois Council exception was extremely narrow and appropriately applied only in cases where judicial review would be entirely unavailable through the prescribed administrative procedures. Because Southwest has not carried its heavy burden of showing that the Illinois Council exception applied, the court affirmed the district court's order dismissing the suit. View "Southwest Pharmacy Solutions, Inc. v. Centers for Medicare & Medicaid, et al" on Justia Law

Plaintiff appealed the denial of his claim for disability-insurance benefits and supplemental-security-income benefits. The magistrate judge recommended reversing the SSA's denial of benefits and remanded for plaintiff's claim to the SSA for further proceedings. The district court then entered an order adopting the magistrate judge's recommendation and granted plaintiff's counsel's request and award for attorneys' fees. At issue in this appeal was the type of judgment for which a district court could grant attorneys' fees under the Social Security Act, 42 U.S.C. 406(b). The court reversed the district court's denial of attorneys' fees, concluding that the district court's construction of section 406(b) unavoidably reduced the likelihood that an attorney who undertook a disability benefits representation would receive reasonable compensation for his work. Section 406(b) fees were authorized in cases where an attorney obtained a favorable decision on remand and the SSA has not opposed such fees for over 25 years. View "Jackson v. Astrue" on Justia Law

Plaintiff appealed the denial of her social security disability benefits, arguing that the ALJ improperly disregarded evidence from her treating physicians without re-contacting him to obtain further documentation. Because (1) the ALJ had no duty to re-contact that physician where the record contained sufficient evidence from other physicians and (2) any error was harmless even if the ALJ were required to re-contact the doctor, the court affirmed the judgment. View "Jones v. Astrue" on Justia Law