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

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

Plaintiff Rebecca Gonzalez (Relator) brought a qui tam action under the False Claims Act (FCA) against Defendants, Fresenius Medical Care N.A., Fresenius Medical Care Holdings, Inc., Bio-Medical Applications of Texas, Inc. (collectively, Fresenius), and Dr. Alfonzo Chavez. Relator also brought retaliation claims against Fresenius and her former supervisor Larry Ramirez. The district court granted in part and denied in part Defendants' motions for judgment as a matter of law, and the jury returned a verdict in favor of Defendants on the remaining claims. The district court then awarded Fresenius $15,360 in attorney's fees from Relator's counsel. The Fifth Circuit Court of Appeals affirmed the district court's judgment in all instances, holding (1) the district court correctly granted Defendants' motion for judgment as a matter of law on Relator's FCA claims, and the court's FCA jury instructions were not in error; (2) the district court did not err in granting Defendants' motion for judgment as a matter of law on Relator's retaliation claims; and (3) the district court did not abuse its discretion in awarding sanctions under 28 U.S.C. 1927. View "Gonzalez v. Fresenius Med. Care N.A." on Justia Law

Defendant was convicted by a jury of defrauding Medicaid and Medicare of $1.4 million. On appeal, defendant argued that the evidence was insufficient; prejudicial evidence was admitted; the jury instructions were flawed; her sentencing level was erroneously increased for obstruction of justice; and the district court erred by denying her request for post-trial contact with a juror. The court affirmed the judgment because there was sufficient evidence to support the conviction and there was no reversible error.

This case stemmed from a dispute regarding the individualized education program (IEP) of C.C., a child with a disability. At issue was whether a school district, after being declared in compliance with the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400-1490, in respect to a disabled child's entitlements, by an administrative hearing officer, could bring a civil action in court for attorneys' fees as a prevailing party against the child's parents on the grounds that their IDEA administrative complaint was brought for an "improper purpose, such as to harass, to cause unnecessary delay, or to needlessly increase the cost of litigation," although the parents had voluntarily dismissed their administrative complaint without prejudice. The court held that, under the plain meaning of the IDEA and its implementing regulations, the administrative proceeding through which the school district sought a declaratory ruling was a proceeding under section 1415. The court also held that the declaratory ruling favorably altered the school district's legal relationship with the parents. Therefore, the court reversed the district court's legal relationship dismissing the school district's civil action and remanded the case for determination of whether the parents' administrative complaint "was delay or to needlessly increase the cost of litigation," and if so, whether the district court should, within its discretion, award attorneys' fees to the school district.

Plaintiffs brought this action for damages under 42 U.S.C. 1983 on behalf of their minor daughter, who allegedly was deprived of her constitutional rights when she was expelled from public school and refused alternative education benefits during the 2005-2006 academic school year by defendants. The district court granted summary judgment in favor of defendants dismissing all of plaintiffs' claims. The court affirmed the district court's summary judgment in principal part, but reversed summary judgment with respect to plaintiffs' claims that their daughter was deprived of her constitutional right to procedural due process when defendants denied her right under state law to continued public educational benefits through an alternative education program without some kind of notice and some kind of hearing. Accordingly, the court remanded the case to the district court for further proceedings.

Plaintiff (relator) filed a qui tam complaint under the False Claims Act (FCA), 31 U.S.C. 3730, against defendants, alleging that they participated in a fraudulent scheme where the durable medical equipment (DME) supplier allowed the nursing home to keep a portion of the reimbursement from Medicare in return for a guarantee that the nursing home would buy all of its DME from that supplier. The district court subsequently dismissed relator's action on the ground that it violated the public disclosure provisions of the FCA. Relator appealed, arguing that this suit was not based on public disclosures and that he was an original source of the information on which his suit was based. The court held that because relator's action included no allegations specific to defendants, but merely repeated a general description of fraud easily available in several government documents, the court affirmed the judgment of the district court.

Ernestine Girod, Una Favorite Brown, and Melinda Langley were each indicted on one count of conspiracy and multiple counts of healthcare fraud, and Brown and Girod were charged with three counts each of making false statements to law enforcement officers, all in relation to fraudulent Medicaid reimbursement claims made through A New Beginning of New Orleans, a Medicaid Early Periodic Screening Diagnosis and Treatment organization that provided minor, disabled Medicaid recipients with Personal Care Services. A jury convicted defendants on all but three of Langley's healthcare fraud counts. Brown, Girod, and Langley separately appealed their convictions and sentences on various grounds. The court discussed Brown's motion to dismiss the indictment due to prosecutorial misconduct; the sufficiency of the evidence supporting Girod's convictions; Girod's sentencing enhancements; and testimony of Langley's other acts. Accordingly, the court held that all the convictions and sentences were affirmed.

Plaintiff brought a Federal Tort Claims Act (FTCA), 28 U.S.C. 2671-2680, action on behalf of her minor son against the government for injuries allegedly related to his exposure to potentially dangerous, high levels of formaldehyde in their Federal Emergency Management Agency (FEMA) provided emergency housing unit (EHU). At issue was whether the district court properly dismissed plaintiff's claim for lack of subject matter jurisdiction because the claim was time-barred. The court held that neither the discovery rule, equitable estoppel, or the continuing tort doctrine applied in this case and therefore, plaintiff's FTCA claim accrued in May 2006 and her July 2008 administrative filing was untimely. Accordingly, the court affirmed the district court's dismissal of the case for lack of subject matter jurisdiction.