Articles Posted in Health Law

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The Second Circuit certified the following question to the New York Court of Appeals: Does New York Public Health Law Section 230(11)(b) create a private right of action for bad faith and malicious reporting to the Office of Professional Medical Conduct? View "Haar v. Nationwide Mutual Fire Insurance Co." on Justia Law

Posted in: Health Law

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The Second Circuit affirmed the district court's grant of a permanent injunction enjoining the government from continuing to apply the requirement that government funds assisting plaintiffs' efforts to fight HIV/AIDS abroad could not be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking. In Agency for Int'l Dev. v. Alliance for Open Soc. Int'l, Inc., 570 U.S. 205 (2013), the Supreme Court concluded that the requirement compelled speech in violation of the First Amendment. Applying the Supreme Court's reasoning in AOSI to this case, the court held that the speech of a recipient who rejects the government's message was unconstitutionally restricted when it has an affiliate who is forced to speak the government's contrasting message. The court rejected the remaining claims and held that the district court did not abuse its discretion. View "Alliance for Open Society International v. United States Agency for International Development" on Justia Law

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The Second Circuit denied a petition for review of OSHA's final order affirming a citation issued to a construction company for a repeat violation of an excavation standard and assessing a penalty of $25,000. The court held that the Commission did not abuse its discretion by relying on previous violations more than three years old, because neither the Manual nor the Commissionʹs precedent limits OSHA to a three‐year look back period. Furthermore, the Commissionʹs precedents established that ʺthe time between violations does not bear on whether a violation is repeated.ʺ Finally, this was the company's third violation in six years. View "Triumph Construction Corp. v. Secretary of Labor" on Justia Law

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Plaintiffs, two individual psychiatrists and three professional associations of psychiatrists, filed suit against defendants, four health‐insurance companies, alleging that the health insurers’ reimbursement practices discriminate against patients with mental health and substance use disorders in violation of the Mental Health Parity and Addition Equity Act of 2008 (MHPAEA), 29 U.S.C. 1185(a), and the Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001-1461. The court concluded that, because the psychiatrists are not among those expressly authorized to sue, they lack a cause of action under ERISA. The court also concluded that the association plaintiffs lack constitutional standing to pursue their respective ERISA and MHPAEA claims because their members lack standing. Accordingly, the court affirmed the judgment. View "Am. Psychiatric Ass’n v. Anthem Health Plans, Inc." on Justia Law

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Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" on Justia Law

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In 2000, the Secretary of Health and Human Services issued a regulation, known as the “reclassification rule,” 42 C.F.R. 412.230(a)(5)(iii), which provided that a hospital that has been reclassified from urban to rural under the Medicare Act, 42 U.S.C. 1395ww(d)(8)(E), may not thereafter receive an additional reclassification by the Medicare Geographic Classification Review Board (MGCRB) for reclassification as urban under subsection (d)(10). Lawrence filed suit seeking a preliminary injunction to enjoin defendants from applying the Secretary's reclassification rule to Lawrence's MGCRB application. The district court denied the motion. However, the court found the statutory language to be plain and unambiguous, and at odds with the Secretary’s reclassification rule, 42 C.F.R. 412.230(a)(5)(iii). Therefore, the court declared the regulation invalid and reversed the judgment of the district court, remanding for a determination of the appropriate remedy. View "Lawrence + Memorial Hosp. v. Burwell" on Justia Law

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Plaintiffs, a group of religious non-profit organizations affiliated with the Roman Catholic Archdiocese, filed suit challenging regulations promulgated under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, 124 Stat. 119. The district court concluded that regulations promulgated under the Act that allow religious non-profit employers to opt out of providing contraceptive coverage themselves violate these religious employers’ rights under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb et seq. The court concluded, however, that the challenged accommodation for religious objectors relieves, rather than imposes, any substantial burden on plaintiffs’ religious exercise, and thus does not violate the Religious Freedom Restoration Act. Accordingly, the court reversed the district court's judgment. View "Catholic Health Care Sys. v. Burwell" on Justia Law

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Plaintiffs, a group of religious non-profit organizations affiliated with the Roman Catholic Archdiocese, filed suit challenging regulations promulgated under the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, 124 Stat. 119. The district court concluded that regulations promulgated under the Act that allow religious non-profit employers to opt out of providing contraceptive coverage themselves violate these religious employers’ rights under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb et seq. The court concluded, however, that the challenged accommodation for religious objectors relieves, rather than imposes, any substantial burden on plaintiffs’ religious exercise, and thus does not violate the Religious Freedom Restoration Act. Accordingly, the court reversed the district court's judgment. View "Catholic Health Care Sys. v. Burwell" on Justia Law

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Plaintiff filed suit, alleging that the DOH violated the Medicaid Act, 42 U.S.C. 1396 et seq., when it determined that guardianship fees approved by a state court could not be deducted from plaintiff’s Medicaid-required contributions to her nursing home costs. The district court dismissed the complaint based on lack of standing or, in the alternative, plaintiff failed to state a claim upon which relief could be granted. The court concluded that plaintiff did have standing where her injury was incurring debts beyond her means to the nursing facility or to her guardian. The court concluded, however, that plaintiff's claim failed on the merits because DOH was not under any unambiguous and binding obligation to allow deduction of the guardianship fees from plaintiff's net available monthly income. Accordingly, the court affirmed the judgment. View "Backer v. Shah" on Justia Law

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Home health care plaintiffs sought to prevent the Commissioner of the New York State Department of Health, from enforcing the Wage Parity Law, which sets the minimum amount of total compensation that employers must pay home care aides in order to receive Medicaid reimbursements for reimbursable care provided in New York City and Westchester, Suffolk, and Nassau Counties, N.Y. Pub. Health Law 3614‐c. Plaintiffs claim the Law was either preempted by the National Labor Relations 8 Act, 29 U.S.C. 151, or the Employee Retirement Income Security Act, 29 U.S.C. 1001, or was unconstitutional under the Due Process and Equal Protection Clauses. The Second Circuit affirmed the district court conclusion that the state law, except for one severable provision subdivision that singles out Taft‐Hartley plans for special treatment, is neither preempted nor unconstitutional. View "Concerned Home Care Providers, Inc. v. Cuomo" on Justia Law