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In 2016, Kansas sent notices of decisions to terminate its Medicaid contracts with two Planned Parenthood affiliates, Planned Parenthood of Kansas and Mid-Missouri (“PPGP”), and Planned Parenthood of the St. Louis Region (“PPSLR”). The notices cited concerns about the level of PPGP’s cooperation in solid-waste inspections, both Providers’ billing practices, and an anti-abortion group’s allegations that Planned Parenthood of America (“PPFA”) executives had been video-recorded negotiating the sale of fetal tissue and body parts. Together, the Providers and three individual Jane Does (“the Patients”) immediately sued Susan Mosier, Secretary of the Kansas Department of Health and Environment (“KDHE”), under 42 U.S.C. 1983, alleging violations of 42 U.S.C. 1396a(a)(23) and the Equal Protection Clause of the Fourteenth Amendment. The Plaintiffs sought a preliminary injunction enjoining Kansas from terminating the Providers from the state’s Medicaid program. "States may not terminate providers from their Medicaid program for any reason they see fit, especially when that reason is unrelated to the provider’s competence and the quality of the healthcare it provides." The Tenth Circuit joined four of five circuits that addressed this same provision and affirmed the district court’s injunction prohibiting Kansas from terminating its Medicaid contract with PPGP. But the Court vacated the district court’s injunction as it pertained to PPSLR, remanding for further proceedings on that issue, because Plaintiffs failed to establish standing to challenge that termination. But on this record, the Court could not determine whether PPSLR itself could establish standing, an issue the district court declined to decide but now must decide on remand. View "Planned Parenthood v. Andersen" on Justia Law

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Area 51 used Alameda city property for events it planned for third-party companies. PM assisted the city with managing the license arrangements. Due to problems connected with Area 51 events, the city ceased doing business with it. Area 51 had committed to third-party entities based on PM’s previous confirmation of the city’s willingness to license space. Area 51 sued. Defendants (city, PM, and individuals) filed a demurrer and a motion to strike under Code of Civil Procedure section 425.16, the anti-SLAPP (strategic lawsuit against public participation) statute. The court denied that motion and granted the demurrer. The court of appeal reversed in part. While the thrust of the claims against the city is breach of contract, the individual defendants were not contracting parties; the sole basis for asserting liability against them is what they did on behalf of the city. That conduct is expressive in nature (emails confirming dates, and announcing termination of the leasing relationship), which qualify as “written or oral statement[s] . . . made in connection with an issue under consideration . . . by a[n] . . . executive . . . body,” under the anti-SLAPP law. Area 51 could not show a probability of prevailing on the merits. The case was remanded for consideration of an award of attorneys’ fees and costs. View "Area 51 Productions, Inc. v. City of Alameda" on Justia Law

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Oklahoma and the Citizen Potawatomi Nation (the “Nation”) entered into a Tribal-State gaming compact; Part 12 of which contained a dispute-resolution procedure that called for arbitration of disagreements “arising under” the Compact’s provisions. The terms of the Compact indicated either party could, “[n]otwithstanding any provision of law,” “bring an action against the other in a federal district court for the de novo review of any arbitration award.” In Hall Street Associates, LLC. v. Mattel, Inc., 552 U.S. 576, (2008), the Supreme Court held that the Federal Arbitration Act (“FAA”) precluded parties to an arbitration agreement from contracting for de novo review of the legal determinations in an arbitration award. At issue before the Tenth Circuit Court of Appeals was how to treat the Compact’s de novo review provision given the Supreme Court’s decision in Hall Street Associates. The Nation argued the appropriate course was to excise from the Compact the de novo review provision, leaving intact the parties’ binding obligation to engage in arbitration, subject only to limited judicial review under 9 U.S.C. sections 9 and 10. Oklahoma argued the de novo review provision was integral to the parties’ agreement to arbitrate disputes arising under the Compact and, therefore, the Tenth Circuit should sever the entire arbitration provision from the Compact. The Tenth Circuit found the language of the Compact demonstrated that the de novo review provision was a material aspect of the parties’ agreement to arbitrate disputes arising thereunder. Because Hall Street Associates clearly indicated the Compact’s de novo review provision was legally invalid, and because the obligation to arbitrate was contingent on the availability of de novo review, the Tenth Circuit concluded the obligation to arbitrate set out in Compact Part 12 was unenforceable. Thus, the matter was remanded to the district court to enter an order vacating the arbitration award. View "Citizen Potawatomi Nation v. State of Oklahoma" on Justia Law

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The pro-forma provision in the tariff in this case, which set the rates and terms for a utility’s relationship with its retail customers, did not conflict with a prior franchise agreement, which reflected the common law rule requiring utilities to pay public right-of-way relocation costs, or the common law, and the franchise agreement controlled as to the relocation costs at issue. At issue was whether the City of Richardson or Oncor Electric Delivery Company must pay relocation costs to accommodate changes to public rights-of-way. The City negotiated a franchise agreement with Oncor requiring Oncor to bear the costs of relocating its equipment and facilities to accommodate changes to public rights-of-way, but Oncor refused to pay such costs. While the relocation dispute was pending, Oncor filed a case with the Public Utility Commission (PUC) seeking to alter its rates. The case was settled, and the resulting rate change was filed as a tariff with the PUC. The City enacted an ordinance consistent with the tariff, which included the pro-forma provision at issue. The Supreme Court held that the provision in the tariff did not conflict with the franchise contract’s requirement that Oncor pay the right-of-way relocation costs at issue. View "City of Richardson v. Oncor Electric Delivery Co." on Justia Law

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Relators filed suit under the False Claims Act (FCA), 31 U.S.C. 3729-30, alleging that MD and others misled the Government by providing material false or incomplete information at two points in the transactional relationship, as well as improprieties between the remaining defendants. The Eleventh Circuit held that the district court must revisit whether the relators alleged facts sufficient to support a theory of implied certification as articulated in Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016). The court also held that the complaint did plead fraud in the inducement, and thus the court remanded so that the district court could reexamine the allegations relating to that theory. View "Marstettler v. Tilton" on Justia Law

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The Supreme Court affirmed the decision of the district court finding that Plaintiffs, two Wyoming citizens, lacked standing to challenge legislation that authorized two construction projects while maintaining a degree of legislative control and that Plaintiffs’ proposed amendment to their complaint would be futile. In their complaint, Plaintiffs alleged that the legislation at issue violated the Wyoming Constitution and that government officials unconstitutionally engaged in a pattern of letting state contracts without competitive bidding or required safeguards. The district court found that Plaintiffs lacked standing and that their proposed amendment to add a third plaintiff who would have alleged economic harm resulting from the contracting practices would be futile. The Supreme Court affirmed, holding (1) Plaintiff lacked standing to bring this lawsuit; and (2) because there was no justiciable controversy, this court declines to address the constitutionality of a statute enacted in 2017 that prohibits naming a legislator in a lawsuit if he or she is sued in an official capacity. View "Allred v. Bebout" on Justia Law

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The Court of Federal Claims enjoined the U.S. Army from proceeding with, or awarding, a contract to Airbus Helicopter, finding that Army Execution Order 109-14, which implemented the Army’s Aviation Restructure Initiative designating the UH-72A Lakota helicopter as the Army’s “Institutional Training Helicopter,” was a procurement decision in violation of the Competition in Contracting Act and the Federal Acquisition Regulation. The court also found the Sole Source Justification and Approval (J&A) was arbitrary and capricious. The Federal Circuit reversed and vacated the injunction, holding that Execution Order 109-14 was not a procurement decision subject to Tucker Act review because it did not begin “the process for determining a need for property or services.” The Order simply formalized the Army’s decision designating the UH-72A Lakota as the Army’s training helicopter. The Sole Source J&A was not arbitrary and capricious, and it was an abuse of discretion to supplement the administrative record. The J&A sufficiently supports the Army’s decision to award a sole-source follow-on contract because it is likely that award to any other source would result in substantial duplication of cost to the government that is not expected to be recovered through competition, or unacceptable delays in fulfilling the agency’s requirements.” View "AgustaWestland North America v. United States" on Justia Law

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Brown, the manager of a company that provided home physician visits, and Talaga, who handled the company’s billing, were convicted of conspiracy to commit health-care fraud, 18 U.S.C. 1349; six counts of health-care fraud, 18 U.S.C. 1347; and three counts of falsifying a matter or providing false statements, 18 U.S.C. 1035(a). The district court sentenced Mr. Brown to 87 months’ imprisonment, 34 months below the Guidelines’ range, stating that a significant sentence was warranted because of the duration of the scheme, the amount of the fraud, the need for general deterrence, and Brown’s failure to accept responsibility. Ms. Talaga was sentenced to 45 months. The Seventh Circuit affirmed, rejecting Brown’s argument that the court’s assumptions about the need for general deterrence were unfounded and constituted procedural error and Talaga’s arguments that the court calculated the amount of loss for which she was responsible by impermissibly including losses that occurred before she joined the conspiracy. The district court was under no obligation to accept or to comment further on Brown’s deterrence argument. Talaga, as a trained Medicare biller, knew that that the high-volume billings were fraudulent. View "United States v. Talaga" on Justia Law

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Accredo delivers clotting medication and provides nursing assistance for hemophilia patients. Accredo makes donations to charities concerned with hemophilia, including HSI and HANJ, which allegedly recommended Accredo as an approved provider for hemophilia patients. Greenfield, a former Accredo area vice president, sued, alleging violations of the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), and the False Claims Act, 31 U.S.C. 3729(a)(1)(A)-(B). If Greenfield prevailed, he would get at least 25% of any civil penalty or damages award. The government did not intervene. The district court, following discovery, granted Accredo summary judgment, finding that Greenfield failed to provide evidence of even a single federal claim for reimbursement that was linked to the alleged kickback scheme. The Third Circuit affirmed. The Anti-Kickback Statute prohibits kickbacks regardless of their effect on patients’ medical decisions. Because any kickback violation is not eligible for reimbursement, to certify otherwise violates the False Claims Act but there must be some connection between a kickback and the reimbursement claim. It is not enough to show temporal proximity. Greenfield was required to show that at least one of the 24 federally-insured patients for whom Accredo provided services and submitted reimbursement claims was exposed to a referral or recommendation by HSI/HANJ in violation of the Anti-Kickback Statute. View "Greenfield v. Medco Health Solutions Inc" on Justia Law

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The Idaho Supreme Court answered a certified question of Idaho law from the United States District Court for the District of Idaho. The question certified centered on whether, for purposes of the dispute in this lawsuit, the terms ‘state board of correction’ as used in Idaho Code 20-237B(1) and ‘department of correction’ as used in Idaho Code § 20-237B(2), included privatized correctional medical providers under contract with the Idaho Department of Correction. The Court answered the question certified in the negative. View "In Re: Pocatello Hospital, LLC v. Corazon, LLC" on Justia Law