Justia Government Contracts Opinion Summaries

Kentucky provided medical care to its poorest citizens through Medicaid (42 U.S.C. 1396-1) using a traditional fee-for-service model until 2011, when it transitioned to a managed-care program and awarded Coventry a contract to administer Medicaid services in southeastern Kentucky. Coventry entered into a temporary agreement with Appalachian, the dominant hospital care provider in that area, to provide members in-network hospital care and other services. Coventry soon realized it was losing money, partly because its network included Appalachian, whose patients, on average, were sicker and more expensive to treat. Coventry learned that its competitors were not required to contract with Appalachian and unsuccessfully sought an increase in payment rates. Coventry then noticed termination of Appalachian’s contract, which would have made thousands of Medicaid recipients unable to access healthcare providers at Appalachian’s facilities without first paying fees. Appalachian sued Coventry and state defendants. The district court required Coventry to keep Appalachian in its network for four months longer than the contract specified (until November 1, 2012) and denied Coventry’s motion to require Appalachian to post a security bond. The Sixth Circuit affirmed with respect to the bond and otherwise dismissed an appeal as moot because no recognized exception permits review of an expired injunction. View "Appalachian Reg'l Healthcare, Inc. v. Coventry Health & Life Ins. Co." on Justia Law

Under the Medicaid program, the federal government offsets some state expenses for medical services to low-income persons; a state’s plan must cover medical assistance for specific populations, but a state may expand its Medicaid program by obtaining a waiver for an “experimental, pilot, or demonstration project.” In 1993, Tennessee obtained a waiver for TennCare, to cover uninsured and uninsurable individuals. Following approval, hospitals received reimbursement under the umbrella of TennCare. Because hospitals serving large numbers of low-income patients generally incur higher costs than Medicaid flat payment rates reflect, hospitals that treated a disproportionate share of low-income patients could apply for the “DSH” adjustment. A fiscal intermediary processed requests for reimbursement, including DSH adjustment payments. Due to discrepancies between the practices of fiscal intermediaries in different states, the Secretary issued a 2000 rule, providing that eligibility waiver patients were to be included as individuals “eligible for medical assistance” under Medicaid for purposes of DSH adjustment calculations. The 2005 Deficit Reduction Act ratified the rule. Adventist, a not-for-profit hospital network, provided more than 1,200 patient care days to TennCare expansion waiver patients 1995-2000. The fiscal intermediary did not include those days in calculating the adjustment. The Secretary’s Provider Reimbursement Review Board upheld the exclusion. The district court dismissed, concluding that section 1315 provided the Secretary discretion to exclude expansion waiver patient days from the DSH calculation. The Sixth Circuit affirmed. View "Adventist Health Sys./Sunbelt, Inc. v. Sebelius" on Justia Law

Defendants' convictions arose out of a series of events that took place while Defendant Robles was Treasurer of the City of South Gate, California. Robles, along with Defendant Garrido, a local businessman and friend, were implicated in two schemes to award city contracts to particular companies while reaping substantial benefits for themselves. On appeal, defendants challenged their convictions. In light of the the Supreme Court's decision in Skilling v. United States, which narrowed the scope of 18 U.S.C. 1346 to include only honest services fraud based on bribery and kickback schemes, the court reversed Robles's and Garrido's honest services fraud convictions and reversed Robles's money laundering convictions. The court affirmed Robles's bribery convictions under 18 U.S.C. 666 because such convictions did not required the defendant to be engaged in an official act. Accordingly, the court remanded for further proceedings. View "United States v. Garrido" on Justia Law

The Village commenced this action against the Corps to require it to honor commitments made to the Village and other North Carolina towns when developing its plan to widen, deepen, and realign portions of the Cape Fear River navigation channel. The district court dismissed the complaint for lack of subject matter jurisdiction. The court agreed with the district court's holding that the Corps' failure to implement "commitments" made to the Village during development of the plans for the project was not final agency action subject to judicial review. The court also concluded that the alleged contracts on which the Village relied for its contract claims were not maritime contracts that justified the exercise of admiralty jurisdiction. Accordingly, the court affirmed the judgment. View "Village of Bald Head Island v. U. S. Army Corps" on Justia Law

The County appealed from a judgment of the district court finding that the County was in violation of its duty to promote source-of-income legislation under a Stipulation and Order of Settlement and Dismissal (consent decree) entered into by the County with the United States to resolve a qui tam action initially brought by relator, ADC, under the False Claims Act, 31 U.S.C. 3729-33, alleging the submission of false claims by the County to HUD in order to obtain federal grant monies for fair housing. As a preliminary matter, the court held that the district court had jurisdiction to review the decision of the reviewing magistrate judge under the consent decree. On the merits, the court held that the County violated the terms of the consent decree. Accordingly, the court affirmed the judgment. View "United States v. Westchester County, New York" on Justia Law

In 1983, the Nuclear Waste Policy Act established a plan for spent nuclear fuel (SNF) generated by nuclear power plants, 42 U.S.C. 10101–10270. The Act made utilities responsible for SNF storage until the U.S. Department of Energy (DOE) accepts the material. The Secretary of Energy entered into contracts with nuclear utilities to accept SNF in return for payment of fees. The Act provided that the Nuclear Regulatory Commission “shall not issue or renew a license” to any nuclear utility unless the utility has entered into a contract with DOE or DOE certifies ongoing negotiations. Nuclear utilities, including the owner of the Entergy nuclear power stations, entered into contracts and began making payments, which have continued. By 1994, DOE knew it would be unable to accept SNF by the Act’s January 31, 1998 deadline. In 1995, DOE issued a “Final Interpretation” that took the position that it did not have an unconditional obligation to begin performance on that date. Entergy sued, asserting that DOE’s partial breach caused it to incur additional costs for SNF storage. The claims court struck an unavoidable delay defense, based on a prior decision rejecting DOE’s argument that its failure was “unavoidable” under the contract. The Federal Circuit affirmed. View "Entergy Nuclear Fitzpatrick, LLC v. United States" on Justia Law

MedQuest is a diagnostic testing company that operates more than 90 testing facilities in 13 states. In 2006 a former MedQuest employee, brought a qui tam suit against MedQuest alleging violations of the False Claims Act. The United States intervened and obtained summary judgment ($11,110,662.71) that MedQuest used supervising physicians who had not been approved by the Medicare program and the local Medicare carrier to supervise the range of tests offered at the Nashville-area sites, and after acquiring one facility, MedQuest failed to properly re-register the facility to reflect the change in ownership and enroll the facility in the Medicare program, instead using the former owner’s payee ID number. The Sixth Circuit reversed, stating that the Medicare regulatory scheme (42 U.S.C. 1395x) does not support FCA liability for failure to comply with the supervising-physician regulations. MedQuest’s failure to satisfy enrollment regulations and its use of a billing number belonging to a physician’s practice it controlled do not trigger the hefty fines and penalties created by the FCA. View "United States v. MedQuest Assocs, Inc." on Justia Law

Berrien worked for a civilian contractor (TECOM) at a military base in Michigan. He was fatally injured by a gutter that fell from the liquor store on the base while he was working alone, behind the store. The district court awarded $1.18 million in damages for failure to warn, under the Federal Tort Claims Act, 28 U.S.C. 1346(b)(1). The Sixth Circuit reversed. Because the Act does not waive the immunity of the United States for acts of independent contractors, liability could only be based on the negligence of government employees. There was no evidence that government employees actually knew of the dangerous condition of the liquor store, so that, under applicable Michigan law, any liability for failure to warn an invitee of a dangerous condition would have to have been based on a negligent failure to discover the dangerous condition. Even though the United States retained the right to conduct spot checks under its contract with TECOM, this right does not subject it to FTCA liability. View "Berrien v. United States" on Justia Law

Plaintiffs are motorists who use the Grand Island Bridge but, because they are not residents of Grand Island, did not qualify for the lowest toll rate. Plaintiffs sought a judgment declaring that the toll discount policies violated the dormant Commerce Clause as well as the constitutional right to travel that courts have located in the Privileges and Immunities and Equal Protection Clauses of the Fourteenth Amendment, both in violation of 42 U.S.C. 1983. On appeal, plaintiffs challenged the November 28, 2011 Memorandum Decision and Order of the district court, among other things, that granted judgment in favor of defendants. The court held that plaintiffs have standing under Article III, the toll policy at issue was a minor restriction on travel and did not involve "invidious distinctions" that would require strict scrutiny analysis pursuant to the Fourteenth Amendment; the district court correctly used, in the alternative, the three-part test set forth in Northwest Airlines, Inc. v. County of Kent, to evaluate both plaintiffs' right-to-travel and dormant Commerce Clause claims; and the Grand Island Bridge toll scheme was based on "some fair approximation of use" of the bridges; was not "excessive in relation to the benefits" it conferred; and did not "discriminate against interstate commerce." Accordingly, the court affirmed the judgment. View "Selevan, et al. v. New York Thruway Authority, et al." on Justia Law

In 2004 the U.S. Department of Health and Human Services promulgated 42 C.F.R. § 412.106(b), concerning the amount that certain hospitals are entitled to receive as enhancements to their regular reimbursement payments from the Medicare program. In connection with the Medicare program, Congress created a statutory formula to identify hospitals that serve a disproportionate number of low-income patients and to calculate the increased payments due such hospitals. Metropolitan Hospital challenged the way that the Secretary of HHS interprets this statutory formula to exclude certain patients who are simultaneously eligible for benefits under both Medicare and Medicaid, claiming that exclusion of dual-eligible patients cost it more than $2.1 million in 2005. The district court ruled that the challenged HHS regulation was invalid as violating the statute that it purported to implement. The Sixth Circuit reversed, upholding HHS’s interpretation of 42 U.S.C. 1395. View "Metro. Hosp. v. U.S. Dept of Health & Human Servs." on Justia Law