Justia U.S. 4th Circuit Court of Appeals Opinion SummariesArticles Posted in Health Law
Kadel v. North Carolina State Health Plan for Teachers and State Employees
Enrollees in the North Carolina State Health Plan for Teachers and State Employees (NCSHP) sued, alleging that NCSHP discriminates against its transgender enrollees by categorically denying coverage for gender dysphoria treatments like counseling, hormone therapy, and surgical care, in violation of section 1557 of the Patient Protection and Affordable Care Act, which prohibits “any health program or activity” that receives federal funds from discriminating against individuals on any ground prohibited by various federal statutes, including Title IX, 42 U.S.C. 18116(a).The Fourth Circuit affirmed the denial of NCSHP’s motion to dismiss, asserting that it was entitled to sovereign immunity under the Eleventh Amendment. NCSHP waived its immunity against this claim by accepting federal financial assistance. Under the Civil Rights Remedies Equalization Act (CRREA), “[a] State shall not be immune under the Eleventh Amendment of the Constitution of the United States from suit in Federal court for a violation of . . . any other Federal Statute prohibiting discrimination by recipients of Federal financial assistance,” 42 U.S.C. 2000d-7. View "Kadel v. North Carolina State Health Plan for Teachers and State Employees" on Justia Law
Mayor and City Council of Baltimore v. Azar
Baltimore filed suit against the Government, alleging that HHS's Final Rule, prohibiting physicians and other providers in Title X programs from referring patients for an abortion, even if that is the patient's wish, violates the Administrative Procedure Act (APA). The Final Rule, instead, requires them to refer the patient for prenatal care. Furthermore, the Final Rule requires entities receiving Title X funds, but offering abortion-related services pursuant to another source of funds, to physically separate their abortion-related services from the Title X services. After the district court issued a preliminary injunction enjoining the Government from implementing or enforcing the Final Rule because the Final Rule is likely not in accordance with law, the Government appealed. While the appeal of the preliminary injunction was pending and after discovery, the district court issued a permanent injunction on different grounds.The Fourth Circuit consolidated the appeals and a majority of the full court voted to hear both cases en banc. The court upheld the district court's grant of the permanent injunction on two grounds: first, the Final Rule was promulgated in an arbitrary and capricious manner because it failed to recognize and address the ethical concerns of literally every major medical organization in the country, and it arbitrarily estimated the cost of the physical separation of abortion services; and second, the Final Rule contravenes statutory provisions requiring nondirective counseling in Title X programs and prohibiting interference with physician/patient communications. Accordingly, because the court affirmed the permanent injunction in Case No. 20-1215, the appeal of the preliminary injunction in Case No. 19-1614 is moot and the court dismissed it. View "Mayor and City Council of Baltimore v. Azar" on Justia Law
Williams v. Dimensions Health Corp.
Plaintiff filed suit against the hospital, alleging that it violated the Emergency Medical Treatment and Active Labor Act (EMTALA) by failing to properly screen him and stabilize his condition.The Fourth Circuit adopted the requirement of a good faith admission and held that a party claiming an admission was not in good faith must present evidence that the hospital admitted the patient solely to satisfy its EMTALA standards with no intent to treat the patient once admitted and then immediately transferred the patient. The court held that plaintiff failed to point to evidence that creates a genuine issue of material fact as to this high standard. Furthermore, plaintiff failed to point to any evidence in support of his theory that the hospital admitted plaintiff to improperly hoard him in order to garner his premium insurance benefits. View "Williams v. Dimensions Health Corp." on Justia Law
Accident, Injury and Rehabilitation, PC v. Azar
Advantage Health filed suit, alleging that HHS's continuing recoupment of overpayments before completion of the severely delayed administrative process was denying it procedural due process. The district court granted a preliminary injunction, enjoining HHS from withholding Medicare payments to Advantage Health to effectuate recoupment of any alleged overpayments.The Fourth Circuit held that the injunction entered in this collateral proceeding, which prohibits HHS from recouping overpayments in accordance with applicable law, was inappropriately entered because the delay of which Advantage Health complains could have been and still can be avoided by bypassing an ALJ hearing and obtaining judicial review on a relatively expeditious basis, as Congress has provided. Therefore, this administrative review process did not deny Advantage Health procedural due process and thus Advantage Health has not demonstrated a likelihood of success on the merits. View "Accident, Injury and Rehabilitation, PC v. Azar" on Justia Law
Planned Parenthood South Atlantic v. Baker
Plaintiff filed suit challenging South Carolina's decision to terminate PPSAT's provider agreement because it offers abortion services. At issue was whether, and on what basis, the Medicaid Act's free-choice-of-provider provision affords a private right of action to challenge a state’s exclusion of a healthcare provider from its Medicaid roster.The Fourth Circuit affirmed the district court's grant of a preliminary injunction in favor of plaintiff and held that Congress's intent to create an individual right enforceable under 42 U.S.C. 1983 in the free-choice-provider provision is unambiguous. The court also held that a plain-language reading of the provision's mandate—that states "must" furnish Medicaid recipients the right to choose among providers "qualified to perform the service or services required"—bars states from excluding providers for reasons unrelated to professional competency. Because the individual plaintiff in this case has a private right of action to challenge South Carolina's denial of her right to the qualified and willing family-planning provider of her choice, the court agreed with the district court that she has demonstrated a substantial likelihood of success on her free-choice-of-provider claim. Furthermore, the district court did not abuse its discretion in enjoining South Carolina from terminating PPSAT's provider agreement; it was clear that plaintiff would suffer irreparable harm in the absence of a preliminary injunction; and the remaining preliminary injunction factors were satisfied. View "Planned Parenthood South Atlantic v. Baker" on Justia Law
Children’s Hospital v. Azar
The Secretary appealed the district court's order enjoining him from enforcing a Medicaid policy set forth in a Frequently Asked Questions document (FAQ 33), which purported to clarify the methodology for calculating the maximum amount of financial assistance available to hospitals, like Children's Hospital, that serve a disproportionate number of low-income or special needs patients (DSHs).The Fourth Circuit held that the district court correctly determined that the policy set forth in FAQ 33 constituted a "legislative rule" and thus the Administrative Procedure Act mandated that the agency establish the FAQ 33 policy through notice-and-comment rulemaking. Therefore, the court affirmed the district court's judgment enjoining the Secretary from enforcing the policy set forth in FAQ 33 against Children's Hospital. The court declined to reach the substantive challenge and vacated the part of the district court's opinion addressing whether the policy conflicts with the language of 42 U.S.C. 1396r-4(g). View "Children's Hospital v. Azar" on Justia Law
Netro v. Greater Baltimore Medical Center, Inc.
Plaintiff filed suit against GBMC, seeking to recover funds to Medicare and to collect for herself under the Medicare Secondary Payer Act, 42 U.S.C. 1395y, which authorizes a private cause of action for double damages where a recalcitrant payer "fails" to reimburse Medicare. Sixteen days after plaintiff filed the federal suit, GBMC paid her $403,722.24, which represented the amended final judgment amount plus post-judgment interest. The Fourth Circuit affirmed the district court's grant of GBMC's motion for summary judgment, holding that, although plaintiff was injured when GBMC was obligated under law to pay for her medical care but did not, GBMC did not fail to reimburse plaintiff because its payment was well within plaintiff's proposed deadline. View "Netro v. Greater Baltimore Medical Center, Inc." on Justia Law
Association for Accessible Medicine v. Frosh
In 2017, Maryland enacted “An Act concerning Public Health – Essential Off-Patent or Generic Drugs – Price Gouging – Prohibition.” The Act, Md. Code, Health–General 2-802(a), prohibits manufacturers or wholesale distributors from “engag[ing] in price gouging in the sale of an essential off-patent or generic drug,” defines “price gouging” as “an unconscionable increase in the price of a prescription drug,” and “unconscionable increase” as “excessive and not justified by the cost of producing the drug or the cost of appropriate expansion of access to the drug to promote public health” that results in consumers having no meaningful choice about whether to purchase the drug at an excessive price due to the drug’s importance to their health and insufficient competition. The “essential” medications are “made available for sale in [Maryland]” and either appear on the Model List of Essential Medicines most recently adopted by the World Health Organization or are “designated . . . as an essential medicine due to [their] efficacy in treating a life-threatening health condition or a chronic health condition that substantially impairs an individual’s ability to engage in activities of daily living.” The Fourth Circuit reversed the dismissal of a “dormant commerce clause” challenge to the Act, finding that it directly regulates the price of transactions that occur outside Maryland. View "Association for Accessible Medicine v. Frosh" on Justia Law
US ex rel. Carson v. Manor Care, Inc.
Plaintiff filed a qui tam suit under the False Claims Act (FCA), 31 U.S.C. 3729-3733, and the state equivalents, alleging that Manor Care was overbilling the government for medical services. Plaintiff also alleged a separate claim of retaliation, claiming that he was terminated after he notified his employer of the alleged overbilling. Christine A. Ribik had previously filed a qui tam suit under seal in the Eastern District of Virginia on behalf of the United States against Manor Care. The court dismissed the complaint under the FCA's first-to-file rule. The court concluded that plaintiff has not managed to avoid the first-to-file bar simply by alleging additional facts relating to how Manor Care overbilled, even though some of those specific allegations were not mentioned in Ribik's complaint. The court also concluded that plaintiff's alternative argument, that his complaint should not be dismissed because the district court consolidated them with Ribik's, failed under the plain language of the FCA. Therefore, the district court properly determined that it lacked subject matter jurisdiction over plaintiff's qui tam action under the FCA. The court concluded, however, that the first-to-file rule has no relation to a claim for retaliation. Finally, the court concluded that the district court did not support its decision with any discussion or authority to establish that any of the states apply the FCA first-to-file rule, or its equivalent, to that state's statute. Therefore, the court affirmed in part, but vacated and remanded that part of the judgment concerning plaintiff's retaliation and state fraud claims. View "US ex rel. Carson v. Manor Care, Inc." on Justia Law
Seaside Farm, Inc. v. United States
Seaside filed suit under the Federal Tort Claims Act (FTCA), 28 U.S.C. 1346(b), 2671-2680, alleging that the FDA negligently issued a contamination warning in response to an outbreak of Salmonella Saintpaul that devalued Seaside’s tomato crop by $15,036,293.95. The court affirmed the district court's holding that the FDA was exercising a discretionary function in connection with the contamination warning. The court explained that the ruling was essential to protect the FDA’s vital role in safeguarding the public food supply. Accordingly, the court affirmed the judgment. View "Seaside Farm, Inc. v. United States" on Justia Law