Justia U.S. 4th Circuit Court of Appeals Opinion Summaries

The Commonwealth of Virginia brought suit against the Secretary of the Department of Health and Human Services, challenging one provision of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, as an unconstitutional exercise of congressional power. Virginia maintained that the conflict between this provision and a newly-enacted Virginia statute provided it with standing to pursue this action. The court held that Virginia, as the sole plaintiff here, lacked standing to bring this action because the challenged provision, the individual mandate, imposed no obligation on Virginia and the Virginia statute did not confer on Virginia a sovereign interest in challenging the individual mandate. Accordingly, the court vacated the judgment of the district court and remanded with instructions to dismiss the case for lack of subject-matter jurisdiction.

Plaintiffs brought this suit to enjoin, as unconstitutional, enforcement of two provisions of the recently-enacted Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119. The challenged provisions amended the Internal Revenue Code by adding: (1) a "penalty" payable to the Secretary of the Treasury by an individual taxpayer who failed to maintain adequate health insurance coverage and (2) an "assessable payment" payable to the Secretary of the Treasury by a "large employer" if at least on of its employees received a tax credit or government subsidy to offset payments for certain health-related expenses. The court held that because this suit constituted a pre-enforcement action seeking to restrain the assessment of a tax, the Anti-Injunction Act, 28 U.S.C. 2283, stripped the court of jurisdiction. Accordingly, the court vacated the judgment of the district court and remanded the case with instructions to dismiss for lack of jurisdiction.

West Virginia sued pharmaceutical manufacturers, claiming that the defendants artificially inflated the reimbursement values of certain drugs, in violation of the West Virginia Consumer Credit and Protection Act, W. Va. Code 46A-1-101, and a state statute prohibiting fraud and abuse in the Medicaid program. The complaint alleged that the defendants inflated the average wholesale price of certain drugs and caused the state to pay an artificially inflated amount of reimbursement for the drugs. One company agreed to pay West Virginia $850,000. After learning of the settlement in 2007, the federal Centers for Medicare & Medicaid Services notified West Virginia of a disallowance in federal funding for the state’s Medicaid program for failure to credit the federal government its share of the settlement proceeds. The Appeals Board sustained the disallowance. The district court upheld the decision. The Fourth Circuit affirmed, rejecting an argument the Medicaid Act, 42 U.S.C. 1396b(d)(2)(A), authorizes a disallowance only when the state has recovered from a "provider."

Plaintiff sued defendant seeking a declaratory judgment that defendant was required to comply with the rules laid out in Title XIX of the Social Security Act, section 1396-1396v, where there was a dispute as to what rate plaintiff must pay defendant when defendant provided emergency transportation services to plaintiff's Medicaid enrollees. At issue was whether the definition of emergency services in section 1396(u)-2(b)(2)(B) applied to section 1396(u)-2(b)(2)(D) and whether section 1396(u)-2(b)(2)(D) covered the services provided by defendants to members of plaintiff's Medicaid program. The court held that the definition of emergency services found in 1396(u)-2(b)(2)(B) applied to section 1396(u)-2(b)(2)(D) where applying different definitions to a single term of art within this one statute would be both cumbersome and illogical. The court also held that the district court erred in granting summary judgment to defendant where the plain meaning of the word outpatient and the structure of the statute supported a finding in favor of plaintiff.