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

Articles Posted in Public Benefits
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Plaintiffs, parents of nine-year-old E.L., who has autism, initiated an administrative complaint against the school board under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. An ALJ determined that the school board violated the IDEA by failing to provide E.L. with required speech therapy but, in all other respects, she was provided an appropriate special education program. The school board appealed and the state review officer reversed the ALJ's conclusion regarding the speech therapy. Plaintiffs then filed a civil action seeking judicial review of the administrative proceedings. The court concluded that E.L. did not exhaust her administrative remedies and that the school board did not violate the IDEA where the review officer's conclusion that E.L. received the speech therapy mandated by her individualized education program is supported by the evidence. Accordingly, the court affirmed the judgment. View "E. L. v. Chapel Hill-Carrboro Board of Education" on Justia Law

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Plaintiff appealed the district court's denial of his motion for attorney's fees under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(1)(A). The court affirmed the district court's determination that, although plaintiff prevailed in his lawsuit against the Commissioner, attorney's fees were unwarranted because the Commissioner had pursued a substantially justified position. Despite the oddity of the Commissioner's original position, his misstep did not merit a fee award.View "Meyer, III v. Astrue" on Justia Law

Posted in: Public Benefits
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Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, against Omnicare, alleging that defendants violated a series of FDA safety regulations requiring that penicillin and non-penicillin drugs be packaged in complete isolation from one another. The court concluded that the public disclosure bar did not divest the district court of jurisdiction over relator's FCA claims. The court concluded that once a new drug has been approved by the FDA and thus qualified for reimbursement under the Medicare and Medicaid statutes, the submission of a reimbursement request for that drug could not constitute a "false" claim under the FCA on the sole basis that the drug had been adulterated as a result of having been processed in violation of FDA safety regulations. The court affirmed the district court's grant of Omnicare's motion to dismiss, holding that relator's complaint failed to allege that defendants made a false statement or that they acted with the necessary scienter. The court also concluded that the district court did not abuse its discretion in denying relator's request to file a third amended complaint. View "United States ex rel. Rostholder v. Omnicare, Inc." on Justia Law

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After the Appeals Board denied plaintiff's request for review of the denial of social security disability benefits, plaintiff sought judicial review of the ALJ's decision in federal district court. The district court found in favor of plaintiff and the Acting Commissioner appealed. The court held that the district court did not err in its application of Listing 1.04A. Listing 1.04A is the listing identifying disorders of the spine that merit a conclusive presumption of disability and an award of benefits. The court concluded, however, that the district court abused its discretion in directing an award of benefits rather than remanding for further explanation by the ALJ of why plaintiff did not meet Listing 1.04A. Accordingly, the court vacated and remanded for further proceedings. View "Radford v. Colvin" on Justia Law

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Mingo Logan challenged the award of benefits to claimant under the Black Lung Benefits Act (BLBA), 30 U.S.C. 921(c)(4). Because the court concluded that the ALJ did not in fact apply rebuttal limitations to Mingo Logan, and the Board affirmed the ALJ's analysis, the court did not reach Mingo Logan's challenge to the standard announced by the Board to rebut the section 921(c)(4) presumption of entitlement to benefits. The court affirmed the Board's award of benefits because it also found that Mingo Logan's other challenges to the ALJ's factual findings lacked merit. Accordingly, the court denied the petition for review. View "Mingo Logan Coal Co. v. Owen" on Justia Law

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Claimant was awarded benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901-945. At issue was whether the awards of attorneys' fees properly reflected market-based evidence of counsel's hourly rate, as required by the lodestar analysis in Hensley v. Eckerhart. The court held that neither the ALJ nor the BRB abused its discretion in concluding that counsel provided sufficient market-based evidence of rates, and that the number of hours billed for attorneys' services reasonably reflected the work completed. The court also held that the award of fees for work performed by certain legal assistants was not supported fully by the record, and modified that award accordingly. View "Eastern Associated Coal Corp. v. DOWCP" on Justia Law

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These consolidated cases involved claims for survivors' benefits under the Black Lung Benefits Act, 30 U.S.C. 901 et seq. Petitioners, the coal mine operators responsible for payment of respondents' benefits, petitioned for review, claiming that principles of res judicata foreclosed respondents - each of whom previously and unsuccessfully sought survivors' benefits under the Act - from relying on a recent amendment to the Act to pursue benefits again through a "subsequent claim." The court affirmed the Board's awards, concluding that res judicata did not bar the subsequent claims because the amendment created a new cause of action that was unavailable to respondents when they brought their initial claims. View "Union Carbide Corp. v. Richard" on Justia Law

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Plaintiff, by and through her adoptive parents, brought this action challenging South Carolina's reduction of monthly adoption assistance benefits, claiming that the reduction violated the Adoption Assistance and Child Welfare Act, 42 U.S.C. 670 et seq. The court held in this case that section 673(a)(3) did set forth a privately enforceable right under 42 U.S.C. 1983, but that the parents have failed to plead any violation of that right by defendants. Accordingly, the court reversed and remanded. View "Hensley v. Koller" on Justia Law

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Debtor appealed the district court's denial of the confirmation of his proposed Chapter 13 plan on the grounds that it did not accurately reflect his disposable income and that it was unfeasible if debtor's Social Security income was excluded from his "projected disposable income." The court vacated and remanded, holding that the plain language of the Bankruptcy Code excluded Social Security income from the calculation of "projected disposable income," but that such income nevertheless must be considered in the evaluation of a plan's feasibility. View "Ranta v. Gorman" on Justia Law

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Plaintiffs, a class of Medicaid beneficiaries who suffered from severe developmental disabilities, sued the NCDHHS, PBH, and the director of PBH, alleging that defendants violated their rights under the Medicaid statute and the Due Process Clause of the Fourteenth Amendment by reducing their health care services without notice and an opportunity for a hearing. On appeal, PBH and the director challenged the district court's entry of a preliminary injunction. However, the NCDHHS did not join the appeal. Given that the NCDHHS had decided not to litigate the appeal, the court concluded that the Medicaid statute, 42 U.S.C. 1396a(a)(5), and accompanying regulations precluded PBH from appealing in the absence of the NCDHHS. Accordingly, the court dismissed the appeal. View "K.C. v. Shipman" on Justia Law