Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

The Secretary appealed the district court's order certifying a nationwide class of Medicare beneficiaries and granting summary judgment in the beneficiaries' favor. The beneficiaries raised two claims: (1) the Secretary's practice of demand "up front" reimbursement for secondary payments from beneficiaries who have appealed a reimbursement determination or sought waiver of the reimbursement obligation was inconsistent with the secondary payer provisions of the Medicare statutory scheme; and (2) the Secretary's practice violated their due process rights. The court concluded that Patricia Haro had Article III standing on behalf of the class; John Balentine, as counsel for Haro, had Article III standing on his individual claim; and the beneficiaries' claims for injunctive relief were not moot and Article III's justiciability requirements were satisfied. The court concluded, however, that the beneficiaries' claim was not adequately presented to the agency at the administrative level and therefore the district court lacked subject matter jurisdiction under 42 U.S.C. 405(g). On the merits of Balentine's claim, the court concluded that the Secretary's interpretation of the secondary payer provisions was reasonable. Therefore, the court vacated the district court's injunctions, reversed the district court's summary judgment order, and remanded for consideration of the beneficiaries' due process claim. View "Haro v. Sebelius" on Justia Law

Planned Parenthood and others filed suit challenging Ariz. Rev. Stat. 35-196.05(B) as a violation of the federal Medicaid Act, 42 U.S.C. 1396a. Ariz. Rev. Stat. 35-196.05(B) barred patients eligible for the state's Medicaid program from obtaining covered family planning services through health care providers who performed abortions in cases other than medical necessity, rape, or incest. The court concluded that the district court's entry of final judgment and a permanent injunction mooted Arizona's appeal of the district court's preliminary injunction. Therefore, the court dismissed that appeal (Case No. 12-17558), and considered only Arizona's appeal of the summary judgment order and permanent injunction (Case No. 13-15506). The court held that the Medicaid Act's free-choice-of-provider requirement conferred a private right of action under 42 U.S.C. 1983. The court also held that the Arizona statute contravenes the Medicaid Act's requirement that states give Medicaid recipients a free choice of qualified provider. Accordingly, the court affirmed the district court's summary judgment and permanent injunction. View "Planned Parenthood v. Betlach" on Justia Law

Plaintiff filed suit against the district alleging claims for disability discrimination and failure to accommodate under the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. 12101-12213. On appeal, plaintiff challenged the district court's grant of summary judgment in favor of the district. The court concluded that the district court did not abuse its discretion by reconsidering its prior order denying summary judgment where the district court found that it had committed clear error by not considering whether plaintiff gave a sufficient explanation for the conflict between her ADA claim and her Nevada Public Employees' Retirement Systems (PERS) application under the Supreme Court's decision in Cleveland v. Policy Mgmt. Sys. Corp. Under the standard set forth in Cleveland, the court concluded that plaintiff gave sufficient explanations for the inconsistencies between her ADA claim and her PERS and Family Medical Leave Act (FMLA), 29 U.S.C. 2601, applications to survive summary judgment. Accordingly, the court affirmed in part and reversed in part, remanding for further proceedings. View "Smith v. Clark County School District" on Justia Law

Plaintiff, a severely disabled student, filed suit arguing that he was entitled to remain at a private school he had been attending since the age of seven. The Department issued a formal notice that plaintiff's special education placement at the school would end when he turned 20 years old. Plaintiff argued that he was entitled to remain at the school until he was 22 years old. At issue on appeal was whether the "stay put" provision in the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1415j, applied to a student who has exceeded a state-imposed age limit on eligibility for public education. The court affirmed the judgment of the district court, concluding that the district court correctly granted plaintiff's motion for stay put. Plaintiff was entitled to remain at the school as his stay-put placement from the date he filed his administrative complaint and he was entitled to remain there until his case was finally resolved. View "A.D. v. State of Hawaii Dep't of Educ." on Justia Law

This case involves a federal rent-subsidy program for Indian Tribes and Tribally Designated Housing Entities (TDHE) that lease housing to Indians. Fort Belknap, a TDHE, petitioned for review of HUD's decision to withhold overpayments from future program payments. The court held that 25 U.S.C. 4161(d) allows an appeal only when HUD takes action pursuant to section 4161(a). In this instance, because HUD has taken no action pursuant to section 4161(a), the court dismissed the petition for lack of jurisdiction. View "Fort Belknap v. Office of Pub. & Indian Hous." on Justia Law

After the court reversed and remanded for an award of social security disability benefits to plaintiff, plaintiff moved for an award of attorney's fees and costs under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The court concluded that the district court abused its discretion in denying the fees where the government's underlying action was not substantially justified in this case. Accordingly, the court reversed the district court's denial of plaintiff's motion and remanded for an award of fees and costs. View "Meier v. Colvin" on Justia Law

The Clinics filed suit challenging California Welfare and Institutions Code 14131.10, which eliminated certain Medi-Cal benefits that the state deemed optional, including adult dental, podiatry, optometry, and chiropractic services. The court reversed the district court's holding that the Clinics have a private right of action to challenge the Department's implementation of the state plan amendments (SPA) prior to obtaining approval; affirmed that the Clinics have a private right of action to bring a claim pursuant to 42 U.S.C. 1983 challenging the validity of section 14131.10; and reversed the district court's interpretation of the Medicaid Act, 42 U.S.C. 1396 et seq., holding that section 14131.10 impermissibly eliminated mandatory services from coverage. View "California Ass'n of Rural Health Clinics v. Douglas" on Justia Law

Plaintiffs appealed the Secretary's denial of their claims for Medicare coverage for dental services. Plaintiffs contended that this denial was premised on the Secretary's unreasonable interpretation of the Medicare Act, Pub. L. No. 89-97, 79 Stat. 286, which contravened the intent of Congress and violated plaintiffs' right to equal protection under the Fifth Amendment. The court concluded that, although the statutory provision for exclusion of dental services was ambiguous in the sense that plausible divergent constructions could be urged, the Secretary's interpretation of the statute was reasonable. The court also concluded that the Secretary's statutory interpretation warranted Chevron deference and the Secretary's statutory interpretation was reasonable. Accordingly, the court affirmed the judgment. View "Fournier v. Sebelius" on Justia Law

These are two appeals stemming from the government's immediate termination of a Medicare Part D services contract with a prescription drug insurance coverage provider, Fox. Fox subsequently filed actions in the district court challenging both the termination and an order for immediate repayment. The court affirmed the district court's holding that the contract was properly terminated; affirmed the district court's ruling that governing regulations authorized the government's demand for immediate repayment of a prorated share of the funds that had been paid to Fox at the beginning of the month and that Fox would not utilize after the contract's termination; and the government's actions were more than justified, as Fox had risked permanent damage to its enrollees by, inter alia, improperly denying coverage of critical HIV, cancer, and seizure medications, and having no compliance structure in place. View "Fox Ins. Co. v. Centers for Medicare and Medicaid" on Justia Law

Plaintiffs claimed that PacifiCare was not entitled to any reimbursement payments out of the wrongful death benefits paid by an insurance policy to them. PacifiCare counterclaimed, arguing that it was entitled to reimbursement under both the terms of its contract with the deceased (Count I) and directly under the Medicare Act (Count 11), 42 U.S.C. 1395. At issue was whether a private Medicare Advantage Organization (MAO) plan could sue a plan participant's survivors, seeking reimbursement for advanced medical expenses out of the proceeds of an automobile insurance policy. Because interpretation of the federal Medicare Act presented a federal question, the district court had subject matter jurisdiction to determine whether that act created a cause of action in favor of PacifiCare against plaintiffs. The district court properly dismissed the causes of action arising under the Medicare Act for failure to state a claim where section 1395y(b)(2) did not create a federal cause of action in favor of a MAO and where, under section 1395y(b)(3)(A), the Private Cause of Action applied in the case of a primary plan which failed to provide for primary payment, which was not applicable in this instance. The court affirmed the district court's dismissal of Count II for failure to state a claim as well as its decision to decline to exercise supplemental jurisdiction over Count 1. View "Parra v. Pacificare of Arizona" on Justia Law