Justia Civil Procedure Opinion Summaries

This case was one in a longstanding dispute between major health services providers operating in Western Pennsylvania: UPE, a/k/a Highmark Health and Highmark, Inc. (collectively, Highmark) and UPMC (University of Pittsburgh Medical Center). Highmark and UPMC separately entered into Consent Decrees with the Commonwealth's Office of Attorney General (OAG). In this case, an issue arose concerning the obligations imposed by the Consent Decrees relative to UMPC's attempt to terminate ten hospital Medicare Acute Care Provider Agreements it had with Highmark. Pertinent here, UPMC's Consent Decree required it to treat Highmark's Medicare Advantage Plan consumers as in-network through the end date of the Consent Decree. UPMC allowed Provider Agreements with Highmark to renew annually in satisfaction of its in-network obligation. UPMC informed Highmark in accordance with the notice provisions, it would terminate the Provider Agreements on December 31, 2018, but would nonetheless continue to comply with all terms and obligations of those agreements through June 30, 2019, pursuant to the Decree runout provision. Highmark filed for an injunction and to hold UPMC in contempt. The Commonwealth granted OAG's petition to enforce, rejecting UPMC's contention that the six-month runout provision of the Provider Agreements satisfied its obligation to remain in "contract" with Highmark. The Pennsylvania Supreme Court reversed, finding the runout provision of the Provider Agreement satisfied UPMC's obligation to contract for in-network access to its facilities for Highmark's MA Plan subscribers through June 30, 2019. View "Pennsylvania v. UPMC, et al" on Justia Law

This case was a qui tam action alleging violations of the False Claims Act (“FCA”) involving fraudulent reimbursements under the Medicare Act. Plaintiff Gerald Polukoff, M.D., was a doctor who worked with Defendant Sherman Sorensen, M.D. After observing some of Sorensen’s medical practices, Polukoff brought this FCA action, on behalf of the United States, against Sorensen and the two hospitals where Sorensen worked (collectively, “Defendants”). Polukoff alleged Sorensen performed thousands of unnecessary heart surgeries and received reimbursement through the Medicare Act by fraudulently certifying that the surgeries were medically necessary. Polukoff further alleged the hospitals where Sorensen worked were complicit in and profited from Sorensen’s fraud. The district court granted Defendants’ motions to dismiss, reasoning that a medical judgment could not be false under the FCA. The Tenth Circuit reversed and remanded, holding that a doctor’s certification to the government that a procedure is “reasonable and necessary” is “false” under the FCA if the procedure was not reasonable and necessary under the government’s definition of the phrase. View "Polukoff v. St. Mark's Hospital" on Justia Law

When Charlotte Fischer moved into a nursing home, she received an admissions packet full of forms. Among them was an agreement that compelled arbitration of certain legal disputes. The Health Care Availability Act (“HCAA” or “Act”) required such agreements contain a four-paragraph notice in a certain font size and in bold-faced type. Charlotte’s agreement included the required language in a statutorily permissible font size, but it was not printed in bold. Charlotte’s daughter signed the agreement on Charlotte’s behalf. After Charlotte died, her family initiated a wrongful death action against the health care facility in court. Citing the agreement, the health care facility moved to compel arbitration out of court. The trial court denied the motion, and the court of appeals affirmed, determining the arbitration agreement was void because it did not strictly comply with the HCAA. At issue was whether the Act required strict or substantial compliance. The Colorado Supreme Court held "substantial:" the agreement at issue her substantially complied with the formatting requirements of the law, notwithstanding the lack of bold type. View "Colorow Health Care, LLC v. Fischer" on Justia Law

The Alaska Supreme Court granted this petition for review to consider how the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) affected Alaska personal injury case law allowing a defendant ex parte contact with a plaintiff’s doctors as a method of informal discovery. The issue the Court requested the parties specifically brief was whether the federal law preempted Alaska case law, or, if not, whether federal law otherwise required us to overrule or modify our case law. After review, the Court concluded the federal law did not preempt existing Alaska case law. But the Court also concluded it should overrule the case law because its foundations "have been eroded by a cultural shift in views on medical privacy and new federal procedural requirements undermining the use of ex parte contact as an informal discovery measure." The Court therefore held that - absent voluntary agreement - a defendant may not make ex parte contact with a plaintiff’s treating physicians without a court order, which generally should not be issued absent extraordinary circumstances. "We believe that formal discovery methods are more likely to comply with the federal law and promote justice and that such court orders rarely, if ever, will be necessary." View "Jones v. Drury" on Justia Law

On October 8, 2016, Rita Kay filed a complaint against "Brookwood Baptist Health LLC" and fictitiously named defendants pursuant to the Alabama Medical Liability Act, based on injuries she allegedly suffered at the hands of another patient while she was being treated in the Psychiatric and Behavioral Health Inpatient Services Unit at Brookwood Baptist Medical Center from October 8, 2014, until October 12, 2014. She asserted claims of medical negligence, false imprisonment, negligence and wantonness, breach of contract, and negligent and/or wanton hiring, training, and/or supervision. Brookwood Health Services, Inc., filed a petition for a writ of mandamus directing the Circuit Court to dismiss Kay's action against it. Assuming, without deciding, that service on Brookwood Baptist Health LLC, the original defendant, was proper, the materials before the Alabama Supreme Court established that Brookwood Baptist Health LLC did not receive the complaint until February 13, 2017 -- 128 days after the lawsuit was commenced. Therefore, the Court concluded Brookwood established it was added as a defendant after the expiration of the applicable limitations period and that relation-back principles do not apply. Therefore, it has demonstrated that it had a clear legal right to the relief sought. Accordingly, the Supreme Court granted the petition for a writ of mandamus and directed the trial court to vacate its September 7, 2017, order denying the motion to dismiss filed by Brookwood Health Services, Inc., and to dismiss Kay's complaint. View "Ex parte Brookwood Health Services, Inc." on Justia Law

In this interlocutory appeal, the Supreme Court held that sovereign immunity barred the counterclaims filed by Defendants against the State and that it lacked interlocutory jurisdiction to address the trial court’s dismissal of the Defendants’ third-party claims.The State brought this enforcement action under the Texas Medicaid Fraud Prevention Act, alleging that Defendants - several dentists and their professional associations and employees - fraudulently obtained Medicaid payments for providing dental and orthodontic treatments to children. Defendants asserted counterclaims and third-party claims alleging that the State and its contractor mismanaged the payment-approval process and misled Defendants regarding the requirements imposed by the Texas Medical Program. The trial court granted the State’s plea to the jurisdiction against the counterclaims and motion to dismiss the third-party claims. Defendants filed this interlocutory appeal. The court of appeals affirmed the trial court’s order dismissing Defendants’ counterclaims and concluded that it lacked jurisdiction over the order dismissing the third-party claims. The Supreme Court affirmed, holding (1) sovereign immunity barred the counterclaims, and (2) this Court lacked interlocutory jurisdiction to address the order dismissing the third-party claims. View "Nazari v. State" on Justia Law

Plaintiffs were 23 federally qualified health centers (FQHC’s) and rural health clinics (RHC’s) that served medically underserved populations (the Clinics). The dispute before the Court of Appeal centered on coverage for adult dental, chiropractic, and podiatric services the FQHC’s and RHC’s provided to Medi-Cal patients for a period between 2009 and 2013. Prior to July 1, 2009, the Department processed and paid claims for these services. In 2009, in a cost-cutting measure due to budget problems, the Legislature enacted Welfare and Institutions Code section 14131.101 to exclude coverage for these services (and others) “to the extent permitted by federal law.” After the Department stopped paying claims for these services, various FQHC’s and RHC’s challenged the validity of section 14131.10, claiming it conflicted with federal Medicaid law. In California Assn. of Rural Health Clinics v. Douglas, 738 F.3d 1007 (9th Cir. 2013), the Ninth Circuit held section 14131.10 was invalid to the extent it eliminated coverage for these services when provided by FQHC’s and RHC’s because the federal Medicaid Act imposed on participating states the obligation to cover these services by these providers. In response to CARHC, the Department announced it would reimburse FQHC’s and RHC’s for these services for dates of service only on or after September 26, 2013, the date of the Ninth Circuit’s mandate. Seeking reimbursement for services provided prior to September 26, 2103, the Clinics petitioned for a writ of mandate to compel the Department to accept, process, and pay claims for these services for the period July 1, 2009, to September 26, 2013. The trial court granted the petition in part and entered judgment for the Clinics. The Department appeals. Characterizing the Clinics’ writ petition as a suit for damages, it contended: (1) sovereign immunity barred the Clinics’ claims for retroactive payment; (2) the CARHC decision was retroactive because the Medicaid Act is spending clause legislation and its terms were not sufficiently clear as to the requirement to cover adult dental, chiropractic, and podiatric services provided by FQHC’s and RHC’s; and (3) retroactive relief violated the separation of powers doctrine because it forces the Legislature to appropriate money. The Court of Appeal disagreed with the Department’s characterization of the Clinics’ lawsuit. "Rather than a suit for damages, the lawsuit seeks an order to compel performance of a mandatory duty and did not result in a money judgment. Under well-settled California law, such a mandamus proceeding is not barred by sovereign immunity. The Department’s contentions based on spending clause legislation and separation of powers are new arguments raised for the first time on appeal. We exercise our discretion to consider only the spending clause argument. We reject it because the Department has not shown its obligations under Medicaid law, as determined by CARHC, came as a surprise. The separation of powers argument raises factual issues about appropriations that should have been presented in the trial court and we decline to consider this new argument." Accordingly, the Court affirmed the judgment. View "American Indian Health etc. v. Kent" on Justia Law

In this case alleging health care liability claims, the trial court erred by allowing Plaintiff to amend her complaint after the expiration of the statute of limitations to substitute as a defendant a health care provider to which Plaintiff had not sent pre-suit notice.The Supreme Court reversed the decisions of the trial court and court of appeals, holding that Plaintiff did not comply with the mandatory pre-suit notice provision of the Tennessee Health Care Liability Act, Tenn. Code Ann. 29-26-121(a)(1), because she did not give written pre-suit notice of the potential claim to the health care provider she later sought to substitute as a defendant after the expiration of the statute of limitations. View "Runions v. Jackson-Madison County General Hospital District" on Justia Law

Abramge is a Brazilian nonprofit professional association of private health insurance providers, many of whom were impacted by a bribery and kickback scandal in the medical device market that broke in the Brazilian media in 2015. Abramge alleged that Stryker, a Michigan corporation, masterminded an “illicit scheme, which was planned and run from Michigan, designed to increase its market share by making improper payments and paying bribes and kickbacks to Brazilian doctors to induce the use of Stryker products” and “made improper payments and paid kickbacks to Brazilian doctors with the intent of influencing those doctors to use Stryker devices and products in patients even if those devices ... did not best meet the patients’ medical needs.” The scheme allegedly increased the cost of devices and the number of devices implanted and surgeries performed; health insurance providers paid for those increases. Abramge claims that Stryker’s actions injured not only its insurer members but also the entire Brazilian public health system and patients throughout the country. Abramge filed suit in the Western District of Michigan, claiming fraud, civil conspiracy, tortious interference with contractual relationships, and unjust enrichment. The district court dismissed, citing forum non conveniens. The Sixth Circuit reversed and remanded. Stryker did not carry its burden of proving that Brazil is an available and adequate alternative forum in which the case may be heard. View "Associacao Brasileira de Medicina v. Stryker Corp." on Justia Law

In consolidated petitions, defendant Mobile Infirmary Medical Center ("MIMC") sought a writ of mandamus to direct the Mobile Circuit Court to vacate portions of its May 5, 2017, discovery orders. More specifically, in case no. 1160731, MIMC sought mandamus review of the portion of the trial court's order compelling MIMC to produce certain documents previously submitted to the trial court for in camera review on the ground that the documents are protected from discovery under section 6-5-551 and/or section 22-21-8, Ala. Code 1975. In case no. 1160815, MIMC sought mandamus review of another May 5, 2017, order denying MIMC's motions seeking reconsideration of, or in the alternative, a protective order regarding the trial court's November 10, 2016 order compelling MIMC's response to various discover requests. The underlying case centered on a negligence action brought by the administrator of the estate of Rhonda Lynn Snow who sought surgery at an MIMC facility in 2013. At around 5:50 a.m. on December 11, 2013, a nurse allegedly administered a dose of Dilaudid to Rhonda; thereafter, at 6:40 a.m. Rhonda was found "non-responsive" in her room and the staff at the medical center were unable to resuscitate her. Rhonda remained on life support until her death on January 3, 2014. The Alabama Supreme Court determined MIMC demonstrated the trial court exceeded its discretion in requiring MIMC to respond to the discovery requests at issue, and accordingly, issued writs in both cases. View "Ex parte Mobile Infirmary Association d/b/a Mobile Infirmary Medical Center." on Justia Law