Justia U.S. 3rd Circuit Court of Appeals Opinion Summaries

Until 2003, Hagans worked as a security guard and as a sanitation worker. At 44 years old, Hagans required open-heart surgery. Hagans claims additional medical problems relating to his cerebrovascular and respiratory systems, hypertension and dysphagia, insomnia, and back pain. He has been diagnosed with depression. Hagans began receiving disability benefits as of January 30, 2003. In September, 2004, pursuant to an updated Residual Function Capacity assessment showing his condition had improved, SSA determined that Hagans was no longer eligible for benefits. The ALJ considered several evaluations of Hagans’s condition, most of which were completed in mid-2004, and found that he was capable of engaging in substantial gainful activity, although he could not perform his past relevant work. The Appeals Council denied review; the district court affirmed. The Third Circuit affirmed, after determining that “relatively high” deference should be afforded to SSA’s Acquiescence Ruling interpreting the cessation provision of 42 U.S.C. 423(f) as referring to the time of the SSA’s initial disability determination. SSA correctly evaluated Hagans’s condition as of the date on which the agency first found that Hagans’s eligibility for disability benefits ceased. Substantial evidence supported the conclusion that Hagans was not fully disabled as of that date. View "Hagans v. Comm'r of Soc. Sec." on Justia Law

TriCenturion audited Nichole Medical as a Program Safeguard Contractor under the Medicare Integrity Program, 42 U.S.C. 395ddd(a), and concluded that Nichole “might” be improperly billing for medical equipment; that Nichole had received overpayments; and that it had not maintained sufficient medical records to establish reasonableness or medical necessity. TriCenturion directed Nichole’s carrier, HealthNow, to withhold payments. TriCenturion calculated the actual overpayment of several specific claims, used those as a representative sampling, and extrapolated an overpayment amount for all relevant claims. The Attorney General found no evidence of fraud and refused to prosecute; HealthNow stopped withholding payments. TriCenturion instructed HealthNow’s successor to re-institute the offset. Nichole went out of business, but pursued an appeal. An ALJ determined that Nichole was entitled to reimbursement on some, but not all, appealed claims and found that the process for arriving at the extrapolated overpayment was flawed. The Medicare Appeals Council found that all 39 claims had been reopened and reviewed improperly. The district court dismissed Nichole’s suit against TriCenturion, which alleged torts and breach of the statutory duty of care under 42 U.S.C. 1320c-6(b). The Third Circuit affirmed. Defendants are immune from suit as officers or employees of the Secretary of the Department of Health and Human Services. View "Nichole Medical Equip & Supply, Inc. v. Tricenturion, Inc." on Justia Law

The Port Authority’s subsidiary, PATH, operates the Grove Street Station in Jersey City. The Station was built in 1910. In 2000 PATH planned to expand the Station to accommodate larger trains and persons with disabilities, a project that would have involved construction of a new entrance and two elevators. After September 11, 2001, and the resulting closure of two stations, ridership increased at the Station. Concerned about congestion and safety, PATH scrapped its renovation plans and undertook a “fast track” project. Construction began in 2002 and concluded in 2005. Plaintiffs alleged that the renovations triggered an obligation under the Americans with Disabilities Act, 42 U.S.C. 12101–12213, to make the Station accessible to handicapped persons. They also alleged violations under New Jersey’s Law Against Discrimination and certain state construction code provisions. The district court dismissed, state-law claims on the basis that allowing such claims to proceed would violate the interstate compact between New York and New Jersey that created the Authority, but ordered the Authority to make the east entrance accessible. The Third Circuit affirmed dismissal of the state law claims, but remanded the ADA issue for trial on the issue of feasibility. View "Hip Heightened Indep. & Progress, Inc. v. Port Auth. of NY & NJ" on Justia Law

Seven states sought to recover proceeds of matured but unredeemed U.S. savings bonds from the Treasury, asserting that Treasury has possession of approximately $16 billion worth of matured but unredeemed savings bonds, of which persons whose last known addresses were within the plaintiff states own $1.6 billion. The states contended that their respective unclaimed property acts obliged Treasury to account for and deliver the proceeds of these bonds to the states for reunification with their owners. The district court dismissed, reasoning that sovereign immunity and intergovernmental immunity barred the action and that federal law and regulations preempted the states’ statutory authority to obtain the proceeds of the savings bonds. The Third Circuit affirmed. Although the federal government has waived sovereign immunity (5 U.S.C. 702), states may not directly regulate the federal government’s operations or property and federal law is sufficiently pervasive so as not to leave room for the enforcement of the unclaimed property acts to achieve the result that the states seek. View "Treasurer, State of NJ v. U.S. Dept of Treasury" on Justia Law

Plaintiffs brought a putative class action challenging 62 Pa. Stat. 1414, which was enacted to regulate special needs trusts. The comprehensive Medicaid eligibility rules enacted by Congress generally mandate that trusts be counted as assets of those seeking Medicaid, but exempt special needs trusts, which are intended to provide disabled individuals with necessities and comforts not covered by Medicaid. Plaintiffs allege Section 1414 is preempted by 42 U.S.C. 1396p(d)(4). The district court held that all but one of the challenged provisions of Section 1414 was preempted, finding that plaintiffs had a private right of action under both Section 1983 and the Supremacy Clause. The court also held that Section 1414 was severable, certified a class, and appointed class counsel. The Third Circuit affirmed in part, agreeing that the case is justiciable and that plaintiffs have a private right of action. Section 1414's 50% repayment provision, "special needs" provision, expenditure provision, and age restriction are all preempted by federal law. The enforcement provision of Section 1414, however, when used to enforce provisions not otherwise preempted, is a reasonable exercise of the Commonwealth's retained authority to regulate trusts. View "Lewis v. Alexander" on Justia Law

Title insurance purchasers, on behalf of themselves and similarly situated consumers, claimed that insurers collectively fixed title insurance rates in violation of the Sherman Act. Title insurers in Delaware are required to file their insurance rates with the state Department of Insurance, Del. Code tit. 18, 2504(a). Insurers may comply with the state’s rate filing requirements through a licensed rating organization. Defendants, title insurers, are members of and file their rates through the Delaware Title Insurance Rating Bureau, which is licensed by the DOI; the statutory scheme authorizes cooperative action. The district court dismissed, holding that the complaint is barred by the filed-rate doctrine (which precludes antitrust suits based on rates currently filed with federal or state agencies), lack of standing, and federal antitrust liability exemptions. The Third Circuit affirmed. View "McCray v. Fidelity Nat'l Title Ins. Co." on Justia Law

Title insurance purchasers, on behalf of themselves and similarly situated consumers, claimed that insurers collectively fixed title insurance rates in violation of the Sherman Act and the New Jersey Antitrust Act. In New Jersey, the Department of Banking and Insurance approves and regulates title insurance rates, N.J. Stat. Ann. 17:1C-19(a)(1). Insurers may collectively file rates for approval through a licensed rating organization, thereby authorizing cooperative action. The district court dismissed, holding that the complaint is barred by the filed-rate doctrine (which precludes antitrust suits based on rates currently filed with federal or state agencies), lack of standing, and federal and state antitrust liability exemptions. The Third Circuit affirmed. View "Swick v. Censtar Title Ins. Co." on Justia Law

A psychologist challenged the government's claim that he had over-billed Medicare and owed the government more than $600,000 in overpayments. At a hearing on the claim, the doctor presented extensive evidence, but the government neither appeared nor presented argument or advocacy, either written or in person. The ALJ concluded that the overpayment was actually $5,434.48. The doctor moved, under the Equal Access to Justice Act, 5 U.S.C. 504(a)(1), to recoup tens of thousands of dollars in attorneys' fees and expenses incurred in fighting the claim. His request was denied by an administrative appeals council and the district court based on their conclusion that the hearing before the ALJ was not an adversary adjudication, as is required for a fee award under the EAJA. The Third Circuit affirmed denial, finding that the government did not engage in purposeful advocacy.View "Handron v. Sec'y of Health & Human Servs." on Justia Law

Married couples formed Virgin Islands corporations that were limited partners in a VI limited liability limited partnership, Four Points, and derived all of their income from Four Points. The couples assert that they were not bona fide residents of the Virgin Islands in 2006, but that a portion of their income was derived from sources there, I.R.C. 932(a)(1)(A)(ii). Both couples filed 2006 tax returns with the U.S. and with the Virgin Islands, but, rather than paying the Virgin Islands, they paid all taxes to the U.S., claiming that they believed that the IRS would pay the Virgin Islands or that the VIBIR would obtain the amounts from the IRS. The couples filed suit to compel the VIBIR to declare whether the income was derived from sources within the Virgin Islands and, against the U.S., requested refunds. The district court dismissed with respect to the Virgin Islands and transferred the claim against the U.S. to Florida. The Third Circuit affirmed. Taxpayers stated no cause of action against the Virgin Islands and any claims are not ripe, as there has been no administrative action against them. The District Court of the Virgin Islands may transfer VI tax cases to other district courts. View "In re:Birdman" on Justia Law

Plaintiff, 12 years old, was bitten by a barracuda while playing in shallow water near Buck Island Reef National Monument. Buck Island is accessible only by watercraft and is open to the public for recreational activities. When boat owners apply for a permit to visit, they receive a brochure detailing hazards. There are also signs posted on the Island, warning of the same hazards. The warnings indicate that barracuda should be treated with caution, but are not usually aggressive toward humans. The government was aware of only one incident in 22 years involving a barracuda bite near Buck Island. Plaintiff filed suit under the Federal Tort Claims Act, 28 U.S.C. 2671, alleging negligent failure to warn. The district court dismissed, citing the discretionary function exception to the FTCA. The Third Circuit affirmed. No statute, regulation, or policy mandated any particular method for warning about marine hazards. The National Park Service has discretion regarding whether to provide warnings and the extent of any such warnings, in light of the information available. View "S.R.P. v. United States" on Justia Law