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

Articles Posted in Public Benefits
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Ehnert was placed at WPP by Staffmark as a temporary general laborer. It was understood that Ehnert would be considered for hire as a WPP employee. Ehnert suffered from various medical conditions but never requested accommodations. On May 23, 2012—the last day of his work placement—Ehnert was informed that he would not be hired by WPP. Ehnert completed applied for social security disability insurance (SSDI) benefits, representing that he had been unable to work due to a “disabling condition” since May 21, 2012. An ALJ granted Ehnert benefits. Ehnert then sued WPP and Staffmark, alleging discrimination on the basis of disability and age, under the Americans with Disabilities Act, the Pennsylvania Human Relations Act, and the Age Discrimination in Employment Act.The Third Circuit affirmed summary judgment for the defendants. Ehnert was unable to establish a prima facie case of discrimination because a necessary element was lacking for his ADA and PHRA claims--that he was otherwise qualified to perform the essential functions of the job as of the date WPP informed him that he would not be hired. Ehnert’s statements regarding his disability for SSDI purposes preclude his subsequent claim that, for the purposes of the ADA and the PHRA, he was “qualified” for the position; Ehnert failed to advance a reasonable explanation that reconciles those positions. View "Ehnert v. Washington Penn Plastic Co Inc." on Justia Law

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Care Alternatives provides hospice care to New Jersey patients, employing “interdisciplinary teams” of registered nurses, chaplains, social workers, home health aides, and therapists working alongside independent physicians who serve as hospice medical directors. Former Alternatives employees filed suit under the False Claims Act, 31 U.S.C. 3729–3733 alleging that Alternatives admitted patients who were ineligible for hospice care and directed its employees to improperly alter those patients’ Medicare certifications to reflect eligibility. They retained an expert, who opined in his report that, based on the records of the 47 patients he examined, the patients were inappropriately certified for hospice care 35 percent of the time. Alternatives’ expert testified that a reasonable physician would have found all of those patients hospice-eligible. The district court determined that a mere difference of opinion between experts regarding the accuracy of the prognosis was insufficient to create a triable dispute of fact as to the element of falsity and required that the plaintiffs provide evidence of an objective falsehood. Upon finding they had not adduced such evidence, the court granted Alternatives summary judgment. The Third Circuit vacated, rejecting the objective falsehood requirement for FCA falsity. The plaintiffs’ expert testimony created a genuine dispute of material fact as to falsity. View "Druding v. Care Alternatives" on Justia Law

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After the plaintiffs’ disability claims were denied by ALJs employed by the Social Security Administration (SSA), the Supreme Court held in Lucia v. SEC (2018), that ALJs in the Securities and Exchange Commission (SEC) exercised “significant discretion” in carrying out “important functions” and were required, under the Appointments Clause, to be appointed by the President, a court of law, or the head of a department. Because the SEC ALJs were not so appointed, the petitioner there was entitled to a new hearing. When Lucia was decided, the plaintiffs were already in the process of challenging the SSA’s denial of their claims in the district court and demanded new hearings on the ground that the SSA ALJs were unconstitutionally appointed. The Acting Commissioner of SSA quickly reappointed the administrative judges but argued that the plaintiffs were not entitled to relief because they had not previously presented their Appointments Clause challenges to their ALJs or the Appeals Council and had not exhausted those claims before the agency. The district court declined to require exhaustion, vacated the agency’s decisions, and remanded for new hearings. The Third Circuit affirmed. Both the characteristics of the SSA review process and the rights protected by the Appointments Clause favor resolution of these claims on the merits, so exhaustion is not required in this context. View "Cirko v. Commissioner Social Security" on Justia Law

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Chang filed a qui tam action against the Center, asserting claims on behalf of the United States and the state under the False Claims Act (FCA). and the Delaware False Claims Act. Chang alleged that the Center had sought and received funding from the state and federal governments by misrepresenting material information. Both governments declined to intervene as plaintiffs. Chang filed an amended complaint and the Center answered. Nearly three years after Chang filed his original complaint, the U.S. and Delaware moved to dismiss the case, asserting that they had investigated Chang’s allegations and discovered them to be “factually incorrect and legally insufficient.” The court granted the motions without conducting an in-person hearing or issuing a supporting opinion. The Third Circuit affirmed. If the government chooses not to intervene, the relator may still “conduct the action” but the government may still “dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the Government of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion,” 31 U.S.C. 3730(c)(2)(A). Chang never requested a hearing; the FCA does not guarantee an automatic in-person hearing to relators before their cases may be dismissed. View "Chang v. Children's Advocacy Center of Delaware" on Justia Law

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The ALJ who ruled on Hess’s application for social security disability benefits concluded that Hess had “moderate difficulties” in “concentration, persistence or pace,” but offered a detailed explanation for why she believed those difficulties were not serious and why Hess was capable of performing simple tasks. She found that Hess was “limited to jobs requiring understanding, remembering, and carrying out only simple instructions and making only simple work-related decisions[.]” In a series of hypothetical questions meant to include Hess’s limitations, she asked a vocational expert whether there were jobs in the national economy available to someone with those limitations. The expert said there were. The ALJ decided that Hess was not disabled and rejected his claim. The district court determined that the ALJ had erred because, in her hypothetical questions to the vocational expert, she failed to include or account for her finding that Hess had “moderate” difficulties in “concentration, persistence, or pace.” The Third Circuit reversed, refusing to elevate “form over substance.” An ALJ’s statement of a limitation confining a person to “simple tasks” is permissible after a finding of “moderate” difficulties in “concentration, persistence, or pace,” if the ALJ offers a “valid explanation” for it. The explanation given by the ALJ was “valid.” View "Hess v. Commissioner of Social Security" on Justia Law

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Nita and her husband, Kirtish, pled guilty to defrauding Medicare (18 U.S.C. 1347), based on having forged physicians’ signatures on diagnostic reports and having conducted diagnostic testing without the required physician supervision. The government then brought this civil action for the same fraudulent schemes against Nita, Nita’s healthcare company (Heart Solution), Kirtish, and Kirtish’s healthcare company (Biosound). The district court granted the government summary judgment, relying on the convictions and plea colloquies in the criminal case, essentially concluding that Nita had admitted to all elements and issues relevant to her civil liability. Nita and Heart Solution appealed. The Third Circuit affirmed Nita’s liability under the False Claims Act, 31 U.S.C. 3729(a)(1)(A) and for common law fraud but vacated findings that Heart Solution is estopped from contesting liability and damages for all claims and Nita is estopped from contesting liability and damages for the remaining common law claims. The district court failed to dissect the issues that were determined in the criminal case from those that were not, lumping together Nita and Heart Solution, even though Heart Solution was not involved in the criminal case. It also failed to disaggregate claims Medicare paid to Nita and Heart Solution from those paid to Kirtish and Biosound. The plea colloquy did not clarify ownership interests in the companies; who, specifically, made certain misrepresentations; nor whether one company was paid the entire amount or whether the payments were divided between the companies. View "Doe v. Heart Solution PC" on Justia Law

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Silver’s qui tam action, filed under the False Claims Act (FCA), 31 U.S.C. 3729–33, alleged that PharMerica, which owns and operates institutional pharmacies serving nursing homes, unlawfully discounted prices for nursing homes’ Medicare Part A patients (reimbursed by the federal government to the nursing home on a flat per-diem basis) in order to secure contracts to supply services to patients covered by Medicare Part D and Medicaid (reimbursed directly to the pharmacy by the government on a cost basis) in the same nursing homes--a practice called swapping. The district court dismissed, based on the FCA’s public disclosure bar. The Third Circuit reversed. The district court improperly determined that documents publicly describing the generalized risk of swapping in the nursing home industry served to bar his specific claim, which depended on non-public information that PharMerica was actually engaging in swapping in specific contracts. The district court also erred in concluding, on the basis of Silver’s testimony, that he relied upon certain publicly available information to reach his conclusion and that the information itself disclosed the fraud, without independently determining that the relevant public document did, in fact, effectuate such a disclosure. View "Silver v. Omnicare Inc" on Justia Law

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The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act, 42 U.S.C. 1437f(t) (Section 8). Enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.”because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent. The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit initially affirmed. On rehearing, the Third Circuit reversed. The statute’s plain language and history indicate that enhanced voucher holders may not be evicted absent good cause, even at the end of a lease term. The court remanded so that the district court may consider whether Harvey has good cause to evict. View "Hayes v. Harvey" on Justia Law

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Accredo delivers clotting medication and provides nursing assistance for hemophilia patients. Accredo makes donations to charities concerned with hemophilia, including HSI and HANJ, which allegedly recommended Accredo as an approved provider for hemophilia patients. Greenfield, a former Accredo area vice president, sued, alleging violations of the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), and the False Claims Act, 31 U.S.C. 3729(a)(1)(A)-(B). If Greenfield prevailed, he would get at least 25% of any civil penalty or damages award. The government did not intervene. The district court, following discovery, granted Accredo summary judgment, finding that Greenfield failed to provide evidence of even a single federal claim for reimbursement that was linked to the alleged kickback scheme. The Third Circuit affirmed. The Anti-Kickback Statute prohibits kickbacks regardless of their effect on patients’ medical decisions. Because any kickback violation is not eligible for reimbursement, to certify otherwise violates the False Claims Act but there must be some connection between a kickback and the reimbursement claim. It is not enough to show temporal proximity. Greenfield was required to show that at least one of the 24 federally-insured patients for whom Accredo provided services and submitted reimbursement claims was exposed to a referral or recommendation by HSI/HANJ in violation of the Anti-Kickback Statute. View "Greenfield v. Medco Health Solutions Inc" on Justia Law

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The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act of 1937, 42 U.S.C. 1437f(t) (Section 8). Because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent, enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.” The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Toward the end of their most recent lease term, Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate the premises, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit affirmed. The Act does not obligate property owners to renew enhanced-voucher tenancies after the initial lease term. View "Hayes v. Harvey" on Justia Law