Articles Posted in Health Law

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Plaintiff-Appellant Suture Express, Inc. appeals from the district court’s entry of summary judgment in favor of Cardinal Health 200, LLC (“Cardinal”) and Owens & Minor Distribution, Inc. (“O&M”) under Section 1 of the Sherman Antitrust Act, Section 3 of the Clayton Act, and the Kansas Restraint of Trade Act (“KRTA”). Suture Express, Cardinal, and O&M compete in the national broadline medical-and-surgical (“med-surg”) supply and distribution market. After Suture Express entered the "suture-endo" market and steadily grew its market share, Cardinal and O&M responded by instituting bundling packages in their contracts. Suture Express sued Cardinal and O&M, alleging that their bundling arrangements constituted an illegal tying practice in violation of federal and state antitrust laws. The court held that Suture Express’s federal claims failed as a matter of law because it could not establish that either Cardinal or O&M individually possessed sufficient market power in the other-med-surg market that would permit it to restrain trade in the suture-endo market. Even were this not the case, however, the court also held that: (1) Suture Express could not establish antitrust injury because it had not shown that competition itself had been harmed; and (2) Cardinal and O&M cited sufficient procompetitive justifications for the bundling arrangement to overcome any harm caused by any anticompetitive effects resulting from the bundle. Viewing the evidence in the light most favorable to Suture Express, the Tenth Circuit did not think the company could survive summary judgment under Section 1 of the Sherman Act, Section 3 of the Clayton Act, or the Kansas Restraint of Trade Act. "There simply is not enough probative evidence by which a reasonable jury could find that Cardinal’s and O&M’s bundling arrangement unreasonably restrained trade in violation of federal or state antitrust law." View "Suture Express v. Owens & Minor" on Justia Law

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In 2010, Lenox MacLaren Surgical Corporation (“Lenox”) sued several related corporations, Medtronic, Inc.; Medtronic PS Medical, Inc. (“PS Medical”); Medtronic Sofamor Danek, Inc. (“MSD, Inc.”); and Medtronic Sofamor Danek Co. Ltd. (“MSD Japan”) (collectively, “Defendants”), for monopolization and attempted monopolization in violation of section 2 of the Sherman Act. Lenox alleged that Defendants engaged in illegal activity to advance a coordinated, anticompetitive scheme in which a related non-party, Medtronic Sofamor Danek USA, Inc. (“MSD USA”), also participated. Lenox sued MSD USA in 2007 on claims arising from the same set of facts. In this case, Lexon challenged the district court’s disposition of Defendants’ second motion for summary judgment, which claimed that Lenox could not prove the elements of its antitrust claims against any of the named Defendants individually, and that Defendants cannot be charged collectively with the conduct of MSD USA or of each other. They also argued that the doctrine of claim preclusion barred Lenox’s claims, in light of the prior proceeding against MSD USA. The district court granted summary judgment, holding that because Lenox could not establish each of the elements of an antitrust claim against any one defendant, or establish a conspiracy among them, Lenox’s claims failed as a matter of law. Lenox appealed. But finding no reversible error, the Tenth Circuit affirmed. View "Lenox MacLaren Surgical Corp. v. Medtronic" on Justia Law

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LeGrand Belnap, M.D., was a surgeon at the Salt Lake Regional Medical Center (“SLRMC”). Dr. Belnap and SLRMC entered into a Management Services Agreement under which he would provide consulting services to help SLRMC develop a new surgical center. The Agreement contained an arbitration provision, including an agreement to arbitrate questions of arbitrability. SLRMC subsequently disciplined Dr. Belnap for alleged misconduct and then reversed course and vacated the discipline. As a result, Dr. Belnap brought various claims against SLRMC, its alleged parent company, and several of its individual employees. These Defendants moved to compel arbitration on the basis of the arbitration provision in the Agreement. The district court determined that most of the claims fell outside the scope of the Agreement, and granted in part and denied in part the motion. Defendants appealed the portions of the district court’s order denying their motion to stay litigation and to compel arbitration, arguing: (1) because the parties agreed to arbitrate arbitrability, the district court erred when it failed to submit all questions of arbitrability to an arbitrator; and (2) even if the parties did not agree to arbitrate arbitrability, the district court erred when it found that any of Dr. Belnap’s claims fell outside the scope of the Agreement, despite also finding that the Agreement’s dispute-resolution provision was broad. The Tenth Circuit found that by incorporating the JAMS Rules into the Agreement, Dr. Belnap and SLRMC evidenced a clear and unmistakable intent to delegate questions of arbitrability to an arbitrator. Nevertheless, the Tenth Circuit concluded the district court reached the right outcome regarding Dr. Belnap’s first claim against SLRMC (compelling that claim to arbitration) and upheld that portion of its order. The Court felt “constrained,” however, to reverse the order as to the remainder of the SLRMC claims. The Court remanded, instructing the court to compel all of Dr. Belnap’s claims against SLRMC to arbitration. With respect to Defendants wh did not sign the Agreement, the Court held they were not entitled to enforce the arbitration provision of the Agreement. Thus, the Court affirmed the district court’s order in this respect. View "Belnap v. Iasis Healthcare" on Justia Law

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At issue in this case was the interpretation of 42 U.S.C. 12181(7)(F), which makes certain "service establishments" public accommodations for purposes of Title III of the Americans with Disabilities Act. Title III, in turn, generally prohibits public accommodations from discriminating against individuals on the basis of disability. Brent Levorsen suffered from various psychiatric disorders, including borderline schizophrenia. For years, Levorsen has donated plasma in exchange for money in an effort to supplement his limited income. And in May 2013, he attempted to do just that at a Salt Lake City branch of Octapharma Plasma, Inc. When an Octapharma employee learned that Levorsen suffers from borderline schizophrenia, the employee became concerned that Levorsen might have a schizophrenic episode while donating and dislodge the collecting needle, possibly injuring himself or someone else. The employee thus advised Levorsen that he was ineligible to donate plasma. Levorsen then provided Octapharma with a signed form from his psychiatrists, who both indicated that Levorsen is medically suitable to donate plasma twice a week. When Octapharma maintained its refusal to allow Levorsen to donate, he brought this action under Title III of the ADA. The district court concluded that plasma-donation centers (PDCs) aren’t service establishments because, unlike section 12181(7)(F)’s enumerated examples, PDCs don’t provide a service to the public in exchange for a fee. The Tenth Circuit found this "superficial distinction" irrelevant. Under the plain language of section 12181(7)(F), a PDC was a "'service establishment' for two exceedingly simple reasons: It’s an establishment. And it provides a service." Because the district court erred in concluding otherwise, and in dismissing the underlying action on that basis, the Tenth Circuit reversed and remanded for further proceedings. View "Levorsen v. Octapharma Plasma" on Justia Law

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Caring Hearts Personal Home Services, Inc. provided physical therapy and skilled nursing services to “homebound” Medicare patients. It sought reimbursement from Medicare for services provided. The definition of who qualified as "homebound" or what services qualified as "reasonable and necessary" was unclear, even to the Centers for Medicare & Medicaid Services (CMS). CMS has developed its own rules on both subjects that had been repeatedly revised and expanded over time. In an audit, CMS purported to find that Caring Hearts provided services to at least a handful of patients who didn’t qualify as “homebound” or for whom the services rendered weren’t “reasonable and necessary.” As a result, CMS ordered Caring Hearts to repay the government over $800,000. It was later found that in reaching its conclusions CMS applied the wrong law: the agency did not apply the regulations in force in 2008 when Caring Hearts provided the services in dispute. Instead, it applied considerably more onerous regulations the agency adopted years later, "[r]egulations that Caring Hearts couldn’t have known about at the time it provided its services." The Tenth Circuit found that Caring Hearts "[made] out a pretty good case that its services were entirely consistent with the law as it was at the time they were rendered" when CMS denied Caring Hearts' request for reconsideration. The Tenth Circuit reversed the district court's judgment affirming CMS' denial to Caring Hearts for reimbursement, and remanded for further proceedings. View "Caring Hearts v. Burwell" on Justia Law

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Plaintiff Leslie Taylor asked the Colorado Medicaid program to combine the benefits she received through two assistance programs to help her get to medical appointments. If approved, this combination would allow the agency to pay attendants for time driving Taylor to and from her appointments. The agency refused, and the plaintiffs in this case alleged that the refusal constituted discrimination against Taylor based on her disability. The Tenth Circuit concluded that this refusal did not constitute discriminate against Taylor based on her disability. View "Taylor v. Colorado Dept of Health Care" on Justia Law

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The appeals before the Tenth Circuit in this opinion concerned the regulations (as a part of the Affordable Care Act ("ACA")) that required group health plans to cover contraceptive services for women as a form of preventive care ("Mandate"). In response to religious concerns, the Departments implementing the ACA (Health and Human Services ("HHS"), Labor, and Treasury) adopted a regulation that exempted religious employers (churches and their integrated auxiliaries) from covering contraceptives. When religious non-profit organizations complained about their omission from this exemption, the Departments adopted a regulation that allowed them to opt out of providing, paying for, or facilitating contraceptive coverage. Under this regulation, a religious non-profit organization could opt out by delivering a form to their group health plan’s health insurance issuer or third-party administrator or by sending a notification to HHS. The Plaintiffs in the cases here were religious non-profit organizations. They argued that complying with the Mandate or the accommodation scheme imposed a substantial burden on their religious exercise. The Plaintiffs argued the Mandate and the accommodation scheme violated the Religious Freedom Restoration Act (“RFRA”) and the Religion and Speech Clauses of the First Amendment. While Tenth Circuit recognized the sincerity of Plaintiffs’ beliefs and arguments, it concluded the accommodation scheme relieved Plaintiffs of their obligations under the Mandate and did not substantially burden their religious exercise under RFRA or infringe upon their First Amendment rights. The Court affirmed the district court’s denial of a preliminary injunction to the plaintiffs in Little Sisters of the Poor Home for the Aged v. Sebelius, (6 F.Supp. 3d 1225 (D. Colo. 2013)), and reversed the district courts’ grants of a preliminary injunction to the plaintiffs in "Southern Nazarene University v. Sebelius," (No. CIV-13-1015-F, 2013 WL 6804265 (W.D. Okla. Dec. 23, 2013)), and "Reaching Souls International, Inc. v. Burwell," (No. CIV-13-1092-D, 2013 WL 6804259 (W.D. Okla. Dec. 20, 2013)). View "Little Sisters of the Poor v. Burwell" on Justia Law

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The plaintiffs in this case were David and Barbara Green, their three children, and the businesses they collectively owned and operated: Hobby Lobby Stores, Inc. and Mardel, Inc. As owners and operators of both Hobby Lobby and Mardel, the Greens organized their businesses with express religious principles in mind. As was particularly relevant to this case, one aspect of the Greens’ religious principles was a belief that human life begins when sperm fertilizes an egg. In addition, the Greens believed it was immoral for them to facilitate any act that caused the death of a human embryo. Plaintiffs brought an action to challenge portions of the Patient Protection and Affordable Care Act (ACA) whereby employment-based group health plans covered by the Employee Retirement Income Security Act (ERISA) were required provide certain types of health services for women that implicated contraceptive methods, sterilization procedures, and patient education and counseling (without cost-sharing by plan participants or beneficiaries) - all "abortifacients" that went against plaintiffs' religious beliefs. Plaintiffs filed suit to challenge the contraceptive-coverage requirement of the ACA under the Religious Freedom Restoration Act (RFRA), the Free Exercise Clause of the First Amendment, and the Administrative Procedure Act. Plaintiffs simultaneously moved for a preliminary injunction on the basis of their RFRA and Free Exercise claims. The district court denied that motion. Plaintiffs appealed the denial of the injunction. After review by the Tenth Circuit Court of Appeals, the Court held that Hobby Lobby and Mardel were entitled to bring claims under RFRA, established a likelihood of success that their rights under statute were substantially burdened by the contraceptive-coverage requirement, and established an irreparable harm. However, the case was remanded back to the district court for further proceedings on two remaining factors governing the grant or denial of a preliminary injunction. View "Hobby Lobby Stores, et al v. Sebelius, et al" on Justia Law

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George Cohlmia appealed a district court's decision to award attorney’s fees to St. John Medical Center pursuant to the Health Care Quality Improvement Act (HCQIA). This case arose from two surgeries Cohlmia performed: one patient died as a result of surgery, another was permanently disfigured. After the Hospital conducted an internal review, it concluded Cohlmia failed to follow proper medical protocols, and suspended the doctor’s staff privileges. The district court granted summary judgment in favor of the hospital on all of the doctor’s claims. The Hospital thereafter sought attorney’s fees under the HCQIA. Finding that the district court did not abuse it's discretion in awarding fees under the Act, the Tenth Circuit affirmed. View "Cohlmia, et al v. St. John Medical Center, et al" on Justia Law

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Full Life Hospice participates in the federal Medicare program. It sought reimbursement for hospice services provided to Medicare recipients from the Department of Health and Human Services (HHS). A fiscal intermediary, acting on behalf of HHS, later contested some of these reimbursements and demanded repayment of funds that it claimed were distributed in excess of a spending cap. Full Life unsuccessfully challenged HHS intermediary’s determination through an administrative appeal, which was denied as untimely. On appeal to the district court, the court found no basis to excuse Full Life's untimely challenge. Upon review, the Tenth Circuit agreed with the district court that it lacked subject matter jurisdiction because of Full Life's failure to file a timely administrative appeal. View "Full Life Hospice v. Sebelius" on Justia Law