Justia U.S. 10th Circuit Court of Appeals Opinion Summaries

Blue Valley Hospital, Inc., (“BVH”) appealed a district court’s dismissal of its action for lack of subject matter jurisdiction. The Department of Health and Human Services (“HHS”) and the Centers for Medicare and Medicaid Services (“CMS”) terminated BVH’s Medicare certification. The next day, BVH sought an administrative appeal before the HHS Departmental Appeals Board and brought this action. In this action, BVH sought an injunction to stay the termination of its Medicare certification and provider contracts pending its administrative appeal. The district court dismissed, holding the Medicare Act required BVH exhaust its administrative appeals before subject matter jurisdiction vested in the district court. BVH acknowledged that it did not exhaust administrative appeals with the Secretary of HHS prior to bringing this action, but argued: (1) the district court had federal question jurisdiction arising from BVH’s constitutional due process claim; (2) BVH’s due process claim presents a colorable and collateral constitutional claim for which jurisdictional exhaustion requirements are waived under Mathews v. Eldridge, 424 U.S. 319 (1976); and (3) the exhaustion requirements foreclosed the possibility of any judicial review and thus cannot deny jurisdiction under Bowen v. Michigan Academy of Family Physicians, 476 U.S. 667 (1986). The Tenth Circuit disagreed and affirmed dismissal. View "Blue Valley Hospital v. Azar" 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

The Acting Commissioner of the Social Security Administration appealed a district court order reversing her decision to deny Marla Vallejo’s application for supplemental security income benefits and remanding the case for further administrative proceedings. Because the district court’s order rested on a misapplication of controlling law, the Tenth Circuit reversed and remanded to the district court for further proceedings. View "Vallejo v. Berryhill" on Justia Law

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

Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law

Plaintiff-appellant Michael Allman applied for Social Security disability benefits, claiming he could not work due to spina bifida, a shunt in his brain, chronic back pain, headaches, depression, and anxiety. An administrative law judge (ALJ) concluded that plaintiff's residual functional capacity (RFC) permitted him to perform a number of jobs that existed in significant numbers in the national economy, defeating his disability claim. At step two of the applicable five-step sequential evaluation, the ALJ determined that plaintiff's headaches were not a “severe impairment” within the meaning of the Social Security Act and its corresponding regulations. Nevertheless, the ALJ discussed and considered plaintiff's headaches in assessing his RFC to work. After the ALJ denied his claim, the Appeals Council denied review and the district court affirmed after adopting the magistrate judge’s report and recommendation and overruling plaintiff's objections. The district court concluded that plaintiff failed to demonstrate that his headaches qualified as a severe impairment and that the ALJ had provided sufficient bases for not assigning more weight to his doctor's opinion. On appeal, plaintiff challenged, among other things, the district court’s findings regarding the ALJ’s determinations at steps two and four. Finding no reversible error, the Tenth Circuit affirmed the district court. View "Allman v. Colvin" on Justia Law

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

Plaintiff-appellant Alphonso Myers was injured on the job. He received social security benefits due to his inability to work. While claiming benefits, he applied for a job as an armed guard with defendant-appellee Knight Protective Service. On his job application, plaintiff made no mention of his prior injury. Supervisors at Knight noticed that plaintiff appeared to be in pain. Plaintiff then admitted that he had undergone a series of surgeries from the prior workplace injury. Concerned that this pain might interfere with his duties as an armed guard, Knight required plaintiff to submit to a physical exam before resuming his duties as a guard. Plaintiff waited months for the exam - long enough that plaintiff considered the delay as an effective termination from his job. Plaintiff then filed suit, arguing that he had been discriminated against on the basis of his race and disability. The district court granted summary judgment to Knight, and plaintiff appealed. Finding no reversible error, the Tenth Circuit affirmed the district court's judgment. View "Myers v. Knight Protective Service" on Justia Law

This appeal related to petitioner Linda Hendron's third application for disability benefits. She filed the first in 1999 and was denied on the merits. She applied again in 2001, and was denied on res judicata grounds. This latest application was filed in 2009, claiming a disability onset date of November 1, 1995. After the Social Security Administration denied the claim on res judicata grounds, requested a hearing before an administrative law judge (ALJ). The ALJ heard testimony from petitioner, and considered 19 medical exhibits that had not been submitted in petitioner's previous applications. The ALJ issued a written decision finding that petitioner was not disabled before the expiration of her insured status. The Appeals Council denied review, and petitioner took her appeal to the district court, which concluded the ALJ failed to develop a sufficient record on which to base a disability decision. The Commissioner appealed the district court's decision. Finding ample evidence in the record that the ALJ developed the record on which he denied petitioner's claim, the Tenth Circuit reversed and remanded the case for entry of judgment in favor of the Commissioner. View "Hendron v. Colvin" on Justia Law

Defendant Sevgi Muhammad was indicted on 24 counts of mail fraud, two counts of making a false statement, and one count of stealing public money. All the charges arose out of Defendant’s obtaining housing assistance through the Housing Choice Voucher Program of the United States Department of Housing and Urban Development (HUD). She pleaded no contest to one count of making a false statement. At the sentencing hearing, however, she moved to withdraw her plea. The district court denied the motion, and sentenced defendant to serve three years of probation and pay restitution. On appeal defendant argued her plea was not knowing and voluntary and that the district court erred when it denied her motion to withdraw the plea. Finding no reversible error, the Tenth Circuit affirmed. View "United States v. Muhammad" on Justia Law