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Case Summaries

Government Benefits

[08/31] Jones v. Astrue
In plaintiff's appeal from the district court's judgment upholding the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income, the order is affirmed where: 1) the ALJ had no need to contact plaintiff's treating physician because there was no ambiguity to resolve in her report, and the report contained all the necessary information, including the results of diagnostic testing; 2) the ALJ appropriately considered plaintiff's subjective complaints of pain under Polaski; and 3) substantial evidence on the record as a whole supported the ALJ's decision.

[08/30] Uhm v. Humana, Inc.
In an action against an insurer for nonpayment of Medicare benefits, the dismissal of the action is affirmed where 1) the district court lacked jurisdiction to consider plaintiffs' breach of contract and unjust enrichment claims because they were not properly exhausted under the Medicare Prescription Drug Improvement and Modernization Act; and 2) plaintiffs' fraud and consumer protection act claims, while not subject to the Act’s exhaustion provisions, were expressly preempted.

[08/30] California State Foster Parents' Ass'n v. Wagner
In an action against officials of the State of California under 42 U.S.C. section 1983 claiming a violation of plaintiffs' federal right to payments under the Child Welfare Act (CWA), and seeking declaratory and injunctive relief, judgment for plaintiffs is affirmed where the CWA, at 42 U.S.C. sections 672(a) and 675(4)(A), created an enforceable federal right.

[08/26] US v. Prince
Conviction of defendant for conspiracy to commit money laundering and multiple counts of money laundering, in connection with fraudulent claims for payment for physical therapy services provided to Medicare beneficiaries, is affirmed where: 1) the evidence at trial was sufficient to establish that the defendant committed, or conspired to commit, money laundering by conducting, or aiding and abetting another in conducting, the specified financial transactions knowing that they involved the proceeds of Medicare fraud; 2) a reasonable person would not question the judge's impartiality toward defendant because a government witness was represented by an attorney who previously represented the judge in a prior unrelated matter; and 3) district court did no abuse its discretion by refusing to require the government to provide a pretrial disclosure of its exhibit list.

[08/25] Univ. of Chicago Med. Ctr. v. Sebelius
In University of Chicago Medical Center's claim for $2.8 million in Medicare reimbursements for indirect medical education (IME), based on its total full-time equivalent residents (FTEs) for the 1996 fiscal year that reflected the time medical residents spent conducting educational research unrelated to the care of Medicare patients, a grant of summary judgment in favor of the hospital is affirmed as, pursuant to the Patient Protection and Affordable Care Act, the hospital should have received reimbursement as part of its IME adjustment for pure research in 1996.

[08/20] Hardy Wilson Mem. Hosp. v. Sebelius
In an action against the Secretary of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS), alleging that CMS's method for calculating reimbursement payments for costs incurred by health care providers' psychiatric units between 2003 and 2005 violated 42 U.S.C. section 1395ww(b)(3)(A) and was inconsistent with the agency’s own regulations, summary judgment for defendants is reversed where the plain text of subsection (c)(4)(iii) did not support defendant's contention that "the only reasonable interpretation of the regulations is that all of subsection (c)(4)(iii) expired in 2003 because the statutory authority under which it was promulgated (the BBA) expired at that time."

[08/20] Florida Med. Ctr. of Clearwater, Inc. v. Sebelius

[08/16] Lockwood v. Comm'r Soc. Sec. Admin.
In a petition for review of the denial of social security benefits to petitioner, claiming that the ALJ erred when she failed to explain in her written decision why she treated a social security claimant as being a person closely approaching advanced age instead of treating the claimant as being a person of advanced age, the petition is denied where the ALJ did not err because she was required by regulation only to consider whether to use the older age category.

[08/13] Castile v. Astrue
District court's affirmance of the Social Security Administration's denial of plaintiff's numerous claims under Title II of the Social Security Act for disability insurance and disability widow's benefits is affirmed where: 1) the ALJ considered all available evidence involving plaintiff's chronic fatigue syndrome and there was substantial evidence supporting the ALJ's conclusion that plaintiff's long-standing complaints did not render her disabled; 2) district court did not err in agreeing with the ALJ's obesity finding that plaintiff was not prevented by her impairments from performing her past work; and 3) district court did not err in upholding the ALJ's credibility determinations as the ALJ thoroughly examined the evidence and clearly articulated his findings.

[08/09] Gragg v. Astrue
In plaintiff's appeal from the judgment of the district court upholding the Social Security Commissioner's denial of his application for disability insurance benefits and supplemental security income, the order is affirmed where: 1) plaintiff's experts' reports did not support plaintiff's argument that they concluded borderline intellectual functioning was a severe impairment separate and apart from a learning disorder; and 2) the hypothetical the ALJ gave to a vocational expert properly incorporated the limitations imposed by plaintiff's physical disabilities in combination with his cognitive impairments, and was not defective.

[08/09] Ebeid v. Lungwitz
In an action under the False Claims Act (FCA), claiming that defendant submitted false certifications to the federal government in connection with Medicare payments for three health care businesses, the dismissal of the complaint is affirmed where: 1) plaintiff failed to supply reasonable indicia that false claims were actually submitted; and 2) plaintiff failed to plead an implied certification theory with the particularity required by Fed. R. Civ. P. 9(b) for the same reasons germane to the alleged Stark Act violation.

[08/06] Munro v. Shinseki
Judgment of the United States Court of Appeals for Veterans Claims affirming a decision of the Board of Veterans' Appeals denial of claimant's petition for an earlier effective date for an increased rating for his service-connected granuloma of the left lung and total disability based on individual unemployability is affirmed where: 1) the implicit denial rule may be applied to terminate the pending status of both formal and informal claims; and 2) because claimant's earlier informal claims were identical to his later claim, the VA's denial of his later claim was sufficient to notify him that his earlier informal claims were also denied.

[08/03] Larson v. Astrue
In petitioner's application for Supplemental Security Income, claiming that she is disabled by anxiety, depression, and ankle pain, district court's affirmance of an ALJ's conclusion that petitioner's impairments, although severe, are not disabling, is reversed and remanded where: 1) the ALJ erred by failing to give controlling weight to petitioner's treating physician's opinion about the limitations on petitioner's social functioning and her experience with episodes of decompensation, and as such, petitioner's condition meets the standards of the Listing, and the ALJ should have found petitioner disabled at Step 3; and 2) ALJ's reasons for his adverse credibility ruling find no support, and thus, the credibility determination cannot stand.

[08/03] Khan v. Los Angeles City Employees' Ret. Sys.
Trial court's judgment in favor of plaintiff granting his petition for writ of mandate compelling the Los Angeles City Employees Retirement System (LACERS) to approve his request for concurrent deferred retirement benefits with LACERS and the Judicial Retirement System (JRS), is reversed and remanded where: 1) there is no reciprocity between LACERS and JRS/JRS II, such that plaintiff, a judge of the Superior Court of Los Angeles County who had worked for the City of Los Angeles as a City Attorney, may retire from LACERS at his higher judicial salary; and 2) provisions relating to the County Employees' Retirement Law of 1937 (CERL) do not control the court's analysis.

[08/02] Turner v. Comm'r of Soc. Sec.
In a challenge to the denial of social security benefits by the Commissioner of Social Security, summary judgment for defendant is affirmed where: 1) there was no evidence in the record from an appropriate medical source during the relevant time period that refuted the administrative law judge's (ALJ)determination that plaintiff, even with post-traumatic stress disorder, was capable of performing simple, repetitive tasks in an environment where he could work alone and without public contact; and 2) the ALJ did not err in determining Turner's residual functional capacity.

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