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Justia Daily Opinion Summaries

US Court of Appeals for the Sixth Circuit
October 15, 2020

Table of Contents

Fuerst v. Secretary of the Air Force

Civil Procedure, Government & Administrative Law, Labor & Employment Law

Mohlman v. Financial Industry Regulatory Authority

Civil Procedure, Government & Administrative Law, Securities Law

United States v. Wombold

Criminal Law

DaVita, Inc. v. Marietta Memorial Hospital Employee Health Benefit Plan

ERISA, Health Law, Insurance Law

Associate Justice
Ruth Bader Ginsburg

Mar. 15, 1933 - Sep. 18, 2020

In honor of the late Justice Ruth Bader Ginsburg, Justia has compiled a list of the opinions she authored.

For a list of cases argued before the Court as an advocate, see her page on Oyez.

Ruth Bader Ginsburg

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Legal Analysis and Commentary

Racism, Rage, and Raw Political Power: Revisiting the Motivations of Trump’s Supporters

NEIL H. BUCHANAN

verdict post

UF Levin College of Law professor and economist Neil H. Buchanan develops his argument that the only plausible reasons Republicans continue to support President Trump are “bigotry and raw political power.” In this follow-up column, Buchanan explores these explanations a bit further, drawing in part from incensed reader responses to his previous column.

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US Court of Appeals for the Sixth Circuit Opinions

Fuerst v. Secretary of the Air Force

Docket: 19-4139

Opinion Date: October 14, 2020

Judge: Thapar

Areas of Law: Civil Procedure, Government & Administrative Law, Labor & Employment Law

Fuerst fell at a military base, which left her disabled. She returned to work part-time. The Air Force removed Fuerst from service after determining that her ability to work only part-time was affecting the office’s mission. The Department of Labor subsequently determined that Fuerst was no longer disabled. Fuerst applied to participate in a fast-track reemployment program for civil-service employees who were removed from service because of a disability but have recovered, 5 U.S.C. 8151(b). The Air Force did not place her on the priority reemployment list. Fuerst appealed to the Merit Systems Protection Board, which found that her removal was not improper or motivated by discrimination, but ordered the Air Force to rehire her. The Air Force offered Fuerst two jobs at her pay grade. Fuerst did not accept the offers. The Board ruled that the Air Force had complied. Fuerst appealed to a federal district court. The Sixth Circuit affirmed the dismissal of the claim for lack of subject matter jurisdiction. Employees must generally appeal Board decisions to the Federal Circuit. Fuerst’s case could not qualify as a “mixed case” within the district court’s jurisdiction; it was not an appeal of an agency's action, but a petition for enforcement, although Fuerst sought to enforce an order issued in a mixed case. In a mixed case, the Board decides "both the issue of discrimination and the appealable action[s].” When Fuerst petitioned for enforcement, the Board had decided those issues already. Fuerst had a chance to ask a district court to review those decisions but did not do so.

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Mohlman v. Financial Industry Regulatory Authority

Docket: 20-3257

Opinion Date: October 14, 2020

Judge: Gilbert Stroud Merritt, Jr.

Areas of Law: Civil Procedure, Government & Administrative Law, Securities Law

Mohlman became a licensed securities professional in 2001. The Financial Industry Regulatory Authority, a not-for-profit member organization, regulates practice in the securities industry and enforces disciplinary actions against its members. In 2012, Mohlman had conversations with several individuals concerning WMA. Mohlman did not attempt to sell WMA investments and did not receive compensation from WMA. Mohlman learned in 2014 that WMA was a Ponzi scheme and immediately informed all persons who had invested in WMA. Mohlman appeared for testimony as part of FINRA’s investigation. Another day of testimony was scheduled but instead of appearing, Mohlman and his counsel signed a Letter of Acceptance, Waiver, and Consent, agreeing to a permanent ban from the securities industry. FINRA agreed to refrain from filing a formal complaint against him. Mohlman waived his procedural rights under FINRA’s Code of Procedure and the Securities Exchange Act, 15 U.S.C. 78a and agreed to “not take any position in any proceeding brought by or on behalf of FINRA, or to which FINRA is a party, that is inconsistent with any part of [the Letter].” FINRA accepted the Letter in 2015. In 2019, Mohlman filed suit, alleging that FINRA fraudulently avoided considering mitigating factors in administering the sanction. The Sixth Circuit affirmed the dismissal of the suit without addressing the merits. Mohlman failed to exhaust administrative remedies under the Exchange Act by appealing to the National Adjudicatory Council and petitioning the SEC for review.

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United States v. Wombold

Dockets: 18-6102, 18-6023, 18-6101

Opinion Date: October 14, 2020

Judge: Suhrheinrich

Areas of Law: Criminal Law

Pilot Flying J, headquartered in Knoxville, operates hundreds of truck stops nationwide and sells billions of gallons of diesel fuel annually to trucking companies. Employees in Pilot’s direct-sales division falsely promised discounted fuel prices, and then secretly shorted the customers through deceptive invoicing and rebate techniques. Several pled guilty. The Sixth Circuit reversed conspiracy to commit wire fraud (18 U.S.C. 1343) and mail fraud (section 1341) convictions of three defendants. The district court had allowed the government to play audio recordings in which one defendant, Pilot's President, is heard using deeply offensive racist and misogynistic language, reasoning that if the defendant was reckless enough to use language that could risk public outrage against the company, he was a “bad businessman,” and as a bad businessman, he was also reckless enough to commit fraud. “This is vintage bad character evidence—and precisely the type of reasoning the Federal Rules of Evidence forbid.” None of the Rules of Evidence support the recordings’ admissibility and, even if somehow otherwise admissible, the recordings are a “textbook violation” of Rule 403, because the risk of unfair prejudice eviscerates any purported probative value.

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DaVita, Inc. v. Marietta Memorial Hospital Employee Health Benefit Plan

Docket: 19-4039

Opinion Date: October 14, 2020

Judge: Karen Nelson Moore

Areas of Law: ERISA, Health Law, Insurance Law

Beginning in‌ ‌‌2017,‌ ‌DaVita‌ ‌provided‌ ‌dialysis‌ ‌treatment‌ ‌to‌ ‌Patient‌ ‌A,‌ ‌who was ‌diagnosed‌ ‌ with‌ ‌end-stage‌ ‌renal‌ ‌disease‌ ‌(ESRD).‌ ‌‌Patient‌ ‌A‌ assigned his‌ ‌insurance‌ ‌rights‌ ‌to‌ ‌DaVita.‌ ‌Through‌ August‌ ‌2018,‌ ‌the‌ ‌costs‌ ‌of‌ ‌Patient‌ ‌A’s‌ ‌dialysis‌ ‌were‌ ‌reimbursed‌ ‌by‌ ‌the‌ ‌Employee‌ ‌Health‌ ‌Benefit‌ ‌Plan,‌ ‌governed‌ ‌by‌ ‌the‌ ‌Employee‌ ‌Retirement‌ ‌Income‌ ‌Security‌ ‌Act‌ ‌(ERISA), ‌at‌ ‌its‌ ‌bottom‌ ‌tier,‌ ‌which‌ ‌applied‌ ‌to‌ ‌providers‌ ‌who‌ ‌are‌ ‌“out-of-network.”‌ ‌All‌ ‌dialysis‌ ‌providers‌ were‌ ‌out-of-network.‌ ‌While‌ ‌most‌ ‌out-of-network‌ ‌providers‌ ‌are‌ ‌reimbursed‌ ‌in‌ ‌the‌ ‌bottom‌ ‌tier‌ ‌based‌ ‌on‌ ‌a‌ ‌“reasonable‌ ‌and‌ ‌customary”‌ ‌fee‌ ‌as‌ ‌understood‌ ‌in‌ ‌the‌ ‌healthcare‌ ‌industry,‌ ‌dialysis‌ ‌providers‌ ‌are‌ ‌subject‌ ‌to‌ ‌an‌ ‌“alternative‌ ‌basis‌ ‌for‌ ‌payment”;‌‌‌ ‌the‌ ‌Plan‌ ‌reimburses‌ ‌at‌ 87.5%‌ ‌of‌ ‌the‌ ‌Medicare‌ ‌rate.‌ ‌Patient‌ ‌A‌ ‌was exposed‌ ‌to‌ ‌higher‌ ‌copayments,‌ ‌coinsurance‌ ‌amounts,‌ ‌and‌ ‌deductibles and ‌was‌ ‌allegedly‌ ‌at‌ ‌risk‌ ‌of‌ ‌liability‌ ‌for‌ ‌the‌ ‌balance‌ ‌of‌ ‌what‌ ‌was‌ ‌not‌ ‌reimbursed‌ .‌ ‌The‌ ‌Plan‌ ‌identified‌ ‌dialysis‌ ‌as‌ ‌subject‌ ‌to‌ ‌heightened‌ ‌scrutiny,‌ ‌ ‌which‌ ‌allegedly‌ ‌incentivizes‌ ‌dialysis‌ ‌patients‌ ‌to‌ ‌switch‌ ‌to‌ ‌Medicare. Patient‌ ‌A‌ ‌switched‌ ‌to‌ ‌Medicare.‌ ‌DaVita‌ ‌and‌ ‌Patient‌ ‌A‌ ‌sued,‌ ‌alleging‌ ‌that‌ ‌the‌ ‌Plan‌ ‌treats‌ ‌dialysis‌ ‌providers‌ ‌differently‌ ‌from‌ ‌other‌ ‌medical‌ ‌providers‌ ‌in‌ ‌violation‌ ‌of‌ ‌the‌ ‌Medicare‌ ‌Secondary‌ ‌Payer‌ ‌Act‌ ‌(MSPA)‌ ‌and‌ ‌ERISA.‌ ‌ ‌ ‌ The‌ ‌Sixth‌ ‌Circuit‌ ‌reversed,‌ ‌in‌ ‌part,‌ ‌the‌ ‌dismissal‌ ‌of‌ ‌the‌ ‌claims.‌ ‌A‌ ‌conditional‌ ‌payment‌ ‌by‌ ‌Medicare‌ ‌is‌ ‌required‌ ‌as‌ ‌a‌ ‌precondition‌ ‌to‌ ‌suing‌ ‌under‌ ‌the‌ ‌MSPA’s‌ ‌private‌ ‌cause‌ ‌of‌ ‌action;‌ ‌the‌ ‌complaint‌ ‌sufficiently alleges ‌such‌ ‌a‌ ‌payment‌.‌ ‌DaVita‌ ‌plausibly‌ ‌alleged‌ ‌that‌ ‌the‌ ‌Plan‌ ‌violates‌ ‌the‌ ‌nondifferentiation‌ ‌provision‌ ‌of‌ ‌the‌ ‌MSPA,‌ ‌resulting‌ ‌in‌‌ ‌denials‌ ‌of‌ ‌benefits‌ ‌and‌ ‌unlawful‌ ‌discrimination‌ ‌under‌ ‌ERISA.‌ ‌

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