Latest 4 Cases This Week: Martin v. Saul (7th Cir.), United States ex rel. Janssen v. Lawrence Memorial Hospital (10th Cir.), Baystate Franklin ...

The Investors’ Control of Their Investment Advisers. Who Has the Final Word?

TAMAR FRANKEL

BU Law emerita professor Tamar Frankel discusses an emerging issue affecting financial advisers—when a client may exercise control over the actions of the adviser. Frankel relates the story of an investment adviser that did not follow the client’s orders to cease certain investments, at a cost of almost $5 million to the client. As Frankel explains, the Securities and Exchange Commission (SEC) got involved, resulting in the investment adviser’s settlement for a significant payment to the client and other conditions.

Read More

Martin v. Saul

Court: US Court of Appeals for the Seventh Circuit

Docket: 19-1957

Opinion Date: February 7, 2020

Judge: Scudder

Areas of Law: Health Law, Public Benefits

Martin, a 67-year-old woman, sought Social Security Disability benefits. Her persistent back pain stems from two car accidents; she also suffers from depression, anxiety, bipolar disorder, panic disorder, and PTSD. These conditions caused Martin to stop working in 2009. Before then she had worked as a home health aide, data entry clerk, and administrative assistant. An ALJ determined that Martin’s severe impairments left her capable of performing only a limited range of sedentary jobs. The district court remanded for a more thorough consideration of Martin’s mental health problems. A new ALJ then found that Martin had no physical limitations whatsoever and declined to award benefits. The Seventh Circuit reversed, finding the second ALJ’s decision not supported by substantial evidence, and took “the rare step of ordering the award of benefits.” The court rejected Martin’s argument that the ALJ’s residual functional capacity determination failed to translate her mental health symptoms into limitations related to concentration, persistence, and pace but the record is clear that Martin’s physical limitations leave her unable to perform any work above the light level. Given her restricted range of motion and symptoms of pain, light exertion would likely be a challenge for Martin because it requires “a good deal of walking or standing.”

United States ex rel. Janssen v. Lawrence Memorial Hospital

Court: US Court of Appeals for the Tenth Circuit

Docket: 19-3011

Opinion Date: February 7, 2020

Judge: Timothy M. Tymkovich

Areas of Law: Civil Procedure, Health Law, Public Benefits

Stacey Janssen alleged Lawrence Memorial Hospital ("LMH") engaged in two healthcare schemes to fraudulently receive money from the United States. Janssen first contended LMH falsified patients’ arrival times in order to increase its Medicare reimbursement under certain pay-for-reporting and pay-for-performance programs the Government used to study and improve hospitals’ quality of care. Second, Janssen contended LMH falsely certified compliance with the Deficit Reduction Act in order to receive Medicare reimbursements to which it was otherwise not entitled. LMH moved for summary judgment below, arguing Janssen failed to show her allegations satisfied the Act’s materiality requirement - that the alleged falsehoods influenced the Government’s payment decision as required under the FCA. The district court granted LMH summary judgment on all of Janssen’s claims on this basis, and finding no reversible error, the Tenth Circuit affirmed.

Baystate Franklin Medical Center v. Azar

Court: US Court of Appeals for the District of Columbia Circuit

Docket: 18-5264

Opinion Date: February 11, 2020

Judge: Sentelle

Areas of Law: Government & Administrative Law, Health Law

Baystate filed suit against the Secretary, challenging his promulgation of a final rule calculating the wage index for hospital reimbursements in 2017. Baystate alleged that the Secretary failed to comply with the statutory requirement to calculate a wage index that reflected the actual wage levels in Massachusetts, relied on data that he knew to be false, and entirely failed to consider an important aspect of the problem. The DC Circuit affirmed the district court's grant of summary judgment for the Secretary, holding that the Secretary's interpretation of his authority under the Medicare statute was lawful and his action was not arbitrary and capricious. In this case, the Secretary provided a reasonable explanation for his decision to enforce the deadline and reject Nantucket's revised data; the decision to enforce the deadline against third-party hospitals was not arbitrary or capricious; and the Secretary's interpretation of his authority to enforce a deadline in calculating the wage index fell squarely within them.

Central Mississippi Medical Center v. Mississippi Division of Medicaid

Court: Supreme Court of Mississippi

Citation: 2018-SA-01410-SCT

Opinion Date: February 13, 2020

Judge: Michael K. Randolph

Areas of Law: Civil Procedure, Government & Administrative Law, Health Law, Public Benefits

Central Mississippi Medical Center (CMMC) appealed a Chancery Court decision denying its appeal of a Division of Medicaid (DOM) hearing. The DOM had determined that CMMC owed it $1.226 million due to overpayment. The Mississippi Supreme Court recently decided a reimbursement dispute involving the DOM, Crossgates River Oaks Hosp. v. Miss. Div. of Medicaid, 240 So. 3d 385 (Miss. 2018). In Crossgates, the hospitals prevailed because the DOM had failed to adhere to the Medicare State Plan Agreement. Applying the same legal principles to this case, the Supreme Court ruled the DOM prevailed because the DOM adhered to the Plan. The chancellor found sufficient evidence to support the DOM’s decision, decreed that it was neither arbitrary nor capricious, and decreed that it did not exceed the DOM’s authority or violate any of CMMC’s statutory or constitutional rights.