Latest 4 Cases This Week: Winter v. Gardens Regional Hospital & Medical Center, Inc. (9th Cir.), Anaheim Gardens, L.P. v. United States (Fed. ...

Whence Cometh Evil? Making Sense of Human Suffering and COVID-19

CHARLES E. BINKLEY

Surgeon and bioethicist Charles E. Binkley, MD, offers a perspective on how we might make sense of suffering, particularly in light of the present COVID-19 pandemic. Binkley suggests that through suffering, we are paradoxically able to find good, and in this instance, that good might be the practice of social reciprocity.

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Winter v. Gardens Regional Hospital & Medical Center, Inc.

Court: US Court of Appeals for the Ninth Circuit

Docket: 18-55020

Opinion Date: March 23, 2020

Judge: Bennett

Areas of Law: Government Contracts, Health Law

The Ninth Circuit reversed the district court's dismissal of a qui tam action brought by relator under the False Claims Act, alleging that defendants submitted, or caused to be submitted, Medicare claims falsely certifying that patients' inpatient hospitalizations were medically necessary. After determining that it had jurisdiction, the panel held that a plaintiff need not allege falsity beyond the requirements adopted by Congress in the FCA, which primarily punishes those who submit, conspire to submit, or aid in the submission of false or fraudulent claims. The panel wrote that Congress imposed no requirement of proving "objective falsity," and the panel had no authority to rewrite the statute to add such a requirement. The panel held that a doctor’s clinical opinion must be judged under the same standard as any other representation. The panel explained that a doctor, like anyone else, can express an opinion that he knows to be false, or that he makes in reckless disregard of its truth or falsity. Therefore, a false certification of medical necessity can give rise to FCA liability. The panel also held that a false certification of medical necessity can be material because medical necessity is a statutory prerequisite to Medicare reimbursement.

Anaheim Gardens, L.P. v. United States

Court: US Court of Appeals for the Federal Circuit

Docket: 19-1277

Opinion Date: March 25, 2020

Judge: Alan David Lourie

Areas of Law: Constitutional Law, Government Contracts, Real Estate & Property Law

The 1961 National Housing Act provided financial incentives to private developers to build low-income housing, including below-market mortgages insured by HUD. Participating developers had limited ability to increase rents while HUD insured the mortgage. The mortgage term was 40 years but developers could prepay their mortgages after 20 years and convert to market-rate housing. The 1988-1990 Preservation Statutes eliminated the prepayment option, 12 U.S.C. 4101. The 1996 Housing Opportunity Program Extension Act restored prepayment rights to developers still in the program. Four “first wave plaintiffs” (FWPs) owned their properties before the Preservation Statutes and sold after their enactment, consistent with the 1990 Low-Income Housing Preservation and Resident Homeownership Act (LIHPRHA) to organizations that preserved the rent restrictions. One FWP owned its property before the Preservation Statutes and remained in the program, obtaining HUD financial incentives in exchange for abiding by the restrictions for the property's "remaining useful life.” The final FWP (Casa) purchased its property in 1991 and sold pursuant to LIHPRHA. The FWPs alleged regulatory taking. The Claims Court applied the “Penn Central” three-factor test and rejected the claims on summary judgment. The Federal Circuit affirmed with respect to Casa, a sophisticated investor that voluntarily purchased its property with knowledge that it had no prepayment option and had no reasonable investment-backed expectation. The court otherwise vacated. The character of the governmental action and the investment-backed expectations weighed against summary judgment and the Claims Court did not consider certain genuine issues of fact regarding the calculations of economic impact.

Uber Technologies Pricing Cases

Court: California Courts of Appeal

Docket: A154694(First Appellate District)

Opinion Date: March 23, 2020

Judge: Kathleen M. Banke

Areas of Law: Antitrust & Trade Regulation, Consumer Law, Government Contracts, Transportation Law

Taxi companies and taxi medallion owners sued Uber, alleging violations of the Unfair Practices Act’s (UPA) prohibition against below-cost sales (Bus & Prof. Code, 17043) and of the Unfair Competition Law (section 17200). The UPA makes it unlawful “for any person engaged in business within this State to sell any article or product at less than the cost thereof to such vendor, or to give away any article or product, for the purpose of injuring competitors or destroying competition” but does not apply “[t]o any service, article or product for which rates are established under the jurisdiction of the [California] Public Utilities Commission [(CPUC)] . . . and sold or furnished by any public utility corporation.” Uber is a “public utility corporation” under section 17024 and is subject to CPUC’s jurisdiction. CPUC has conducted extensive regulatory proceedings in connection with Uber’s business but has not yet established the rates for any Uber service or product. The trial court ruled the exemption applies when the CPUC has jurisdiction to set rates, regardless of whether it has yet done so, and dismissed the case. The court of appeal affirmed, reaching “the same conclusion as to the applicability of section 17024(1) as have three California federal district courts, two within the last year, in cases alleging identical UPA claims against Uber.”

Mississippi True v. Dzielak et al.

Court: Supreme Court of Mississippi

Citation: 2018-CC-01522-SCT

Opinion Date: March 26, 2020

Judge: Ishee

Areas of Law: Government & Administrative Law, Government Contracts, Public Benefits

An unsuccessful bidder on managed-care contracts for MississippiCAN, the state’s managed-care program, argued that the Division of Medicaid and its executive director violated multiple statutes and regulations in procuring the contracts. Mississippi True appealed the decision of the chancery court affirming the Division of Medicaid’s award of the contracts to three other companies and the chancery court’s order denying its motion to sever and transfer its damages claims to circuit court. The Mississippi Supreme Court "thoroughly reviewed the voluminous record" and concluded that Mississippi True has failed to prove any basis for reversal. "The decision of the DOM was supported by substantial evidence, was not arbitrary or capricious, was not beyond the DOM’s power to make, and did not violate Mississippi True’s statutory or constitutional rights."