Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Defendant-appellant Dr. Kamal Patel was a physician who commonly prescribed home health care services for his patients. Federal investigators learned that defendant had been receiving undisclosed payments from Grand Home Health Care. Patel was charged with six counts of violating (and one count of conspiring to violate) the Anti-Kickback Statute. During his bench trial, at the close of the government’s evidence, defendant moved to acquit, arguing that he had not “referred” any patients to Grand because there was no evidence that he steered or directed his patients to Grand; rather, the patients independently chose Grand as their provider after defendant prescribed home health care. The district court rejected that argument, holding that, even if a patient had initially chosen Grand, defendant “referred” the patient to Grand when he certified or recertified that the patient needed care, that the care would be provided by Grand, and that Grand could be reimbursed by Medicare for services provided. On appeal, defendant argued that the district court erred by holding that the certification and recertification, via a standardized Medicare form (Form 485), of patients for treatment constituted a “referral” under the Anti-Kickback Statute. He also argued that even if those certifications were referrals, there was insufficient evidence to conclude that Patel was paid “in return for” certifications, as required by the statute. Finding no reversible error, the Seventh Circuit affirmed the district court's judgment. View "United States v. Patel" on Justia Law

The Association of Administrative Law Judges, a union, represents the Social Security Administration’s administrative law judges in collective bargaining pursuant to the Federal Labor-Management Relations Act, 5 U.S.C. 7101. The Association and ALJs employed by the SSA sued, claiming that, by setting a goal that its ALJs decide 500-700 social security disability cases a year, the Administration has interfered with their decisional independence, in violation of the Administrative Procedure Act, 5 U.S.C. 554(d)(2), 3105. The district court dismissed the complaint for want of subject-matter jurisdiction, holding that the Civil Service Reform Act of 1978 precluded resort to the APA by creating remedies for “prohibited personnel practices” taken against federal employees, including “significant change in duties, responsibilities, or working conditions,” 5 U.S.C. 2302(a)(1), (2)(A)(xii), (b). The Seventh Circuit affirmed, holding that the remedy under the Administrative Procedure Act for interference with decisional independence does not extend to the incidental consequences of a bona fide production quota. View "Ass'n of Admin. Law Judges v. Colvin" on Justia Law

Sierra Club challenged the Environmental Protection Agency’s decisions to redesignate three geographic areas—Milwaukee-Racine, Greater Chicago, and the Illinois portion of the St. Louis area—as having attained the 1997 National Ambient Air Quality Standards for ozone under the Clean Air Act, 42 U.S.C. 7401. The CAA mandates that before redesignating an area, EPA must confirm not just that ozone in an area dropped below a certain level, but also that the improvement in air quality resulted from “permanent and enforceable reductions in emissions.” EPA interprets that edict to require a finding that the requisite ozone drops are “reasonably attributable” to permanent and enforceable reductions. Sierra Club argued that the Agency acted arbitrarily and capriciously in making this causation finding in each of the redesignations. The Seventh Circuit denied a petition for review. EPA demonstrated that it “examined the relevant data and articulated a satisfactory explanation for its action including a rational connection between the facts found and the choice made, that the Agency’s decision was based on a consideration of the relevant factors, and that the Agency has made no clear error of judgment.” View "Sierra Club v. United States Envtl. Prot. Agency" on Justia Law

Whitaker, formerly employed by Milwaukee County, alleged that she was discriminated against in violation of the Americans with Disabilities Act, 42 U.S.C. 12101 when the county failed to accommodate her disability by refusing to extend her period of medical leave, refusing to transfer her to another position, and then terminating her for reasons related to her disability. The district court granted the County summary judgment. The Seventh Circuit affirmed, upholding the district court’s conclusion that the complaint impermissibly went beyond the scope of the EEOC charge and that the County was not her “employer” under the statute. Although Milwaukee County was Whitaker’s official employer and was responsible for her compensation, it had no involvement in the principal decisions that she claims violated the statute and no authority to override those decisions, made by the State Department of Health Services. With respect to whether the County is liable for any of its own actions,. Whitaker’s allegations on these matters were outside the scope of her EEOC charge, and, therefore, not subject to judicial consideration. View "Whitaker v. Milwaukee Cnty." on Justia Law

Applying for federal grants between 2005 and 2008, Chicago represented that it had formulated an Equal Employment Opportunity Plan in accordance with 28 C.F.R. 42.301. This certification is required by regulations implementing the Omnibus Crime Control and Safe Streets Act, under which the grants were made. Hill claimed, in a qui tam action under the False Claims Act, 31 U.S.C. 3729–33, that the first certification was false because, although the city had a written plan, and implemented an equal opportunity and affirmative action program, the program differs from the plan. Hill did not contend that the city’s program falls short of federal requirements only that the program does not follow the written plan. The district court granted summary judgment to the city. The Seventh Circuit affirmed. Any written plan sensibly can be understood to allow adaptations. No federal agency has parted with money under false pretenses and the record does not establish that the people in the Police Department and other bureaus who wrote grant applications and attached the city’s plan knew that the Department of Human Resources was implementing a program different from the plan, and without knowledge of falsity there cannot be a knowingly false claim. View "Hill v. City of Chicago" on Justia Law

Kolbusz owns and operates the Illinois Center for Dermatology and Skin Cancer and was a participating Medicare provider from 1993 until December 2012, receiving payment directly from Medicare. In October 2012 he was indicted for Medicare fraud. As a consequence, the Department of Health and Human Services imposed fraud prevention procedures on the practice, including payment suspension, resulting in his ultimate withdrawal from the Medicare program. In 2013, Kolbusz filed suit against the Secretary of Health and Human Services and her contractors, asserting jurisdiction under 28 U.S.C. 1331 (federal question); the Medicare Act, 42 U.S.C. 1395; and 28 U.S.C. 1361 (mandamus) to compel review of reimbursement claims he had submitted. The district court dismissed for failure to exhaust administrative remedies. The Seventh Circuit affirmed. Kolbusz’s failure to exhaust Medicare’s administrative appeals process precludes subject-matter jurisdiction of his mandamus action.View "Ctr for Dermatology & Skin Cancer, Ltd. v. Burwell" on Justia Law

Khan is a Mohajir: his parents were immigrants into Pakistan when it was partitioned from the British Indian Empire in 1947. Some Mohajirs formed a political party—the Mohajir Qaumi Movement—in response to perceived repression by nonimmigrant locals. Khan joined in 1992 when he was 14 or 15 years old. He distributed flyers, attended meetings, and recruited people to the cause. The group became increasingly violent, however, and many Mohajirs, including Khan, left to join a new, supposedly more peaceful group, MQM-Haqiqi. But this party too resorted to violence, so Khan eventually left. Khan became a target and was repeatedly attacked, kidnapped, and tortured by members of the first party. He fled to the U.S. on a visitor visa, and when it expired, sought asylum and other forms of relief from removal. While his case was pending, he married a U.S. citizen, making him eligible for permanent residency through his marriage. An immigration judge accepted the government’s position, rejecting Khan under the “terrorism bar,” 8 U.S.C. 1182(a)(3)(B)(i)(I); the BIA affirmed. The Seventh Circuit denied review, declining to interpret the “knowledge exception” to the terrorism bar because Khan did not raise it before the BIA.View "Khan v. Holder" on Justia Law

Scrogham, then age 53, applied for disability benefits under the Social Security Act, submitting medical conditions including degenerative discs, spinal stenosis, sleep apnea, hypertension, arthritis, atrial fibrillation and restless leg syndrome. An ALJ denied the application and the Appeals Council denied his request for review. The district court affirmed, holding that the ALJ did not err in giving less weight to the opinion of a treating physician than to the opinions of nontreating physicians, that the ALJ permissibly found Scrogham not to be credible and that the ALJ’s decision otherwise was supported by substantial evidence. The Seventh Circuit reversed and remanded. The ALJ impermissibly ignored a line of evidence demonstrating the progressive nature of Scrogham’s degenerative disc disease and arthritis and inappropriately undervalued the opinions of Scrogham’s treating physicians, whose longitudinal view of Scrogham’s ailments should have factored prominently into the ALJ’s assessment of his disability status. Even considering only “the snapshots of evidence that the ALJ considered,” that limited evidence does not build the required logical bridge to her conclusions. The ALJ apparently misunderstood or at least considered only partially some of the evidence about Scrogham’s daily activities, rehabilitation efforts and physicians’ evaluations.View "Scrogham v. Colvin" on Justia Law

Two nurses, formerly employed by Momence, alleged that, during their employment at Momence, they uncovered evidence that Momence knowingly submitted "thousands of false claims to the Medicare and Medicaid programs” in violation of the False Claims Act (FCA) and Illinois Whistleblower Reward and Protection Act. They filed a qui tam action on behalf of the government and alleged that Momence retaliated against them for reporting its fraud. A jury awarded the government more than $3 million in compensatory damages and imposed about $19 million in fines for the qui tam claims. Pursuant to the FCA, the compensatory damages were trebled to more than $9 million. The district court set aside the fines as violating the Excessive Fines Clause of the Eighth Amendment. The jury also awarded the nurses $150,000 and $262,320, respectively, on their retaliation claims. The Seventh Circuit vacated. Both claims failed as a matter of law. Rejecting claims of “worthless services” and false certification, the court stated that, at best, a reasonable jury might be able to say that some of Momence’s claims were false, but that is not enough to satisfy the burden of proof. The employment of one nurse was not terminated, the other’s employment was terminated for an unrelated matter.View "Absher v. Momence Meadows Nursing Ctr., Inc." on Justia Law

An MRI had revealed plaintiff’s herniated disc in 1998. The medical record is blank from then until 2007, when she complained to an emergency room physician that she had been suffering from lower-back pain. She mentioned the herniated disc, and was prescribed Vicodin. Almost a year later she was examined by an anesthesiologist who specializes in pain management, who prescribed Lyrica. The plaintiff subsequently sought disability benefits and testified that her pain, combined with the drowsiness induced by the pain medication, limited her daily activities to eating, caring for her dogs, taking naps, and watching television. The anesthesiologist opined that the plaintiff was “unable to work” because of “lumbar disc protrusion.” Another anesthesiologist reviewed her records, and concluded that she was able to work full time despite the diagnoses of lumber disk herniation, lumbar radiculopathy, and myofascial pain, and a Social Security field officer’s observation that “she had a hard time sitting in the chair during the interview.” He did not identify evidence supporting his conclusion. The district court affirmed the agency’s denial of benefits. The Seventh Circuit remanded, stating that the plaintiff deserves a more careful evaluation than she has received to date. The ALJ’s critical error was failure to obtain a medical report on the results of a 2010 MRI.View "Goins v. Colvin" on Justia Law