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

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

Hansen’s employer has an attendance policy, under which employees accumulate points for unexcused absences. When an employee incurs 10 points within a year, his employment is subject to termination. Leave under the Family and Medical Leave Act (FMLA), 29 U.S.C. 2601–2654 is not counted. As of May 2, 2011, Hansen had nine points. He was absent from work from May 3-6 and May 9. On May 3, he requested FMLA leave for depression. On May 11, he provided medical certification, documenting episodic flare-ups periodically preventing him from performing his job. Hansen’s absences earlier that month were approved as FMLA leave. Hansen requested FMLA leave for eight days in June and incurred no attendance points for these absences. Based on the doctor’s faxed response to an inquiry, three subsequent requests were denied. Hansen accumulated 13 points in one year and his employment was terminated because he “exceeded [his] frequency” under which he could “miss 4 times every 6 months.” Later, the doctor sent a letter, modifying his original certification. The letter did not mention the July absences. The company did not retract the termination. Hansen sued under the FMLA alleging interference and retaliation. The district court granted summary judgment in favor of the employer, holding that without expert testimony Hansen could not show that his serious health condition rendered him unable to work during the absences for which he was terminated. The Seventh Circuit reversed. The law does not require a plaintiff to present expert testimony as to his incapacity, and Hansen’s evidence has raised a genuine issue of material fact for trial. View "Hansen v. Fincantieri Marine Grp LLC" on Justia Law

To compensate teaching hospitals for the extra financial burden of providing training, the Medicare program provides additional reimbursement for expenses beyond the immediate costs of patient care, including for “indirect medical education” (IME) costs to account for the time medical interns and residents spend in ways that enhance their ability to provide patient care but that are not connected to the treatment of any particular patient, 42 U.S.C. 1395ww(d)(5)(B)(ii). The district court held that time spent by interns and residents in research activities wholly unrelated to the diagnosis or treatment of patients could be counted as part of this indirect-education time and that Rush University Medical Center, was entitled to Medicare reimbursements for these activities between the years 1983 and 2001. The Seventh Circuit reversed and remanded, noting that the Secretary of Health and Human Services has interpreted the Medicare Act consistently since 1983 to exclude pure research activities from compensable IME costs. Congress codified this exclusion for Fiscal Years 2001 onward in the Patient Protection and Affordable Care Act of 2010, but explicitly declined to lay down a rule for the years 1983 to 2001. The Secretary has now promulgated a regulation excluding pure research from the IME cost calculation for all years since 1983. View "Rush Univ. Med. Ctr v. Sebelius" on Justia Law

Yurt suffers from a psychotic disorder which causes him to experience auditory hallucinations and bouts of uncontrollable rage. He also has obsessive compulsive disorder, moderately severe chronic obstructive pulmonary disease (COPD), and chronic bifrontal tension headaches. He has worked as a cook and a janitor, last working in May 2010, when he suffered a mental break and was terminated for threatening a coworker with a knife. He applied for Disability Insurance Benefits from the Social Security Administration, but an ALJ denied his application. The Appeals Council declined review. The district court affirmed. The Seventh Circuit reversed and remanded, agreeing that the ALJ erred by failing to include many of his medical limitations in the hypothetical that she posed to the vocational expert. View "Yurt v. Colvin" on Justia Law

E.Y., a child, was diagnosed with diplegic cerebral palsy. His mother alleges that E.Y.’s illness resulted from medical malpractice by the federally-funded Friend Family Health Center, where she received her prenatal care, and the private University of Chicago Hospital, where she gave birth. Federal law makes a suit against the Center a suit against the United States under the Federal Tort Claims Act (FTCA) that had to be filed within the FTCA’s two-year statute of limitations, 28 U.S.C. 2401(b). The district court granted summary judgment for the government, finding that the suit was filed about two weeks too late. The mother argued that although she was aware she might have a claim against the University Hospital more than two years before filing this suit, she remained unaware that the Friend Center might be involved until she received a partial set of medical records on December 14, 2006, making her suit timely. The Seventh Circuit reversed. A reasonable trier of fact could find that Ms. Wallace the mother was unaware and had no reason to be aware of the Friend Center’s potential involvement in her son’s injuries until less than two years before she filed suit. View "E. Y., v. United States" on Justia Law

Townsend applied for social security disability benefits and supplemental security income in 2003, at age 44, claiming that she had become incapable of full‐time gainful employment in May 2002 when she had stopped working as a result of multiple physical and psychiatric ailments, including fibromyalgia. In 2012 an ALJ decided that she had become totally disabled in November 2008. By the time that decision was rendered she had died (of pulmonary diseases apparently unrelated to the ailments alleged to have made her totally disabled). Her father was substituted for her. The district court upheld the decision. The Seventh Circuit reversed and remanded, noting multiple errors in determining the onset of total disability. View "Williams v. Colvin" on Justia Law

Breedlove pleaded guilty to drug trafficking and firearms offenses. Before his sentencing hearing, Breedlove filed a “Notice of Ineffective Counsel,” complaining of a conspiracy between his counsel, co-defendants and the court. Breedlove was provided new counsel, who recommended that Breedlove be evaluated for competence. Dr. Szyhowski diagnosed Breedlove as having paranoid schizophrenia. Breedlove was committed to a federal medical facility in Butner, North Carolina. The Bureau of Prisons requested authorization to involuntarily administer antipsychotic medications. At a hearing, the government presented a psychologist and a psychiatrist who jointly authored the report that recommended involuntary medication. In the psychiatrist's opinion, Breedlove’s delusions would remain fixed and prevent him from consenting to medication. Both doctors testified that Breedlove would be closely monitored while at Butner, but acknowledged that when Breedlove was returned to Illinois, they did not know the extent to which he would be monitored. The defense did not call witnesses, but merely submitted testimony from another case that the 79% success-rate figure in the Butner study was too high. The district court granted the request to medicate and denied Breedlove’s motion for reevaluation. The Seventh Circuit affirmed. In Sell v. United States (2003) the Supreme Court determined that to allow involuntary medication, the government must prove by clear and convincing evidence that: important governmental interests are at stake; involuntary medication would significantly further those interests; no viable alternative exists; and administration of the drugs is in the patient’s best medical interest. The district court’s findings were adequate on each factor. View "United States v. Breedlove" on Justia Law

Gienapp worked at Harbor Crestnursing care facility. In January 2011 she told Chattic, its manager, that she needed leave to care for her daughter, who was being treated for thyroid cancer. Chattic granted leave under the Family and Medical Leave Act, 29 U.S.C. 2612(a)(1). While on leave, Gienapp submitted an FMLA form, leaving blank a question about the leave’s expected duration. Harbor Crest did not ask her to fill in the blank, nor did it pose written questions as the 12-week period progressed. A physician’s statement on the form said that the daughter’s recovery was uncertain, and that if she did recover she would require assistance at least through July 2011. Chattic inferred from this that Gienapp would not return by April 1, her leave’s outer limit, and hired a replacement. When Gienapp reported for work on March 29, Chattic told her that she no longer had a job. The district court entered summary judgment, ruling that Gienapp had forfeited her FMLA rights by not stating exactly how much leave she would take. The Seventh Circuit reversed. Gienapp could not give a firm date; Department of Labor regulations call her situation “unforeseeable” leave, governed by 29 C.F.R. 825.303, which does not require employees to tell employers how much leave they need. View "Gienapp v. Harbor Crest" on Justia Law

Bryn Mawr Chicago nursing home, a Medicaid provider, is subject to Illinois Department of Public Health (IDPH) inspections. In 2010, IDPH inspected the facility following allegations that a resident had been sexually assaulted. Bryn Mawr was eventually cited for three deficiencies, 42 C.F.R. 488.301, two based on sexual abuse and one based on failure to sufficiently monitor a resident. Bryn Mawr challenged the findings by Informal Dispute Resolution, which involved exchange of written information without a live hearing. IDPH simultaneously conducted internal review and found that the deficiencies based on allegations of sexual abuse were not sufficiently supported by credible evidence, but the third party upheld the deficiency findings. Ultimately IDPH maintained the deficiency findings. Meanwhile, Bryn Mawr also engaged in a parallel process to “correct” deficiencies. At the follow-up inspection, IDPH determined that the deficiencies had been corrected, so that remedies would not be imposed. IDPH passed the deficiency findings on to the Centers for Medicare and Medicaid Services, which published them on its website and factored them into its 5-Star Rating System. Bryn Mawr’s rating was supposed to fall from five to four stars because of the deficiencies, but CMS mistakenly reduced it to two stars. Regardless of a partial correction, Bryn Mawr was displeased that it had not had the opportunity to challenge the findings at a hearing and sued to compel a hearing. The district court granted summary judgment to defendants. The Seventh Circuit affirmed. View "Bryn Mawr Care, Inc. v. Sebelius" on Justia Law

In 2008, Shields, an Illinois prisoner was lifting weights and ruptured the pectoralis tendon in his left shoulder. Although he received some medical attention, he did not receive the prompt surgery needed for effective treatment. Due to oversights and delays by those responsible for his medical care, too much time passed for surgery to do any good. He has serious and permanent impairment that could have been avoided. After his release from prison, Shields filed suit under 42 U.S.C. 1983, alleging that several defendants were deliberately indifferent to his serious medical needs and violated his rights under the Eighth Amendment to the Constitution. The district court granted summary judgment in favor of the defendants. The Seventh Circuit affirmed, reasoning that Shields was the victim not of any one person’s deliberate indifference, but of a system of medical care that diffused responsibility for his care to the point that no single individual was responsible for seeing that he timely received the care he needed. As a result, no one person can be held liable for any constitutional violation. Shields’ efforts to rely on state medical malpractice law against certain private defendants also failed. View "Shields v. IL Dep't of Corrs." on Justia Law