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

States may provide certain home-based services through Medicaid's Home and Community Based Waiver program, 42 U.S.C. 1396n(c). Illinois operates a waiver under which it contracts with non-profit organizations (ISCs) to provide case management services for adults with developmental disabilities receiving home- and community-based services as part of Medicaid. Illinois awarded 17 ISC contracts through a non-competitive, annual renewal process. The plaintiffs had received contracts for at least 25 years. In 2018, the state announced a new competitive bidding process to begin on July 1, 2019. The plaintiffs submitted bids but learned in January that their contracts would not be renewed. They sued under 42 U.S.C. 1983, alleging violations of Medicaid’s free-choice-of-provider provision, 42 U.S.C. 1396a(a)(23). On June 5, 2019, with new contracts to go into effect in less than 30 days, they sought a preliminary injunction. The district court denied their motion on June 25, reasoning that ISCs were not “qualified providers” under the statute. The plaintiffs appealed that same day. Four days later, they sought emergency injunctive relief pending appeal, which the Seventh Circuit denied. Months later, at oral argument, plaintiffs’ counsel acknowledged that vacating the new contracts would be too disruptive. The Seventh Circuit dismissed the appeal. With the plaintiffs no longer challenging the denial of their preliminary injunction, it is unnecessary to address the meaning of “qualified providers” or determine what kinds of services the plaintiffs provide. The passage of time has rendered the issue moot. View "Western Illinois Service Coordination v. Illinois Department of Human Services" on Justia Law

Stewart sustained serious injuries upon crashing his car while driving under the influence. Although Stewart does not remember his time at the hospital he signed a form consenting to treatment. An emergency room doctor treated Stewart and in doing so ordered a blood draw, which confirmed that he had been drinking. The police requested and received the blood test results from the hospital’s medical staff. Stewart later sued both officers under 42 U.S.C. 1983 for violating the Fourth Amendment by obtaining his test results without a warrant and the hospital’s medical staff for violating the Health Insurance Portability and Accountability Act by disclosing the results. The Seventh Circuit affirmed summary judgment for the defendants. Indiana law requires medical staff who test a person’s blood “for diagnostic purposes” to “disclose the results of the test to a law enforcement officer who requests the … results as a part of a criminal investigation” regardless of whether the person has “consented to or otherwise authorized their release.” HIPAA does not confer individual enforcement rights—express or implied. The police officers did not violate clearly established statutory or constitutional rights of which a reasonable person would have known. View "Stewart v. Parkview Hospital" on Justia Law

Reed alleged that she suffered discrimination on the basis of her disabilities while she was a patient at Columbia in March 2012. She contends that the hospital failed to accommodate her disabilities by deliberately withholding from her a device she used to speak and discriminated against her by putting her in a “seclusion” room to punish her, in violation of the Americans with Disabilities Act (ADA), 42 U.S.C. 12181, the Rehabilitation Act, 29 U.S.C. 794, and the Wisconsin Mental Health Act. The district court granted the hospital summary judgment, holding that the hospital did not need to comply with Title III of the ADA because it fell within the Act’s exemption for entities controlled by religious organizations and that the hospital’s alleged mistreatment of Reed was not premised solely on Reed’s disability. The Seventh Circuit reversed. The hospital raised its religious exemption affirmative defense to the ADA claims for the first time after discovery, in its motion for summary judgment; it was an abuse of discretion to excuse the hospital’s failure to raise this affirmative defense earlier. Reed’s Rehabilitation Act claims depend on disputed facts. View "Reed v. Columbia St. Mary's Hospital" on Justia Law

Neighbors is a skilled nursing facility participating in Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS) determined that Neighbors inadequately addressed sexual interactions between three cognitively impaired residents and that Neighbors’ failure to act put the residents in “immediate jeopardy,” and issued Neighbors a citation and an $83,800 penalty under 42 U.S.C. 1395i‐3(h)(2)(B)(ii)(I). An ALJ and the Department of Health and Human Services Departmental Appeals Board upheld the decision. The Seventh Circuit affirmed, concluding that substantial evidence supports the Agency’s determinations and rejecting claims that the sexual interactions were consensual. The court noted findings that staff, aware of the sexual interactions, did not talk to the residents about their feelings about these “relationships”; did not document the residents’ capacity for consent (or lack thereof) or communicate with residents’ physicians for medical assessment of how their cognitive deficits impacted that capacity; did not discuss the developments with the residents’ responsible parties; and did not record any monitoring of the behaviors or make any care plans to account for them. Neighbors’ non‐intervention policy prevented any real inquiry into consent, except in the extreme situation where a resident was yelling or physically acting out. View "Neighbors Rehabilitation Center, LLC v. United States Department of Health and Human Services" on Justia Law

Mimms, an Indiana-licensed physician, prescribes controlled substances to patients. Several times, CVS Pharmacy employees informed Mimms’s patients that they would not fill their prescriptions. Mimms sued, alleging defamation. CVS argued that Mimms had no evidence that the speakers knew their statements were false. The court granted summary judgment as to five statements and denied judgment for four statements, reasoning there was a material question of fact regarding whether the speakers knew that their statements were false, given evidence that CVS’s corporate office had investigated Mimms and had not stopped stores from filling his prescriptions. The court rejected CVS’s argument that knowledge held by the corporate office could not be imputed to the speakers. The statements were: “CVS doesn’t fill Dr. Mimms’[s] prescriptions or prescriptions for any other pill mills.” “Mimms went to jail.” “Mimms has been … or will be arrested.” “Mimms is under DEA investigation. A jury found CVS liable for defamation per se and awarded Mimms $1,025,000. The Seventh Circuit reversed. Mimms proffered no evidence that the first three statements were made with actual malice. CVS is entitled to a new trial on the fourth statement; the court should have allowed CVS to present evidence that Mimms was the subject of a DEA investigation and regarding Mimms’s reputation. In a defamation per se case, damage to reputation is presumed but evidence regarding the extent of the harm to his professional reputation was critical for minimizing damages. View "Mimms v. CVS Pharmacy, Inc." on Justia Law

Stephens was born in 1957 and has a ninth-grade education. He worked as a taxi dispatcher and a security guard in the 15 years preceding his alleged disability. Stephens contends that he is disabled by diabetes, kidney disease, knee and back pain, heart disease, high blood pressure, asthma, arthritis, and obesity. He was denied Supplemental Security Income (SSI) benefits. On remand, a different ALJ determined that Stephens’ impairments, although severe, were not disabling and that he could perform relevant past work. The district court and Seventh Circuit upheld the denial, rejecting arguments that the ALJ erred by improperly evaluating Stephens’s obesity (no longer a stand-alone disability) when determining the aggregate impact of his impairments; that the ALJ’s finding that the record lacked medical opinion evidence as to Stephens’ hypersomnolence or excessive sleepiness; and that the ALJ failed to incorporate all of his impairments and consider their combined impact to evaluate his residual functional capacity. View "Stephens v. Berryhill" on Justia Law

For several weeks, Redman posed as a psychiatrist at a Chicago medical clinic using the name and license number of Dr. Garcia. He “treated” patients for mental illnesses, and “prescribed” controlled substances. Redman actually did not attend school past the tenth grade. Before commencing employment, Redman provided falsified documentation: an employment application, payroll application, I‐9 Employment Eligibility Verification form, W‐9 form, photograph of an Indiana driver’s license with Redman’s picture, photocopy of an Illinois medical license, photocopy of a medical school diploma, a residency certificate for training in psychiatry, and a photocopy of a social security card. He used online counterfeiting services; he submitted an online Drug Enforcement Administration application and obtained malpractice insurance using false information. He was discovered when the real Dr. Garcia learned that someone had used his medical license number to obtain a DEA registration. A jury found Redman guilty of wire fraud, aggravated identity theft, furnishing false and fraudulent material information in documents required under the federal drug laws, and distributing controlled substances. The Seventh Circuit affirmed his 157-month sentence, upholding the application of two-level enhancements for use of sophisticated means and for conduct that involved a conscious or reckless disregard of a risk of death or serious bodily injury. View "United States v. Redman" on Justia Law

Armenta worked at Passages as a certified nursing assistant and later as a regional director of certified nursing assistants. Passages billed its services to Medicare. Medicare paid $180 per patient per day for routine services but up to $700 for general inpatient services (GIP). Passages began paying directors based on the number of patients on GIP. The number of patients on GIP significantly increased because directors instructed nurses and nursing assistants to place patients who did not need that level of care on GIP. Passages received an audit request from a Medicare contractor. In response, Armenta and other Passages employees entered false information consistent with GIP care and billing into patient files, then submitted the altered files. Passages employees, including Armenta, were trained on the requirements for placing a patient on GIP. Armenta told the nurses to disregard the training. Armenta and others were charged with health care fraud. Only Armenta proceeded to trial. With a two-level enhancement for obstruction of justice based on lying on the stand and altering records, her Guidelines imprisonment range was 63-78 months.The Seventh Circuit affirmed her conviction and sentence of 20 months’ imprisonment plus $1.67 million in restitution. Although no government witness identified Armenta in court, the defense did not argue that the Armenta in the courtroom was not the same Armenta involved in the fraud. View "United States v. Armenta" on Justia Law

After complaints about his professionalism, Indiana University Hospital required Dr. Hamdan, a U.S. citizen of Palestinian descent, to participate in a peer-review process, which resulted in disciplinary letters. Hamdan successfully appealed. The hospital ultimately voided the letters. Nonetheless, Hamdan resigned and relinquished his hospital privileges. Hamdan sued the hospital for discriminating against him based on race. Hamdan was not a hospital employee and could not sue under Title VII, so he sued under 42 U.S.C. 1981, part of the Civil Rights Act of 1866, intended to protect the ability of newly-freed slaves to enter and enforce contracts. Hamdan alleged discrimination in his contractual relationship with the hospital. The Seventh Circuit affirmed a verdict for the hospital, rejecting an argument that the district court erred in allowing the hospital to ask Hamdan impeachment questions relating to his prior work at other hospitals. The court noted Hamdan’s testimony that his reputation was “untarnished” before he received the disciplinary letters. The Seventh Circuit also rejected an argument that the court erred in permitting the hospital to try to impeach him with questions about matters that were confidential under the peer-review statutes of Indiana, Louisiana, and Michigan. Even if the state laws applied, the judge did not abuse his discretion in allowing impeachment questions about incident reports. View "Hamdan v. Indiana University Health North Hospital, Inc." on Justia Law

After complaints about his professionalism, Indiana University Hospital required Dr. Hamdan, a U.S. citizen of Palestinian descent, to participate in a peer-review process, which resulted in disciplinary letters. Hamdan successfully appealed. The hospital ultimately voided the letters. Nonetheless, Hamdan resigned and relinquished his hospital privileges. Hamdan sued the hospital for discriminating against him based on race. Hamdan was not a hospital employee and could not sue under Title VII, so he sued under 42 U.S.C. 1981, part of the Civil Rights Act of 1866, intended to protect the ability of newly-freed slaves to enter and enforce contracts. Hamdan alleged discrimination in his contractual relationship with the hospital. The Seventh Circuit affirmed a verdict for the hospital, rejecting an argument that the district court erred in allowing the hospital to ask Hamdan impeachment questions relating to his prior work at other hospitals. The court noted Hamdan’s testimony that his reputation was “untarnished” before he received the disciplinary letters. The Seventh Circuit also rejected an argument that the court erred in permitting the hospital to try to impeach him with questions about matters that were confidential under the peer-review statutes of Indiana, Louisiana, and Michigan. Even if the state laws applied, the judge did not abuse his discretion in allowing impeachment questions about incident reports. View "Hamdan v. Indiana University Health North Hospital, Inc." on Justia Law