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

ITT is a for-profit institution with more than 140 locations and offers post-secondary education. Leveski, who worked at the ITT campus, alleged, under the qui tam provisions of the False Claims Act, 31 U.S.C. 3730(b) that ITT knowingly submitted false claims to the Department of Education to receive funds from federal student financial assistance programs under the Higher Education Act, 20 U.S.C. 1001. The district court dismissed for lack of jurisdiction, finding that the allegations had already been publicly disclosed and that Leveski was not the original source of the allegations. The court granted sanctions of $394,998.33 against Leveski's lawyers. The Seventh Circuit reversed, finding the allegations that ITT paid illegal incentive compensation throughout Leveski’s employment as a recruiter and financial aid assistant, sufficiently distinct from prior public disclosures to give the court jurisdiction. The court noted the lack of temporal overlap with allegations by other ITT employees and Leveski’s more detailed allegations. View "Timothy J. Matusheski v. ITT Educational Services, Inc" on Justia Law

The Black Lung Benefits Act, 30 U.S.C. 901, originally included a “15-year presumption” that total pulmonary or respiratory impairment of a coal worker with 15 years of experience in the mines was due to pneumoconiosis (black lung). Congress removed this presumption in 1981, but in 2010 revived the presumption for claims filed after January 1, 2005, still pending on or after March 23, 2010. Bailey, employed by Consolidation Coal for 26 years, also smoked cigarettes for many years. He was diagnosed with chronic obstructive pulmonary disease and sought benefits. Three claims were considered during the interval when the 15-year presumption was withdrawn. Two were denied, and he withdrew a third. For his current claim, filed in 2007, three doctors agreed that Bailey is totally disabled by COPD. Because of the rejected claims, Bailey was required to show a change in condition. An ALJ, using the 15-year presumption, held that Bailey can now establish pneumoconiosis caused in part by coal dust exposure, two elements deficient in earlier claims, and awarded benefits. The Benefits Review Board affirmed. The Seventh Circuit affirmed. The ALJ correctly applied the 15-year presumption, addressed evidence relating to Bailey’s health and smoking history, and delivered a rational decision, supported by substantial evidence. View "Consolidation Coal Co. v. Dir., Office of Workers Comp. Programs" on Justia Law

Natale,a vascular surgeon, was compensated by Medicare for repairing a patient’s aortic aneurysm. Another doctor reviewed the post-surgical CT scan, which did not match the procedure Natale described in his operative reports. After an investigation, Natale was indicted for health care fraud related to his Medicare billing, mail fraud, and false statements related to health care. A jury acquitted Natale on the fraud counts but convicted him of making false statements, 18 U.S.C. 1035. The trial court used jury instructions that seemingly permitted conviction for false statements completely unrelated to Medicare reimbursement. The Seventh Circuit affirmed, finding the error harmless, but clarified that under the statute, even conviction for false statements made in connection with items or services still must relate to a “matter involving a health care benefit program.” View "United States v. Natale" on Justia Law

In 2008, Pepper, then 54 years old, applied for Supplemental Security Disability Insurance Benefits, alleging that she became unable to work in November 1998 as a result of numerous physical and mental impairments. The alleged onset date was later amended to October 2002, when Pepper last worked. Extensive medical records show that Pepper sought treatment for numerous health concerns over the years. At various times, Pepper has been assessed as having ongoing neck pain and limited range of motion in her neck, degenerative disc disease in her spine, left knee problems, migraine headaches, problems with her vision, diabetes, asthma, mitral valve prolapse, sciatica, dyslipidemia, hyperglycemia, hypertension, allergic rhinitis, obesity, plantar fasciitis in her left heel, caregiver stress, and depression. An ALJ denied the claim and the district court affirmed. The Seventh Circuit affirmed, rejecting arguments that the ALJ erred when addressing Pepper’s residual function capacity and that the ALJ’s credibility determination was inadequately supported and patently wrong. Substantial evidence supported denial of benefits. View "Pepper v. Astrue" on Justia Law

Roddy, born in 1964, suffers from several serious medical problems, including severe lower back pain attributable to degenerative disc disease. When her pain became unbearable, she stopped working and applied for disability insurance benefits. She was unsuccessful before the Social Security Administration. An administrative law judge found that there were jobs in the national economy within her capabilities, although she no longer could perform her old job as a shift manager at a Taco Bell restaurant. The district court affirmed. The Seventh Circuit vacated and remanded. The ALJ improperly discounted the opinion of a physician and improperly considered Roddy’s testimony about her ability to do housework. View "Roddy v. Astrue" on Justia Law

The 57-year-old woman, diagnosed with frozen shoulder and later with chronic obstructive pulmonary disease, stopped medical treatment in 2003, having no health insurance and income of $4500 to $9000 a year as a clerical worker. Her last significant employment, as a hotel night-clerk, ended in 2007. She got another clerical job, but was immediately fired because unable to lift a box of paper. She sought social security disability benefits and resumed treatment. She had regained the full range of motion, but muscles in her arms and shoulders were weak and she had chronic obstructive pulmonary disease, causing bronchitis, respiratory infections, and shortness of breath. The ALJ decided that she was capable of performing as hotel clerk and was not disabled; he disregarded findings by a doctor whom he had appointed and with whom the applicant had no prior relationship. He noted the “lack of aggressive treatment” and that she smoked, overlooking that she stopped smoking 30 years earlier. The ALJ focused on her ability to do laundry, take public transportation, and grocery shop. The Appeals Council declined review. The Seventh Circuit remanded, stating that: “Really the Social Security Administration and the Justice Department should have been able to do better.” View "Hughes v. Astrue" on Justia Law

In 2004, Illinois enacted Hospital Provider Funding Legislation imposing a tax on hospital providers, except for certain categories of exempt hospitals, for fiscal years 2004 and 2005, 305 ILCS 5/5A-2(a). The Centers for Medicare and Medicaid Services disallowed the reimbursement of Medicare expenses (42 U.S.C. 1395f(b)(1)) to a group of Illinois hospitals, finding that the amount of a tax assessment paid by the hospitals was a reasonable cost, but was subject to offset by any payments those hospitals received from an Illinois State fund. The district court and Seventh Circuit affirmed, finding that the decision was not inconsistent with established policy. The court rejected an argument that the hospitals incurred the full cost of the tax, as they were billed by and wrote checks to the state, reasoning that the argument ignored the real net impact of the tax and of Access Payments by the state.View "Abraham Lincoln Mem'l Hosp. v. Sebelius" on Justia Law

In his 40s, Kastner had worked as a truck driver and as a delivery manager. Having suffered injuries following a fall and subsequent heavy lifting at work, he suffered from a degenerative disc disorder and pain in various parts of his body, and sought disability insurance benefits under 42 U.S.C. 423(d). An administrative law judge determined that, though Kastner’s impairments are severe, they do not meet listed requirements for a presumptively disabling condition and that Kastner has residual capability to perform certain jobs in the economy. The Appeals Council denied review and the district court affirmed. The Seventh Circuit reversed and remanded, holding that the ALJ did not adequately explain why Kastner had not met the requirements for a presumptive disability. View "Kastner v. Astrue" on Justia Law

Bontrager filed a putative class action complaint challenging Indiana’s $1,000 annual limit for dental services covered by Medicaid, 42 U.S.C. 1396. The district court granted a preliminary injunction, holding that Indiana is required to cover all medically necessary dental services, irrespective of the monetary cap. The Seventh Circuit affirmed. Bontrager has an enforceable federal right capable of redress through Section 1983. The monetary cap, which excludes medically necessary treatment, is not a utilization control procedure, but allows a state to shirk its primary obligation to cover medically necessary treatments. The court acknowledged that Bontrager’s victory may be short-lived if the state decides to end coverage for all dental services. View "Bontrager v. IN Family & Soc. Servs." on Justia Law

Filus, a 50-year-old former truck driver, has twice applied for disability benefits under the Social Security Act, claiming that back problems have left him incapable of gainful employment. An administrative law judge concluded that Filus could perform some light work and denied his most recent application. The Seventh Circuit affirmed, holding that substantial evidence supports the denial. The ALJ adequately considered Filus’s testimony about the limiting effects of his pain along with his testimony that he regularly completed his daily household activities without any pain medication, not even over-the-counter products.View "Filus v. Astrue" on Justia Law