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

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

Claiming anxiety, depression, suicidal tendencies, insomnia, vertigo, migraine headaches, fibromyalgia, carpal tunnel syndrome, and plantar fasciitis, Farrell, then 33 year old, applied for disability insurance benefits. Her initial application was denied, but the Social Security Administration Appeals Council remanded. The Administrative Law Judge again ruled against her, in part because of her failure to establish definitively that she suffered from fibromyalgia. The Appeals Council summarily affirmed this decision, despite new evidence before it that confirmed the fibromyalgia. The district court affirmed. The Seventh Circuit reversed. The Social Security Administration’s regulations require the Appeals Council to consider “new and material evidence.” The ALJ did not adequately deal with competing expert opinions. View "Farrell v. Astrue" on Justia Law

Shideler suffers osteogenesis imperfecta, “brittle bone disease.” In 2006, at age 48, he applied for Social Security Disability Insurance benefits, 42 U.S.C. 423(d), alleging an onset date of 1995. His date last insured was 2000. The ALJ found that despite Shideler’s limitations, there were a sufficient number of jobs in the regional economy available to a person with his restrictions, and denied his application. The Appeals Council denied review. The district court and Seventh Circuit affirmed. The record supported the vocational expert’s testimony concerning available jobs as a clerk, assuming certain restrictions: never climb ladders, ropes, or scaffolds and only occasionally climb ramps or stairs; never crouch, kneel or crawl; never perform overhead reaching; avoid exposure to extreme heat and cold; and perform work that includes occasional, but not frequent, use of fingers. Despite his testimony that he had broken at least 55 bones over the course of his life, the record showed that Shideler had only four surgeries and made a full recovery. The record contained no evidence that Shideler visited any doctors between May 2000 and December 2006. View "Shideler v. Astrue" on Justia Law

Plaintiff and his mother lived in public housing. His mother was arrested and charged with possession of cocaine and resisting law enforcement officers; she later pleaded guilty. Less than one month later she received notice that her arrest violated her lease agreement, that she had 30 days to vacate, and that she could contest termination of her lease during the eviction procedure. The Housing Authority subsequently filed an eviction action in Indiana state court. Before that hearing, plaintiff sought a preliminary injunction. The district judge conducted a telephonic hearing and denied the motion, based mainly on the Anti-Injunction Act, 28 U.S.C. 2283, and in consideration of "the principles of equity, comity, and federalism that restrain a federal court, while recognizing the respect due the courts of a sovereign state." The state court ruled in favor of the Housing Authority, issuing an order for immediate possession of the property and eviction. The Seventh Circuit dismissed, as moot, an appeal from the denial of an injunction.

Medicare pays teaching hospitals for work by residents when a teaching physician supervises. During the 1990s, HHS concluded that many hospitals were billing for unsupervised services and began to audit invoices. There was also a GAO report and private litigation: qui tam suits under the False Claims Act, allowing relators to collect a bounty. Under 31 U.S.C. 3730(e)(4)(A), suits cannot be based upon public disclosure of allegations or transactions in public agencies’ official reports unless the relator is an original source of information. A prior case concluded that the 1998 GAO report and similar public documents disclosed that billing for unsupervised work was common practice. The district court dismissed a suit filed against a teaching hospital in 2004, claiming to describe conduct, such as inadequate supervision, not previously disclosed. The Seventh Circuit vacated. No one who read the GAO report, or followed the progress of the audits, would suspect that Rush University was misrepresenting "immediate availability" of teaching physicians during concurrently scheduled procedures. The complaint alleged a kind of deceit that the GAO report does not attribute to any teaching hospital.

Petitioner, then 45 years old and having previously worked in a factory and as a health aid, applied for disability benefits in 2004, claiming an onset date in 2004. Her conditions include peripheral vascular disease, chronic obstructive pulmonary disease, osteoarthritis, obesity, vascular dementia, depression, panic disorder, and anxiety. The Social Security Appeals Council denied review of the ALJ's adverse decision. The Seventh Circuit reversed and remanded. The ALJ failed to adequately consider petitioner's mental impairments, her obesity, and several of her physical problems.