Justia U.S. 6th Circuit Court of Appeals Opinion Summaries

Cadillac Place (former General Motors Building), a Detroit office complex, is home to state offices, a court of appeals, a restaurant, a gift store, and even a barber shop. It is owned by Michigan Strategic Fund, a public entity, and leased by the state. Babcock, an attorney, s disabled due to Friedreich’s Ataxia, a degenerative neuromuscular disorder that impairs her ability to walk. She worked in Cadillac Place. Babcock alleged that its design features denied her equal access to her place of employment in violation of the Americans with Disabilities Act , 42 U.S.C. 12132, and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794(a). The Sixth Circuit affirmed dismissal. Babcock did not identify a service, program, or activity of a public entity from which she was excluded or denied a benefit. The court noted the dispositive distinction between access to a facility and access to programs or activities. Babcock only identified facilities-related issues. View "Babcock v. State of Mich." on Justia Law

Miller is a single father who, before his alleged disability, held positions as a security guard, machine operator, material handler, and night-club bouncer. In 2006, Miller visited a hospital emergency department with an injured knee. He did not return to work but applied for disability insurance benefits, and supplemental security income. On remand from the Appeals Council, an ALJ determined that Miller was not disabled within the meaning of the Social Security Act and did not qualify for benefits. The Appeals Council declined another review. The district court granted summary judgment, affirming the denial of benefits. Miller’s timely appeal followed. The Sixth Circuit vacated, finding the decision not supported by substantial evidence. A determination concerning Miller’s residual functional capacity (particularly his ability to stand) did not comport with the ALJ’s determination that a doctor’s assessment should be accorded significant weight; the limited discussion of Miller’s obesity arguably did not comply with SSR 02- 1p; the ALJ’s focus on isolated, often stale, portions of the record was an insufficient basis to determine that Miller could conduct work activities on a sustained basis, especially in light of the Appeals Council’s original decision to remand for failure to adequately evaluate Miller’s mental impairments. View "Miller v. Comm'r of Social Sec." on Justia Law

Plaintiffs, 194 employees who were terminated by Vanderbilt University on July 1, 2013, sued, claiming violation of the Worker Adjustment and Retraining Notification Act (WARN), 29 U.S.C. 2101, which requires certain employers to provide at least 60 days’ written notice to affected employees before a mass layoff. The plaintiffs’ class is insufficient to constitute a “mass layoff” (of 500 workers during a 30-day period) as defined by WARN; they cited the Act’s aggregation provision, which allows for separate layoffs within a 90-day period to be counted togetherf. They alleged that a second group of Vanderbilt employees was notified on September 17, 2013, that their jobs would be eliminated 60 days later, on November 16. Although they were no longer permitted to report for work, they continued to receive wages and accrue benefits after the notice was given. They were not eligible for state unemployment benefits until November 16, when they no longer received wages and accrued benefits. The Sixth Circuit ruled in favor of Vanderbilt. The employment relationship between Vanderbilt and the September employees did not end until November 16; they suffered an employment loss more than 90 days after the plaintiffs were terminated and thus cannot be counted under the aggregation provision. View "Morton v. Vanderbilt Univ." on Justia Law

In 2008, Javidan shadowed Shahab, who was involved with fraudulent home-health agencies. Javidan, Shahab, and two others purchased Acure Home Care. Javidan managed Acure, signing Medicare applications and maintaining payroll. She had sole signature authority on Acure’s bank account and, was solely responsible for Medicare billing. Javidan illegally recruited patients by paying “kickbacks” to corrupt physicians and by using “marketers” to recruit patients by offering cash or prescription medications in exchange for Medicare numbers and signatures on blank Medicare forms. Javidan hired Meda as a physical therapist. Meda signed revisit notes for patients that he did not visit. He told Javidan which patients were not homebound and which demanded money for their Medicare information. The government charged both with health care fraud conspiracy (18 U.S.C. 1347) and conspiracy to receive kickbacks (18 U.S.C. 371). At trial, Javidan testified that she did not participate in and was generally unaware of Acure’s fraudulent business practices. Meda called no witnesses. Javidan and Meda were sentenced to terms of 65 and 46 months of imprisonment, respectively. The Sixth Circuit affirmed, rejecting Meda’s claims that his conviction violated the Double Jeopardy Clause and that he was subjected to prosecutorial vindictiveness for refusing to plead guilty and requesting a jury trial in prior case and Javidan’s claims of improper evidentiary rulings and sentence calculation errors. View "United States v. Javidan" on Justia Law

Most Medicare recipients must pay monthly premiums in addition to various co-payments and deductibles, 42 U.S.C. 1395. States that receive federal Medicaid funds must assist certain low-income Medicare beneficiaries with payment of their out-of-pocket expenses related to the Medicare program. To be eligible for such assistance, a Medicare beneficiary must have income less than or equal to certain percentages of the federal poverty line “for a family of the size involved[.]” In calculating 74-year-old Turner’s family size to determine eligibility for assistance, the Ohio Department of Medicaid did not include Turner’s wife, who lives with him, and denied benefits. Ohio generally does not count a Medicare beneficiary’s spouse as a member of his “family.” The Sixth Circuit held that the Department’s use of an individual-need standard to deny applications and the state’s exclusion spouses in determining the size of a family, was contrary to federal law View "Wheaton v. McCarthy" on Justia Law

The Section 8 low-income housing assistance voucher program, 42 U.S.C. 1437f(o), is administered by public housing agencies such as Cuyahoga Metropolitan Housing Authority (CMHA). Program regulations define “rent to [the] owner” as “[t]he total monthly rent payable to the owner under the lease for the unit. Rent to owner covers payment for any housing services, maintenance and utilities that the owner is required to provide and pay for.” Velez and Hatcher, voucher recipients, entered into one-year leases with K&D. The leases provide: “If Resident(s) shall holdover after the end of the term of this Rental Agreement, said holdover shall be deemed a tenancy of month to month and applicable month to month fees shall apply.” Velez entered into a month-to-month tenancy after her one-year term expired; Hatcher entered into month-to-month tenancies, and, later, a nine-month agreement. K&D charged fees of $35.00 to $100.00 per month. CMHA did not treat these short-term rental fees as rent under the voucher program. Velez and Hatcher were required to pay the fees and filed suit under 42 U.S.C. 1983. The court granted CMHA summary judgment, holding that the fees were not rent. The Sixth Circuit reversed. Recasting the charge as a short-term fee, rather than rent, does not change that it is consideration paid by the tenant for use of the rental unit. View "Velez v. Cuyahoga Metro. Hous. Auth." on Justia Law

From 1977-2009, Kennard worked as a blaster on strip mines, sometimes directly for a coal company and sometimes for contractors. In 2009, Kennard filed for black lung benefits, 30 U.S.C. 901. Kennard has a significant history of smoking, which gave him cancer in his right lung. The lung was removed. He experiences shortness of breath, coughing, and sleep apnea. His treating physician diagnosed Chronic Obstructive Pulmonary Disorder (COPD). His breathing is extremely limited. After the claims examiner initially recommended that his claim, an ALJ concluded that Kennard was entitled to a rebuttable presumption that he had pneumoconiosis and that the disease caused his total disability because he had worked in conditions that were substantially similar to those in an underground mine. The ALJ held that the employer had successfully rebutted the presumption that Kennard had clinical pneumoconiosis, but had failed to rebut the presumption of legal pneumoconiosis or the presumption that Kennardʼs disability was caused by his employment in a coal mine. The employer appealed, arguing that the 15-year presumption should not apply, and, if it did apply, the company had successfully rebutted it. The Sixth Circuit denied a petition for review, finding the award supported by substantial evidence. View "Brandywine Explosives & Supply v. Office of Workers' Comp. Programs" on Justia Law

The Medocks’ company, MAS, transported patients to kidney dialysis for Medicare reimbursement. Reimbursement of non-emergency ambulance transport is allowed only if medically necessary for bedridden patients; both a driver and an EMT must accompany any such passenger. Certification of medical necessity (CMN) must be signed by a doctor. A “run sheet” is reviewed by a Medicare contractor other than the ambulance company, such as AdvanceMed, to reduce fraud. AdvanceMed identified MAS as a high biller in Tennessee for dialysis ambulance transport and audited MAS. MAS’s records were missing some CMNs. Covert surveillance resulted in videotapes of patients walking, riding in the front seat, being double-loaded, being driven by single-staffed ambulances, or being transported by wheelchair. MAS had billed the transports as single-passenger and “stretcher required.” Executing a search warrant at the Medlocks’ home, agents seized CMNs and run tickets; some had been altered or forged. The Sixth Circuit reversed a conviction for aggravated identity theft, 18 U.S.C. 1028A, agreeing that misrepresentations that certain beneficiaries were transported by stretcher did not constitute a “use” of identification, but affirmed health-care fraud convictions, rejecting arguments that the court should have instructed the jury that Medicare, not merely a prudent person, was the relevant decision-maker; that Medicare would have reimbursed MAS without their misrepresentations; and that refusal to sever a defendant was prejudicial. View "United States v. Medlock" on Justia Law

The False Claims Act (FCA) imposes civil liability for fraudulent claims for payment to the United States, 31 U.S.C. 3729(a)(1), and authorizes qui tam suits, in which private parties bring civil actions in the government’s name. A relator must first disclose his claims to the government, which then decides whether to take over the action. Whipple alleged that Erlanger knowingly submitted fraudulent claims to federally funded healthcare programs and that he discovered the fraud while working at Erlanger in 2006, by analyzing past billings, reviewing patient records, and observing operations. He claimed to have direct knowledge of fraudulent practices from supervising patient admissions, planning discharges, and reviewing submission of claims. Unbeknownst to Whipple, the government conducted an audit and investigation; the matter was resolved without a hearing by Erlanger’s 2009 payment of a $477,140.42 refund to the government. Whipple disclosed his qui tam claims to the government in 2010 and filed suit in 2011, and the government declined to intervene. The district court dismissed, finding the claims jurisdictionally barred under the FCA’s public-disclosure bar. The Sixth Circuit reversed. Holding that the government audit was not a “public disclosure” sufficient to trigger the jurisdictional bar, the court did not decide whether the original-source exception to that bar would apply. View "United States v. Chattanooga-Hamilton Cnty. Hosp." on Justia Law

In 1992, Fugate, receiving workers’ compensation, obtained disability benefits from the Social Security Administration. In such cases, SSA reduces payments until the total benefits equal 80 percent of the recipient's “average current earnings.” Using Fugate’s December 1991 pay stub, SSA calculated “one-twelfth of the total of his wages . . . for the calendar year in which he had the highest such wages,” on which FICA taxes are paid. Fugate had 1991 gross earnings of $22,964.41. After subtracting pretax benefits and retirement contributions (not subject to FICA), SSA calculated his covered earnings as $21,693.30. Fugate complained that SSA should have used pay stubs from his three highest months of earnings in 1991. In 2004, after a periodic review, SSA erroneously determined that Fugate’s covered earnings should have been $22,964.41 and paid Fugate an extra $8,875. In 2006, after another periodic review, SSA realized its mistake and asked Fugate to refund the $8,875. Instead of requesting a refund waiver, Fugate sought reconsideration of calculation of benefits for the same reasons he had cited since 1993. An ALJ declined to reconsider the 2004 decision, but erroneously held that Fugate was entitled to a waiver even though he had not requested one. Fugate nonetheless appealed. The Appeals Council vacated. The district court granted the Administration summary judgment. The Eighth Circuit affirmed. View "Fugate v. Comm'r of Social Sec." on Justia Law