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

A class of Tennessee residents who applied for Medicaid sought declaratory and injunctive relief, alleging that the delays they have experienced in receiving eligibility determinations on their applications violate 42 U.S.C. 1396a(a)(8) of the Medicaid statute, and that the state’s failure to provide a fair hearing on their delayed applications violates that statute and the Due Process Clause. Regulations implementing the statute provide that “the determination of eligibility for any applicant may not exceed” 90 days for those “who apply for Medicaid on the basis of disability” and 45 days for all other applicants. The district court certified a class and granted a preliminary injunction, which requires the state to grant a fair hearing on delayed applications to class members who request one. The Sixth Circuit affirmed the preliminary injunction, holding that the matter is not moot and that the federal government is not a required party. The court noted that the federal government submitted an amicus brief, supporting plaintiffs’ position. Despite the passage of the Affordable Care Act, states remain ultimately responsible for ensuring their Medicaid programs comply with federal law. View "Wilson v.Gordon" on Justia Law

Hensley, born in 1949, was employed as a coal miner for 13 years, before leaving in 1988 after seriously injuring his hand and arm in an accident. He has not worked since. Hensley also smoked cigarettes for 10-12 years, averaging half a pack a day before quitting 29 years ago. Hensley first noticed issues with his breathing in 1987. In 1990, he filed an unsuccessful claim for benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He filed a second claim in 2003. The claim was denied, despite a finding of pneumoconiosis, because Hensley did not prove that he was totally disabled by the disease. Hensley filed another claim 2006. The Department of Labor recommended awarding benefits.The evidence, which consisted of chest x-rays, biopsy results, CT scans, pulmonary function studies, arterial blood-gas studies, treatment records and several medical opinions, was forwarded to the ALJ, who awarded benefits in 2010, initially holding that Hensley’s x-ray evidence alone was sufficient to establish the existence of pneumoconiosis.. On remand, the ALJ again concluded that Hensley was entitled to benefits. The Sixth Circuit upheld the award as supported by substantial evidence. View "Dixie Fuel Co. v. Office Workers' Comp. Progams" on Justia Law

Taskila, age 37, has several health issues. She was involved in serious car accidents in 1996, 2006, and 2010; underwent successful treatment in 2011 for a mass in her breast; and sought treatment for knee pain. She claims, the injuries have led to unremitting pain in her neck and back, to anxiety and depression, to memory problems, to incontinence, to carpal tunnel syndrome, to an inability to work. Taskila sought Social Security disability insurance and supplemental security income. An initial disability examiner denied her applications. After a hearing, an ALJ did the same. The appeals council denied review. The district court and Sixth Circuit affirmed, finding the denial supported by substantial evidence that Taskila could perform a significant number of jobs in the national economy. View "Taskila v. Comm'r of Social Sec." on Justia Law

Taskila, age 37, has several health issues. She was involved in serious car accidents in 1996, 2006, and 2010; underwent successful treatment in 2011 for a mass in her breast; and sought treatment for knee pain. She claims, the injuries have led to unremitting pain in her neck and back, to anxiety and depression, to memory problems, to incontinence, to carpal tunnel syndrome, to an inability to work. Taskila sought Social Security disability insurance and supplemental security income. An initial disability examiner denied her applications. After a hearing, an ALJ did the same. The appeals council denied review. The district court and Sixth Circuit affirmed, finding the denial supported by substantial evidence that Taskila could perform a significant number of jobs in the national economy. View "Taskila v. Comm'r of Social Sec." on Justia Law

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