Justia U.S. 11th Circuit Court of Appeals Opinion Summaries

Articles Posted in Health Law
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Defendant, a medical doctor licensed by the State of Florida, appealed his convictions for dispensing controlled substances in violation of the Controlled Substances Act (CSA), 21 U.S.C. 801, et seq., and for health care fraud. Defendant's convictions resulted in three separate but related appeals including his contention that the district court erred or abused its discretion by allowing the introduction of autopsy reports or handwritten medical notes without requiring testimony by their authors. The court reversed defendant's convictions because the admission of the autopsy reports and testimony about those reports, without live in-court testimony from the medical examiners who actually performed the autopsies, violated the Confrontation Clause under the facts of the case. Because the court concluded that this issue was dispositive, the court declined to address the other issues raised in defendant's merits appeal, except for the sufficiency of the evidence claim. While the court ultimately concluded that the evidence was sufficient, the degree to which the court viewed the government's case as less than overwhelming compelled the court's conclusion that the Confrontation Clause violation was not harmless in this case. View "United States v. Ignasiak, Jr." on Justia Law

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Plaintiff appealed the district court's dismissal of her two-count complaint alleging interference and retaliation under the Family and Medical Leave Act of 1993 (FMLA), 29 U.S.C. 2601 et seq., against defendant. It was undisputed that plaintiff, at the time she requested leave, was not eligible for FMLA protection because she had not worked the requisite hours and had not yet experienced a triggering event, the birth of her child. It is also undisputed that she would have been entitled to FMLA protection by the time she gave birth and began her requested leave. The court held that because the FMLA required notice in advance of future leave, employees were protected from interference prior to the occurrence of the triggering event; a pre-eligible employee had a cause of action if an employer terminated her in order to avoid having to accommodate that employee with rightful FMLA leave rights once that employee became eligible; a pre-eligible request for post-eligible leave was protected activity because the FMLA aimed to support both employees in the process of exercising their FMLA rights and employers in planning for the absence of employees on FMLA leave; and because plaintiff engaged in protected activity by discussing her maternity plans with her employer, she has alleged a valid cause of action for retaliation.

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Plaintiff, suing on behalf of her husband, obtained a judgment against defendant for benefits payable under a home health care insurance policy. Defendant appealed and following a judgment, the district court awarded plaintiff attorney's fees and costs. Defendant again appealed. The court held that the district court properly granted summary judgment to plaintiff, rejecting defendant's contention that the custodial care expenses claimed were not covered expenses under the policy. Case No. 10-15115 was affirmed. Because defendant challenged the award of attorneys' fees and costs in Case No. 10-15878 on the sole ground that summary judgment was improperly granted in Case No. 10-15115, the award of attorneys' fees and costs in Case No. 10-15878 was affirmed.

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Plaintiff was enrolled in the Counselor Education Program at Augusta State University (ASU), seeking to obtain her master's degree in school counseling. Plaintiff subsequently filed an action pursuant to 42 U.S.C. 1983, alleging that requiring her to complete a remediation plan addressing what the faculty perceived as deficiencies in her ability to be a multiculturally competent counselor violated her First Amendment free speech and free exercise rights. Plaintiff also filed a motion for a preliminary injunction that would prevent ASU's officials from dismissing her from the program if she did not complete the remediation plan. The district court denied her motion for a preliminary injunction and plaintiff appealed. The court held that because plaintiff failed to establish a substantial likelihood of success on the merits with respect to her free speech and free exercise claims, the district court did not abuse its discretion in denying her motion for a preliminary injunction.

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The Commission brought this action to obtain a preliminary injunction against appellees, alleging that the Authority's purchase of Palmyra would create a monopoly in the relevant market. The district court dismissed the complaint under Rule 12(b)(6), holding that appellees were entitled to the state-action immunity. The Commission appealed. The court agreed with the Commission that, on the facts alleged, the joint operation of Memorial and Palmyra would substantially lessen competition or tend to create, if not create, a monopoly. The court held, however, that the acquisition of Palmyra and its subsequent operation at the Authority's behest by PPHS were authorized pursuant to a clearly articulated state policy to displace competition. Consequently, the execution of the plan was protected by state-action immunity. Accordingly, the judgment of the district court was affirmed.

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Defendant was convicted of 130 counts arising, inter alia, from his wire fraud, health care fraud, and unlawful dispensing of controlled substances. Defendant was also convicted of three counts charging a patient's death resulted from the use of controlled substances dispensed by defendant from his health care fraud violation. Defendant appealed his convictions, arguing that the district court gave erroneous instructions to the jury, he received ineffective assistance of trial counsel, and the government's evidence was insufficient to sustain his convictions. The court held that the district court's jury instructions were not erroneous where the district court properly instructed that the 18 U.S.C. 841(b)(1)(C) standard was satisfied upon a finding that, but for the victims ingesting the controlled substances charged in the indictment, the victims would not have died. The court also held that 18 U.S.C. 1347(a) required nothing more than a cause-in-fact connection between defendant's conduct and the death, and that any claimed error in the section 1347(a) charge was harmless. The court rejected defendant's claim that his trial counsel's performance was deficient in that trial counsel failed to make appropriate motions for acquittal at the close of evidence. The court held that, given the overwhelming evidence, the government presented sufficient evidence to sustain all of defendant's convictions and that motions for acquittal, even if made, would have failed. Accordingly, defendant's convictions and sentences were affirmed.

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Plaintiffs brought this action challenging the constitutionality of the Patient Protection and Affordable Care Act, Pub. L. 111-148, 124 Stat. 119, amended by Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. No. 111-152, 124 Stat. 1029 (Act). The government subsequently appealed the district court's ruling that the individual mandate was unconstitutional and the district court's severability holding. The state plaintiffs cross-appealed the district court's ruling on their Medicaid expansion claim. The court held that the Act's Medicaid expansion was constitutional. The court also held that the individual mandate was enacted as a regulatory penalty, not a revenue-raising tax, and could not be sustained as an exercise of Congress's power under the Taxing and Spending Clause; the individual mandate exceeded Congress's enumerated commerce power and was unconstitutional; and the individual mandate, however, could be severed from the remainder of the Act's myriad of reforms. Accordingly, the court affirmed in part and reversed in part the judgment of the district court.

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Defendant, pro se, was convicted of 129 counts of unlawfully dispensing certain controlled substances by means of written prescriptions and sentenced to concurrent terms of imprisonment totaling 97 months and fined $200,000. At issue was whether the district court effectively denied defendant his right to testify. The court held that in these circumstances, where the district court initiated a colloquy with defendant regarding his right to testify, the district court was duty-bound to correct a pro se defendant's obvious misunderstanding of his right to testify. The court also held that the error was not harmless and therefore, the court vacated defendant's convictions and remanded.

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Martin J. Bradley III and his father, Martin J. Bradley, Jr. (collectively, the Bradleys), owned Bio-Med Plus, Inc. (Bio-Med), a Miami-based pharmaceutical wholesaler that purchased and sold blood-derivatives. This case stemmed from multiple schemes to defraud the Florida and California Medicaid programs by causing them to pay for blood-derivative medications more than once. The Government chose to prosecute the schemes and a grand jury indicted eight individuals, including Albert L. Tellechea, and two companies, Bio-Med, and Interland Associates, Inc. The Bradleys, Bio-Med, and Tellechea subsequently appealed their convictions and raised several issues on appeal. The court affirmed the Bradleys', Bio-Med's, and Tellechea's convictions, and Bradley III's and Bio-Med's sentences. The court vacated Bradley, Jr.'s sentences on Counts I and 54 and Tellechea's sentence on Count 3, and remanded those counts for resentencing. The court reversed the district court's October 4, 2006 order appointing the receiver and monitor, and its supplemental receivership order of May 17, 2007. The court finally held that, as soon as circumstances allowed, the receivership should be brought to an immediate close.