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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 07-CV-6149L
Regular Panel Decision
Feb 18, 2010

Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER

Plaintiffs Keith Johnson, M.D., and Laura Schmidt, R.N., filed a qui tam action under the False Claims Act against the University of Rochester Medical Center and Strong Memorial Hospital. They alleged defendants defrauded the government by submitting false claims for anesthesiology services under Medicare/Medicaid, claiming physician supervision when it was absent. Johnson also alleged retaliatory discharge for reporting violations, and Schmidt claimed retaliation for refusing to alter medical records. The defendants moved to dismiss, arguing failure to plead fraud with particularity under Fed. R. Civ. P. 9(b) and failure to state a claim under Rule 12(b)(6). Johnson cross-moved to amend the complaint to add claims of libel per se and prima facie tort against Dr. Lustik. The court granted the defendants' motion to dismiss, finding that the plaintiffs failed to allege that any fraudulent bills were actually presented to Medicare/Medicaid. The retaliation claims were also dismissed because the complaints were not made in furtherance of a qui tam action. Johnson's motion to amend was denied as frivolous and in bad faith. Defendants' request for sanctions was denied without prejudice.

False Claims ActQui TamMedicare FraudMedicaid FraudRetaliatory DischargePleading StandardsRule 9(b)Motion to DismissLeave to AmendLibel
References
28
Case No. MISSING
Regular Panel Decision

Beth Israel Medical Center v. 1199/S.E.I.U. United Healthcare Workers East

Beth Israel Medical Center (BIMC) petitioned to vacate an arbitration award concerning a labor dispute over wage differentials for registered nurses on flex-time schedules at its Kings Highway Division. Local 1199, the nurses' union, moved to confirm the award. The dispute arose when BIMC discontinued pro-rata wage differentials for day shift nurses, arguing a 2002 Memorandum of Agreement (MOA) adopted a different plan. The arbitrator found for Local 1199, concluding the 2002 MOA did not alter the longstanding practice established in prior MOAs. BIMC argued the arbitrator exceeded his power and violated public policy; however, the court denied BIMC's petition and granted Local 1199's motion, affirming the arbitrator's decision that drew its essence from the collective bargaining agreement.

Labor DisputeArbitration AwardWage DifferentialsCollective Bargaining AgreementFlex-Time ScheduleRegistered NursesNew YorkFederal CourtLMRAContract Interpretation
References
14
Case No. MISSING
Regular Panel Decision

De Luca v. United Nations Organization

A former United Nations security officer filed a lawsuit against the United Nations and eight of its officials, alleging breach of contract, forgery, negligence, civil rights violations, and denial of medical benefits. The plaintiff claimed the U.N. failed to reimburse him for 1988 taxes, issued a fraudulent final pay statement with a forged signature, and unlawfully denied him continued health insurance coverage after his resignation. The defendants moved to dismiss the complaint, asserting immunity under international and federal law. The court denied the plaintiff's motion for default judgment and granted the defendants' motion to dismiss the complaint in its entirety with prejudice, finding that the United Nations and its officials were immune from the action for acts performed in their official capacities.

ImmunityInternational OrganizationsUnited NationsDiplomatic ImmunitySovereign ImmunityBreach of ContractEmployment LawTax ReimbursementMedical BenefitsOfficial Capacity
References
10
Case No. MISSING
Regular Panel Decision

ABC Medical Management, Inc. v. GEICO General Insurance

The case addresses whether a plaintiff-assignee medical equipment supplier can recover no-fault first-party benefits when a chiropractor, rather than a physician, issued the prescription. Defendant GEICO General Insurance Company moved for summary judgment, arguing that Education Law § 6551 prohibits chiropractors from prescribing such items. The court denied GEICO's motion, ruling that chiropractors are permitted to prescribe TENS units, thermophore devices, and similar medical supplies, as these do not constitute 'drugs or medicines' under the Education Law. Furthermore, the court found that GEICO failed to properly present its medical necessity defense and that the contested issues should be determined by a trier of fact.

No-Fault BenefitsChiropractic PrescriptionMedical EquipmentEducation Law § 6551Summary JudgmentMedical NecessityTENS UnitThermophoreCervical CollarLumbar Support
References
29
Case No. MISSING
Regular Panel Decision

Levine v. United Parcel Service

A claimant, employed by United Parcel Service, suffered stress and mental depression on May 13, 1982, allegedly due to supervisor harassment, which the Workers' Compensation Board ruled an accidental injury. The employer and its carrier appealed, challenging the facts of the incident and the medical causation, especially given the claimant's preexisting anxiety. The Appellate Division affirmed the Board's decision, citing its prerogative to assess witness credibility and weigh conflicting medical evidence. The Board's findings, based on the claimant's testimony and psychiatrist's report, were deemed supported by substantial evidence. The decision affirmed the compensability of mental injury precipitated by psychic trauma under the Workers' Compensation Law.

Mental InjuryPsychic TraumaHarassmentSupervisor ConductAccidental InjuryPreexisting ConditionCredibility of WitnessesMedical EvidencePosttraumatic Stress DisorderAppellate Review
References
5
Case No. MISSING
Regular Panel Decision
Mar 27, 1985

United States v. $100 in United States Currency

The United States initiated an in rem forfeiture action against $100,000 in U.S. currency, alleging it originated from illegal drug transactions. Claimants Jose Martinez-Torres and Nancy Medina asserted the funds were legitimate lottery winnings. The government sought summary judgment, arguing issue preclusion from a prior Nebbia bail hearing where Medina's lottery claim was found incredible. The Court granted partial summary judgment for the government, establishing probable cause for forfeiture. However, it denied the application of offensive collateral estoppel for full summary judgment, citing the distinct procedural environment and limited scope of the Nebbia hearing, and ruled that claimants are entitled to a plenary trial to prove the legitimate source of the funds.

ForfeitureDrug Trafficking ProceedsCollateral EstoppelIssue PreclusionSummary JudgmentProbable CauseIn Rem ForfeitureBail HearingDue Process ConcernsPuerto Rican Lottery
References
8
Case No. MISSING
Regular Panel Decision
Aug 10, 2012

Williams v. Woodhull Medical & Mental Health Center

Valerie E. Williams filed an action against Woodhull Medical and Mental Health Center and other defendants, alleging discrimination and retaliation under federal and state laws, including Title VII and 42 U.S.C. §§ 1981, 1983, 1985, and 1986. Magistrate Judge Lois Bloom issued a Report and Recommendation, advising to grant the defendants' motion for summary judgment on all claims. Plaintiff Williams filed objections to the R&R, particularly contesting the recommendation on her Title VII retaliation claim. District Judge Nicholas G. Garaufis, upon de novo review of the contested portions and clear error review of the uncontested, adopted the R&R in its entirety. The court granted summary judgment to the defendants, finding no genuine dispute of material fact regarding Williams's claims, specifically noting a lack of causal connection for retaliation and insufficient evidence for a hostile work environment or due process violations.

Employment DiscriminationTitle VII RetaliationSummary JudgmentProcedural Due ProcessHostile Work EnvironmentMedical Negligence AllegationsPublic Health LawHospital EmploymentMagistrate Judge ReviewFederal Rules of Civil Procedure 56
References
80
Case No. MISSING
Regular Panel Decision
Jun 29, 2004

Claim of Rothe v. United Medical Associates

This case involves an appeal from a Workers’ Compensation Board decision, filed on June 29, 2004. The Board reversed a Workers’ Compensation Law Judge's determination that the claimant, a physician with a permanent partial disability, had maintained an attachment to the labor market subsequent to September 18, 2002. The appellate court affirmed the Board's decision, finding that the claimant did not provide evidence demonstrating that his inability to obtain employment was caused by or related to his permanent partial disability. Consequently, the Board's conclusion that the claimant failed to maintain an attachment to the labor market was supported by substantial evidence.

Workers' Compensation AppealLabor Market AttachmentPermanent Partial DisabilityVoluntary WithdrawalAppellate ReviewSubstantial EvidencePhysician ClaimantEmployment SearchWorkers' Compensation Board ReversalJudicial Affirmation
References
5
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. MISSING
Regular Panel Decision

United States v. Caballero

Saul Caballero, who pleaded guilty to two drug conspiracies (heroin and methamphetamine distribution), objected to an aggravating role enhancement under the Sentencing Guidelines, arguing it would increase his mandatory-minimum sentence and thus require a jury finding beyond a reasonable doubt as per Alleyne v. United States. Following a two-day Fatico hearing, the District Court concluded that the government proved by a preponderance of the evidence that Caballero was a manager or supervisor of the heroin distribution conspiracy, but not the crystal methamphetamine conspiracy. The Court also rejected Caballero's argument that Alleyne mandates a jury to determine safety-valve eligibility, affirming that judicial fact-finding by a preponderance of the evidence for safety-valve criteria is constitutionally permissible as it potentially lessens, rather than increases, the mandatory minimum sentence. Therefore, the defendant's motion for a jury determination was denied.

Sentencing GuidelinesAggravating Role EnhancementMandatory Minimum SentenceSafety Valve EligibilityDrug ConspiracyHeroin DistributionMethamphetamine DistributionPreponderance of EvidenceJury DeterminationConstitutional Law
References
24
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