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

Case No. 15-24-00114-CV
Regular Panel Decision
Oct 04, 2024

Cecile Erwin Young, in Her Official Capacity as the Executive Commissioner of the Texas Health and Human Services Commission; Molina Healthcare of Texas, Inc.; And Aetna Better Health of Texas, Inc. v. Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company

This case involves an appeal concerning a temporary injunction and the denial of a plea to the jurisdiction issued by the 353rd Judicial District of Travis County. The appellants, including Cecile Erwin Young (Executive Commissioner of HHSC), Molina Healthcare of Texas, Inc., and Aetna Better Health of Texas, Inc., are challenging the lower court's decision. The appellees (Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company) had sought to enjoin the Texas Health and Human Services Commission (HHSC) from proceeding with STAR & CHIP and STAR Kids managed care procurements. The core legal arguments revolve around whether HHSC's procurement processes violated Texas law, thereby rendering the intended contract awards unlawful ultra vires acts, and whether the appellees' claims are barred by sovereign immunity or failure to exhaust administrative remedies. The appellants contend that the district court abused its discretion by granting the injunction and denying the plea.

Appellate CourtTemporary InjunctionPlea to the JurisdictionSovereign ImmunityUltra Vires ClaimsProcurement DisputeManaged Care ContractsMedicaidCHIPTexas Health and Human Services Commission
References
95
Case No. MISSING
Regular Panel Decision

Texas Health Care Information Council v. Seton Health Plan, Inc.

Seton Health Plan, Inc., a licensed health maintenance organization (HMO), failed to file its annual Health Plan Employer Data Information Set (HEDIS) reports for 1999 and 2000 with the Texas Health Care Information Council, leading to a dispute over civil penalties. The State, through the Attorney General, initially demanded $153,000, interpreting 'each act of violation' as each day of non-compliance, while Seton contended the maximum penalty was $10,000 per unfiled report. Seton filed a declaratory judgment action to construe the statute, and the district court sided with Seton, assessing a minimum penalty of $1,000 for each report. The State appealed, raising issues of mootness, sovereign immunity, the penalty amount, denial of injunctive relief, and attorney's fees. The appellate court affirmed the district court's interpretation of the penalty, the assessed penalties, and the denial of injunctive relief, but remanded the issue of the State's attorney's fees.

Declaratory JudgmentStatutory ConstructionCivil PenaltiesSovereign ImmunityInjunctive ReliefAttorney's FeesHEDIS ReportHealth Maintenance OrganizationTexas Health and Safety CodeAdministrative Procedure Act
References
43
Case No. 03-03-00355-CV
Regular Panel Decision
Apr 08, 2004

Albert Hawkins, in His Capacity as Commissioner of Health & Human Services The Texas Health & Human Services Commission And the Texas Department of Health v. Dallas County Hospital District D/B/A Parkland Health and Hospital System

This case involves an appeal concerning the rules and formulas used to reimburse Texas teaching hospitals for graduate medical education (GME) costs from Medicaid funds. The core dispute is whether the Texas Health and Human Services Commission was legally mandated to use a specific statutory formula based on a hospital's annual actual GME costs, or if it could continue using its existing rule, which derived costs from a 1984 base-period figure adjusted for inflation, mirroring the federal Medicare approach. Dallas County Hospital District, operating Parkland Memorial Hospital, sued the department, alleging underpayment of over $72 million due to the use of the incorrect formula. The district court ruled in favor of Parkland, declaring the department's rules invalid. The appellate court affirmed this judgment, concluding that the statutory formula for reimbursement was mandatory, while the department's discretion was limited to calculating variables within that prescribed formula, not to establishing an alternative method.

Medicaid reimbursementGraduate Medical EducationTeaching HospitalsStatutory interpretationTexas Health and Human Services CommissionParkland Memorial HospitalHealthcare fundingAdministrative lawJudicial reviewHealth policy
References
13
Case No. 03-02-00114-CV
Regular Panel Decision
Dec 19, 2002

Texas Health Care Information Council and the State of Texas, Office of the Attorney General v. Seton Health Plan, Inc.

This case involves an appeal by the Texas Health Care Information Council and the State of Texas, Office of the Attorney General, against Seton Health Plan, Inc. The core dispute centered on the interpretation of civil penalties for Seton's failure to file annual Health Plan Employer Data Information Set (HEDIS) reports as required by the Texas Health and Safety Code. Seton sought a declaratory judgment asserting that the maximum penalty for such a violation was $10,000 per report, while the State initially pursued a penalty based on each day of violation. The district court sided with Seton on the maximum penalty, assessed minimum penalties of $1,000 for each of the two unfiled reports, denied the State's request for injunctive relief, and ordered the State to pay Seton's attorney's fees. On appeal, the Court of Appeals affirmed the district court's declaratory judgment, the denial of injunctive relief, and the penalty assessment. However, the appellate court reversed and remanded the issue of the State's attorney's fees, ruling that the State was statutorily entitled to reasonable attorney's fees under Government Code section 402.006(c) due to its recovery of a civil penalty.

Texas LawHealth Care RegulationHEDIS Report ViolationCivil PenaltiesDeclaratory Judgment ActionSovereign Immunity WaiverInjunctive Relief DeniedAttorney's Fees AwardStatutory ConstructionAdministrative Law
References
44
Case No. MISSING
Regular Panel Decision

Hypolite v. Health Care Services of New York Inc.

The plaintiff, Allison Hypolite, on behalf of a putative class of home health aides, moved for conditional certification and notice to a proposed class under the FLSA. The defendants, HCS Healthcare and Agnes Shemia, opposed and moved to strike portions of the plaintiff's reply. The court denied the motion to strike. The court granted conditional certification for the period between January 1, 2015, and October 13, 2015, finding that the defendants failed to comply with revised FLSA regulations concerning the Home Health Aide Exemption during this time. However, the motion was denied for the period before January 1, 2015, as the plaintiff did not sufficiently demonstrate that other potential opt-in plaintiffs were similarly situated, given the fact-specific nature of the prior exemption rules. The plaintiff's request to extend the notice period to six years for state law claims was also denied.

FLSAConditional CertificationCollective ActionHome Health AidesOvertime PayWage and HourThird Party EmployerCompanionship Services ExemptionDepartment of Labor RegulationsRetroactive Effect
References
36
Case No. MISSING
Regular Panel Decision
Dec 27, 2001

MacRo v. Independent Health Ass'n, Inc.

Plaintiffs Cheryl Macro and Kim Zastrow, insured under a group health contract with Independent Health through the Tonawanda City School District, initiated a class action in state court to challenge Independent Health's modification of infertility treatment coverage. Defendant Independent Health removed the case to federal court, asserting ERISA preemption. Plaintiffs moved to remand, arguing that their claims fell under New York Insurance Law, which is exempt from ERISA preemption by the saving clause, and that their health plan qualified as a 'governmental plan' also exempt from ERISA. The District Court granted the plaintiffs' motion, concluding that the claims were indeed saved from ERISA preemption and that the plan was exempt, thus rendering federal subject matter jurisdiction absent. The court accordingly remanded the case back to New York State Supreme Court.

Infertility CoverageHealth Insurance DisputesERISA PreemptionSaving ClauseGovernmental PlansRemoval to Federal CourtSubject Matter JurisdictionNew York Insurance LawClass Action LitigationEmployee Benefits Plan
References
31
Case No. 09-05-363 CV
Regular Panel Decision
Sep 22, 2005

in Re Christus Health and Christus Health Southeast Texas, Individually and D/B/A Christus St. Elizabeth Hospital

Christus Health and Christus Health Southeast Texas (the Hospital) petitioned for a writ of mandamus to compel the trial court to grant a plea to the jurisdiction and dismiss a class action suit. The real parties in interest, Larry Baker, Anthony Brawley, and Linny Nixon, III (Patients), filed a breach of contract and declaratory judgment action, alleging the hospital overcharged self-pay patients. The Hospital argued the Patients lacked standing as they had not paid their bills. The Court of Appeals denied the writ of mandamus, concluding that the Hospital had an adequate remedy by appeal, specifically an interlocutory appeal, for issues relating to the proposed class action.

MandamusPlea to JurisdictionStandingClass ActionDeclaratory JudgmentBreach of ContractSelf-Pay PatientsHospital ChargesAppellate ProcedureAdequate Remedy by Appeal
References
8
Case No. 99 Civ. 11886 WCC
Regular Panel Decision
Jul 11, 2000

Leonard v. DUTCHESS CTY. DEPT. OF HEALTH

Plaintiffs, including restaurant and bowling center owners and the National Smokers Alliance, challenged smoking regulations promulgated by the Dutchess County Department of Health and Board of Health. They alleged violations of equal protection, free speech, 42 U.S.C. § 1983, the New York State Constitution, and Article 78. The defendants moved to dismiss, arguing lack of subject matter jurisdiction, while plaintiffs moved for summary judgment and injunctive relief. The court, treating both as motions for summary judgment, found that the Board of Health exceeded its authority under the New York State separation of powers doctrine by enacting regulations that balanced economic, social, and privacy interests, rather than solely health concerns. Specifically, the court noted the Board's consideration of non-health factors, the non-interstitial nature of the regulations compared to state law, and the County Legislature's prior failure to pass similar legislation. Consequently, the court granted plaintiffs' motion for summary judgment and permanently enjoined the defendants from enforcing the challenged smoking regulations.

Smoking RegulationsPublic Health LawSeparation of PowersAdministrative Agency OverreachSummary JudgmentInjunctive ReliefDutchess CountyClean Indoor Air ActConstitutional LawArticle 78
References
12
Case No. 10-02-00026-CV
Regular Panel Decision
Mar 24, 2004

Providence Health Center A/K/A Daughters of Charity Health Services of Waco And DePaul Center A/K/A Daughters of Charity Health Services of Waco v. Jimmy and Carolyn Dowell, Individually and on Behalf of the Estate of Jonathan Lance Dowell

This is a dissenting opinion in an appeal of a wrongful death and survival suit. The appellants, Providence Health Center and DePaul Center, argued there was no evidence of proximate cause or inadequate psychiatric screening for Jonathan Lance Dowell, who committed suicide after being released from their care for self-inflicted wrist cuts. The dissenting Chief Justice Gray believes the judgment should be reversed and rendered, as there was no evidence of the appellants' conduct being a substantial cause of death. The main opinion affirmed in part, reversed and remanded in part.

Wrongful DeathSurvival SuitProximate CausePsychiatric ScreeningSuicideMedical NegligenceNo-evidence ComplaintSummary JudgmentAppellate ReviewDissenting Opinion
References
15
Case No. 2019-02-0171
Regular Panel Decision
Oct 23, 2019

Blankenship, Roma v. Ballad Health

Ms. Blankenship, a CNA for Ballad Health, requested an expedited hearing for temporary disability and medical benefits, alleging her work conditions caused knee pain and ankle swelling. Despite her claims, two physicians, Dr. William Brashear and Dr. Michael Anders, could not causally relate her condition primarily to her work. The Court determined Ms. Blankenship failed to provide sufficient expert medical proof to likely succeed in proving causation. Consequently, her claim for benefits was denied, and the case was set for a Status Hearing on January 7, 2020.

Workers' CompensationExpedited HearingTemporary Disability BenefitsMedical BenefitsCausationExpert Medical EvidencePre-existing ConditionOrthopedicsPatellofemoral OsteoarthritisCNA
References
1
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