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Federal New Releases

New Releases
from Federal Courts

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Employer-employee relations -- Employee benefits plan -- Medical benefits -- Plan beneficiary filed suit against health insurance company seeking award of medical benefits under Employee Retirement Income Security Act for continued partial hospital treatment for her anorexia, which was denied on ground that the level of care sought was not medically necessary -- District court correctly determined that record of external review of plaintiff's medical necessity claim was part of the administrative record and thus was properly before district court in this ERISA case, but erred in holding that the adverse external review decision was binding on parties in federal court as to the medical necessity of plaintiff's treatment and thus barred plaintiff from bringing an ERISA action in district court to challenge to the adverse medical necessity determination -- Federal preemption -- State law allowing external review “regulates” insurance and is not preempted by ERISA -- Because external review process is not binding on merits of medical necessity issue and thus does not conflict with ERISA, it is not preempted -- The external review cannot preclude plaintiff from challenging the denial of her benefits under ERISA in a district court
VIEW OPINION

Environmental protection -- Clean Water Act -- Environmental groups, whose members use waters of watershed that flow downstream from mining sites authorized to discharge materials, filed suit under Administrative Procedure Act claiming that U.S. Army Corps of Engineers acted arbitrarily and capriciously in deciding to reissue nationwide permit that authorizes discharges of dredged or fill materials into navigable waters associated with surface coal mining and reclamation operations, and in its findings of no significant environmental impact under Clean Water Act and National Environmental Policy Act -- Where Corps reissued a nationwide permit, which consisted of a provision that added several specific discharge limits on all new surface mining activities and a second provision that grandfathered in activities approved under previous permit so long as the activities do not exceed previously approved discharge levels and meet certain other conditions, Corps' decision to treat old and new activities differently under two new provisions was not arbitrary and capricious under APA -- Corps' finding that activities authorized under both provisions would result in minimal individual and cumulative impacts to the aquatic environment was not arbitrary and capricious
VIEW OPINION

Environmental protection -- Clean Water Act -- Waters of the United States -- Challenge to validity of Clean Water Rule jointly promulgated by Environmental Protection Agency and Army Corps of Engineers, which defines the term “Waters of the United States” for purposes of Clean Water Act -- Appellate court would exercise its discretion to stay appeal from denial of preliminary injunctive relief pending decision of Sixth Circuit on issue involving the validity of Clean Water Rule or further developments -- Sister Circuit, in which issues about validity of rule are pending, is obvious court to proceed to decision because it has already decided the jurisdictional issue, denied rehearing en banc of that decision, set a briefing schedule on merits issues, and is in process of winnowing down the massive administrative record to its most relevant parts
VIEW OPINION

Municipal corporations -- Ordinances -- Constitutionality -- Speech -- City ordinance which authorizes police officers, in their discretion, to issue trespass warnings to any individual who violates any city ordinance or state law which was committed while on or within a city facility, building, or outdoor area, including municipal parks, does not violate the First Amendment on its face, and neither is it unconstitutional as applied -- Ordinance does not violate First Amendment on its face and as applied to plaintiff who uses the city's parks for his ministerial outreach and advocacy work and was arrested for obstructing a police investigation and resisting arrest in city park and was issued a trespass warning, because ordinance did not have inevitable effect of singling out plaintiff or anyone else engaged in expressive activities, plaintiff did not receive his trespass warning because he was engaged in expressive conduct protected under First Amendment, and further, there is no record evidence that plaintiff was arrested as a pretext for suppression of speech protected by First Amendment -- First Amendment scrutiny has no relevance to ordinance directed at imposing sanctions on nonexpressive activity -- Ordinance which allows city to suspend a trespass warning and permit the offender back on the property so that he can exercise his First Amendment rights or conduct necessary municipal business, does not violate First Amendment as applied to plaintiff, because it does not impose an unlawful prior restraint on speech -- Ordinance allows more speech, not less; and speech in more locations, not fewer
VIEW OPINION

Criminal law -- Medicaid health care fraud -- Making false representations or statements to state officials or federal agents -- High-level executives of corporation that provides government-sponsored managed-care health plans for members appeal their convictions arising from their participation in a fraudulent scheme to file false Medicaid expense reports that misrepresented and overstated amounts spent on medical services for Medicaid patients, specifically outpatient behavioral health care services -- Sufficiency of evidence -- Evidence was more than sufficient to sustain defendants' convictions for Medicaid health care fraud in violation of 18 U.S.C. §1347 and defendant's separate conviction for false representation relating to health care matters in violation of 18 U.S.C. § 1035, where evidence amply showed that representations as to expenses in calendar year 2006 expense reports submitted to state Agency for Health Care Administration for outpatient behavioral health care services were, in fact, false, and that defendants knew they were, in fact, false -- Where evidence showed that defendant, as CEO, President, and a director, devised, implemented and supervised a scheme to defraud AHCA and ordered his subordinates to perpetuate the scheme year after year, evidence sufficiently showed that defendant aided and abetted the execution of fraud in year for which he was convicted, and he did so knowingly, willfully, and with intent to defraud AHCA -- Advice-of-counsel evidence defendants offered to support claim that defendants were told their reporting method was legal and common practice in industry does not undermine jury verdict given abundant evidence of defendants' intent to defraud AHCA -- Evidence was sufficient to allow a reasonable jury to find defendant knowingly and willfully made false material statements to federal agents in violation of 18 U.S.C. § 1001 when he told federal agents that outpatient behavioral health care expenses had not been over-reported to AHCA and encounter prices had not been purposefully inflated, despite knowing these things were not true -- Defendant's statements to federal agents were proven false, statements were willfully made, and false statements concerned core conduct that federal agents were investigating -- Jury instructions -- District court did not err by instructing the jury that it could convict defendants under Section 1347 upon finding that defendants made false representations in 2006 expense reports with deliberate indifference as to the truth -- District court properly instructed jury that a “statement or representation is false or fraudulent if it is about a material fact that the speaker knows is untrue or makes with deliberate indifference as to the truth and makes with intent to defraud” -- Representations made with deliberate indifference to truth and with intent to defraud adequately satisfy knowledge requirement -- Evidence -- Wealth evidence -- District court did not abuse its broad discretion in admitting evidence of defendants' compensation, which government introduced to prove motive -- Expert -- Forensic accountant -- District court did not abuse its discretion under Rule 703 of Federal Rules of Evidence by allowing forensic accountant to disclose the fact that an audited financial restatement was publicly filed with SEC and certain financial figures in restatement -- Audited financial restatement was admissible as a business record under Rule 803(6) -- Because financial restatement was audited by independent accounting firm, was publicly filed with SEC, and was reliable and relevant business record, Rule 703 does not bar testimony that forensic accountant offered regarding the statement
VIEW OPINION

Bankruptcy -- Chapter 13 -- Confirmed plan -- Collection of domestic support obligation -- Contempt -- State department of revenue violated confirmed Chapter 13 plan by attempting to intercept debtor's work-related travel reimbursement for the payment of a domestic support obligation, even though the DOR did not violate the automatic stay when it intercepted debtor's reimbursement payment -- Legislative intent behind Section 362(b)(2)(C), which permits a DSO creditor to collect post-petition notwithstanding the automatic stay, does not indicate that Congress intended the exception to interfere with the binding effect of a confirmed plan per Section 1327(a) -- Plain reading of Section 1327(a) makes clear that the binding effect of a confirmed plan encompasses all issues that could have been litigated in debtor's case, including whether the DOR could intercept debtor's reimbursement payment
VIEW OPINION

Criminal law -- Sentencing -- Armed Career Criminal Act -- Habeas corpus -- Second or successive motion to vacate, set aside, or correct federal sentence -- Habeas petitioner is not entitled to leave to file second or successive motion to vacate, set aside, or correct his federal sentence based on rule announced in Johnson v. United States, where petitioner has already filed a request presenting the same claim based on Johnson -- Current request must be dismissed, regardless of its merit
VIEW OPINION

Securities -- Fraud -- Ponzi scheme -- Class actions -- Victims of Ponzi scheme filed putative class action seeking to hold liable banks, which had received victim's investment funds, and two bank employees, alleging violations of Section 20(a) of Securities Exchange Act and federal RICO Act -- Section 20(a) claim alleging defendants were liable as control persons under federal securities laws given their banking relationship with Ponzi schemer and his investment advisory business and their access to bank accounts of business is time-barred because claim was not filed within five years after Ponzi schemer was arrested and his investment advisory business was closed -- Rule of equitable tolling under American Pipe does not apply to statute of repose for a Section 20(a) claim -- Section 20(a) claim was properly dismissed as untimely -- Federal RICO claim was properly dismissed as precluded by Private Securities Litigation Reform Act -- Under PSLRA, no person may rely upon any conduct that would have been actionable as fraud in the purchase or sale of securities to establish a violation of federal RICO Act, and plaintiffs' claims of mail and wire fraud are clearly based upon fraudulent conduct of Ponzi schemer and his business relating to securities investments
VIEW OPINION

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