Justia Non-Profit Corporations Opinion SummariesArticles Posted in Health Law
Pinnacle Health Hospitals v. Sebelius
In 1995, two non-profit hospitals consolidated to form Pinnacle. Pinnacle subsequently submitted a Medicare reimbursement claim for the losses the hospitals had incurred through the sale of their depreciable assets in the consolidation. The Administrator denied Pinnacle's claim, and that order became the final decision of the Secretary. On Pinnacle's Administrative Procedure Act (APA), 42 U.S.C. 12101 et seq., challenge, the district court upheld the Secretary's decision in full. Because the Secretary's interpretation of the relevant Medicare regulations was not plainly erroneous or inconsistent with the regulation, the court concluded that the Secretary reasonably applied the bona fide sale requirement to a reimbursement request from a participant in a "statutory merger." The court also held that the Secretary's finding that the bona fide sale requirement applied to consolidations involving non-profit Medicare providers, like Pinnacle, was not plainly erroneous or inconsistent with the regulation. Finally, substantial evidence supported the Secretary's finding that Pinnacle did not satisfy the bona fide sale requirement. Accordingly, the court affirmed the district court's judgment. View "Pinnacle Health Hospitals v. Sebelius" on Justia Law
Lomando v. United States
Decedent was treated at a non-profit clinic, by volunteer physicians. The U.S. Department of Health and Human Services deemed those physicians to be Public Health Service employees (Public Health Service Act, 42 U.S.C. 233(o)), immune from suit under the Federal Tort Claims Act, 28 U.S.C. 1346, 2671-2680. A suit against the U.S. was the exclusive remedy for alleged malpractice at the clinic. Decedent also treated at a facility where physicians did not enjoy those protections. Her estate sued the U.S., the clinic, the other facility, the doctors at that facility, and their physicians' group. The district court granted summary judgment for the clinic, predicated on immunity under the New Jersey Charitable Immunity Act (NJCIA), and ultimately dismissed. The Third Circuit affirmed, except for remanding with respect to the physicians' group. The trial court properly held that the U.S. was immune from suit under the NJCIA, which provides that a similarly-placed private employer would be entitled to the defense. The court properly held that the treatment provided constituted emergency medicine, so that N.J. Stat. 2A:53A-41 applied and one of plaintiff's experts was not qualified to testify. The court erred in not considering treatment by a physicians' assistant in considering claims against her employer, the physicians' group.View "Lomando v. United States" on Justia Law
Evanston Ins. Co. v. Legacy of Life, Inc.
This case involved the construction and application of a combined professional and general liability insurance policy issued by appellant to appellee where appellee requested a defense from appellant under the policy for a civil lawsuit. In that underlying suit, plaintiff alleged that while her mother was terminally ill, she consented to appellee's harvesting of some of her mother's organs and tissues after her mother's death and consented to the harvesting because appellee was a non-profit corporation. Appellee, instead, transferred the tissues to a for-profit company, which sold the tissues to hospitals at a profit. Appellee subsequently sought coverage under its general liability insurance with appellant and appellant denied coverage because the conduct alleged was outside the scope of the insurance policy's coverage. The court certified the following questions to the Supreme Court of Texas: (1) "Does the insurance policy provision for coverage of 'personal injury,' defined therein as 'bodily injury, sickness, or disease including death resulting therefrom sustained by any person,' include coverage for mental anguish, unrelated to physical damage to or disease of the plaintiff's body?" (2) "Does the insurance policy provision for coverage of 'property damage,' defined therein as 'physical injury to or destruction of tangible property, including consequential loss of use thereof, or loss of use of tangible property which has not been physically injured or destroyed,' include coverage for the underlying plaintiff's loss of use of her deceased mother's tissues, organs, bones, and body parts?" View "Evanston Ins. Co. v. Legacy of Life, Inc." on Justia Law
Petty v. Hospital Service Assoc. of NE Penna.
Appellant Robert Petty is sole owner of Co-Appellant R.G. Petty Masonry. Appellants contracted with Respondent Blue Cross of Northeastern Pennsylvania (Blue Cross), a nonprofit hospital corporation that provides health insurance coverage for its employees. Appellants are covered under the group policy as subscribers. Appellants filed a four-count class action suit against Blue Cross, alleging that it violated the state Nonprofit Law by accumulating excessive profits and surplus well beyond the "incidental profit" permitted by statute. The second count alleged Blue Cross breached its contract with Appellants by violating the Nonprofit Law. The third count alleged Blue Cross owed appellants a fiduciary duty by virtue of their status as subscribers, and that duty was breached when it accrued the excess surplus. The fourth count requested an inspection of Blue Cross' business records. The trial court found Appellants lacked standing to challenge Blue Cross' alleged violations of the Nonprofit Law and dismissed the suit. The Commonwealth Court affirmed the trial court. Upon careful consideration of the briefs submitted by the parties in addition to the applicable legal authorities, the Supreme Court found that Appellants indeed lacked standing under the Nonprofit Law to challenge Blue Cross by their four-count complaint. Accordingly, the Court affirmed the lower courts' decisions and dismissed Appellants' case. View "Petty v. Hospital Service Assoc. of NE Penna." on Justia Law