Environmental Defense Fund v. Lee Zeldin — D.C. Cir. (Oct 14, 2026)

Juan Hernandez challenges a restitution order arising from an HIV-medication kickback case. Prosecutors described pharmacies buying medicines back from patients and dispensing diverted drugs while billing government insurance. Hernandez's own charge concerned cash paid to induce patients to fill prescriptions at particular pharmacies. He pleaded guilty to a conspiracy to violate the Anti-Kickback Statute. His role in the broader operation, and what harm he could foresee, matter in this appeal. The sentencing dispute expanded when Gilead sought restitution of its own and the district court awarded compensation in its favor. Hernandez contends that this went beyond what he understood his plea agreement to involve, and that his former lawyer failed to challenge the request. He now has new counsel and seeks another hearing about restitution. Restitution is part of a criminal sentence that requires payment to compensate legally recognized victims. It is different from a fine paid to the government. The Mandatory Victims Restitution Act, or MVRA, requires restitution for specified offenses. Here, a central question is whether Gilead was directly and proximately harmed by Hernandez's conspiracy: whether the claimed loss has a sufficiently close causal connection to his offense. The government will defend Gilead as a victim whose legitimate drug sales were displaced by black-market medicines. Hernandez will contest whether that loss was legally attributable to his conduct. There is also a procedural dispute. The Crime Victims' Rights Act lets victims assert certain rights themselves. The judges will examine what that means when prosecutors take no position on a victim's request because of their plea agreement. Finally, the claim of ineffective assistance of counsel requires both deficient representation and prejudice. Under Strickland, prejudice means a reasonable probability of a different result without the lawyer's errors, not simply that the defendant received a large bill. The court will discuss whether the present record resolves those questions or whether further proceedings are needed. Steve Zissou will argue for Hernandez.

Bonnie Owens is defending black lung benefits awarded in connection with her late husband, John Owens, a former coal miner. Lodestar Energy and its insurer, Kentucky Employers' Mutual Insurance, seek to overturn the award. The medical record contained five pulmonary function studies, or breathing tests. Three earlier studies met the regulatory disability criteria; the two later studies did not. How to weigh those conflicting results drives this appeal. The administrative law judge initially denied benefits. The Benefits Review Board sent the case back because the judge had relied on the newer tests without adequately explaining his treatment of the earlier evidence. On remand, meaning reconsideration after that return, he awarded benefits. The Board affirmed, and the employer now seeks review in the Sixth Circuit. Total disability here concerns a breathing impairment that prevents the miner's usual coal mine work or comparable work. A qualifying breathing test meets regulatory thresholds; a non-qualifying result does not, by itself, establish that the miner is healthy. Medical opinions can also support a disability finding. That question is distinct from what caused the impairment. The law calls chronic lung disease caused or substantially aggravated by coal mine dust pneumoconiosis. With at least fifteen years of underground or similarly dusty surface mining and a totally disabling breathing impairment, a miner can invoke a rebuttable presumption that the disability was due to pneumoconiosis. That makes the initial disability finding especially important. You will hear repeated references to Woodward, a case about conflicting chest X-rays. It rejects choosing evidence simply because it is newer, or counting readings without evaluating their quality. The employer will argue that breathing function can improve and that the judge wrongly thought he could not consider the tests' timing. A footnote in his decision says he felt constrained. The widow will defend the judge's overall assessment, rather than treating the newer results as automatically controlling. The court must distinguish a legal error from a permissible weighing of evidence. Tighe Estes will argue for the employer and insurer.

Health benefit funds for retired coal miners and their dependents challenge reductions in their Medicare reimbursement. The plaintiffs are trustees of four United Mine Workers of America plans. This is not a lawsuit over one patient's treatment. It concerns how the federal government reimburses these plans for medical services. Under a longstanding Medicare Part B arrangement, the funds pay physicians for covered care and receive reimbursement from the Centers for Medicare and Medicaid Services, or CMS, based on reasonable costs. Advance payments are reconciled through an annual cost report. That payment chain matters because the funds and the government disagree about where a federal budget cut belongs. The first dispute concerns the two-percent Medicare reduction that began in 2013. You will hear it called sequestration: an automatic reduction in federal spending. The funds reduced their payments to physicians by two percent. CMS then applied a two-percent reduction when calculating the funds' reimbursement. The trustees say that imposes a second cut for the same services and shifts Medicare costs onto money intended for miners' benefits. The government sees two different transactions. It will argue that paying physicians less lowers the funds' actual costs, while the law still requires a reduction in the federal reimbursement calculated from those costs. The judges will examine whether the unusual structure of these plans changes that result. There is also a separate dispute over audits of the funds' 2012 and 2013 cost reports. Contractors found payment errors in samples of claims and extrapolated: they used the samples to estimate overpayments across a larger group. The trustees contend that the statutory conditions for using that method were not met. That is a challenge to the audit method, not a finding that the funds committed fraud. After administrative review, the federal district court upheld the government's treatment of both issues. The trustees now seek reversal in the D.C. Circuit. Ron Connelly will present their appeal.

A Rockville Centre police sergeant claims that reporting a superior's outside business led to retaliation against him. John Beatty says he saw his then-lieutenant working in a bagel shop and told senior officers about it. His concern was that the outside business activity violated department rules. He alleges that he later lost a planned promotion because he spoke up. Those are allegations, not findings that the lieutenant violated a rule or that retaliation occurred. Beatty sued the village and the former police commissioner, and brought this appeal following an adverse federal judgment. The First Amendment question is not simply whether reporting suspected misconduct is worthwhile. Government employees retain free-speech rights, but the law distinguishes speaking as a citizen about a matter of public concern from speaking pursuant to official job duties. Speech required by those duties generally does not support this kind of First Amendment retaliation claim. The inquiry is practical: what was the employee actually employed to do? A broad manual provision requiring officers to report misconduct is not, by itself, decisive. Nor does speaking inside the workplace automatically make speech unprotected. You will hear repeated references to Matthews, another police-officer speech case. There, an officer criticized an arrest-quota policy, and the Second Circuit held that he spoke as a citizen. That does not resolve every later police complaint: the officer's actual responsibilities and the circumstances still matter. A civilian analogue means a comparable channel for speaking that ordinary citizens can use, rather than an employee-only grievance procedure. That is relevant evidence, not an automatic answer. Establishing citizen speech would also not, by itself, establish that an employer retaliated because of it. Wayne Schaefer will present Beatty's appeal.

Northwell Health challenges the dismissal of its lawsuit over hospital bills for patients insured by Blue Cross and Blue Shield of Massachusetts. Northwell provided the care, but its provider contracts are with Empire, the New York Blue Cross company, not the Massachusetts insurer. The BlueCard program connects these separate insurers so patients can obtain care through participating providers outside their home plan. Northwell contends that it was underpaid and that the Massachusetts insurer is responsible. The dispute is about who can enforce which obligations in that payment chain. The district court rejected Northwell's contract and restitution claims, and later denied its proposed amendments as futile, meaning they would not cure the legal deficiencies. This appeal concerns the sufficiency of the pleadings, not a trial determination of what money is actually owed. Both lawyers will discuss an earlier Second Circuit decision they call CareFirst. In that similar dispute, the court allowed Northwell's ratification and quasi-contract theories to proceed, but upheld dismissal of its third-party beneficiary claims. That was a different case, not the resolution of this appeal. Ratification means adopting an otherwise unauthorized act or agreement through conduct, including knowing acceptance of its benefits. A quasi-contract claim seeks restitution to prevent unjust enrichment rather than enforcement of an agreed promise. A third-party beneficiary instead claims a right to enforce a contract made by others for its benefit; receiving an incidental benefit is not enough. Northwell will argue that CareFirst requires revival of its contract and quasi-contract claims, and that its proposed new allegations also support a third-party beneficiary claim. The insurer will defend dismissal of that beneficiary claim while preserving its objections to CareFirst's other reasoning. Alternative legal theories may be pleaded together; that does not authorize double recovery for the same loss.