Aaa Pharmacy, Inc. v. United States

112 Fed. Cl. 387, 2013 U.S. Claims LEXIS 1245, 2013 WL 4714150
CourtUnited States Court of Federal Claims
DecidedAugust 30, 2013
Docket11-877C
StatusPublished

This text of 112 Fed. Cl. 387 (Aaa Pharmacy, Inc. v. United States) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aaa Pharmacy, Inc. v. United States, 112 Fed. Cl. 387, 2013 U.S. Claims LEXIS 1245, 2013 WL 4714150 (uscfc 2013).

Opinion

Summary Judgment; Fifth Amendment Taking; Medicare Part B, 42 U.S.C. 1395 et seq. (2000); 42 C.F.R. § 405.874; Regulatory Taking; Extraordinary Delay; Revocation and Reinstatement of Medicare Billing Privileges; Bad Faith.

MEMORANDUM OPINION AND ORDER

WILLIAMS, Judge.

In this Fifth Amendment takings action, Plaintiff, AAA Pharmacy, Inc., claims that by invoking and failing to timely reinstate its Medicare billing privileges, the Government effected a taking of its business. Plaintiff submits that by the time the Government reinstated its Medicare billing privileges, its business had failed.

Defendant filed a Motion for Summary Judgment arguing that Plaintiff cannot prove it suffered a compensable taking. For the reasons that follow, the Court denies Defendant’s motion.

Background 1

*389 Medicare Statutes and Regulations 2

The Supplementary Medical Insurance Benefits for the Aged and Disabled program (“Medicare Part B”) provides the elderly and persons with disabilities limited coverage for durable medical equipment, prosthetic devices, prosthetics, orthotics and other supplies (“DMEPOS”). 42 U.S.C.A. §§ 1395j, k, m, o, x(s) (West, 2005); 42 C.F.R. §§ 414.200-232 (2005). Medicare Part B is administered by private entities known as carriers that contract with and are overseen by the Centers for Medicare and Medicaid Services (“CMS”), a division of the U.S. Department of Health and Human Services (“HHS”). 42 U.S.C.A. § 1395(u) (West, 2005). A earner may contract with CMS to act as the National Supplier Clearinghouse (“NSC”) for DMEPOS suppliers. 42 C.F.R. § 421.210 (2005).

A NSC reviews DMEPOS supplier enrollment applications to determine whether to issue an applicant a billing number. Id.; 42 C.F.R. §§ 424.57, 489.13(c)(2) (2005). If an applicant meets the standards in 42 C.F.R. § 424.57(b)-(c), the NSC may issue a billing number to allow the supplier billing privileges, including the right to receive Medicare reimbursement for covered items and services the supplier provides.

The Supplier Audit and Compliance Unit (“Compliance Unit”), a division of a NSC, monitors enrolled suppliers to ensure continued compliance with 42 C.F.R § 424.57(b)-(c). If a supplier ceases to comply, the NSC, acting as a delegee of the Government, with CMS, will revoke the supplier’s billing number. 42 C.F.R. §§ 424.57(d), 405.874(b) (2005). “Revocation is effective 15 days after the [NSC] mails [the supplier] notice of [NSC’s] determination.” 42 C.F.R. § 405.874(b) (2005). Once billing privileges are revoked, the supplier may no longer service Medicare beneficiaries or receive Medicare reimbursement. Id.

After a supplier receives notice of revocation, the supplier has 90 days to request a hearing before a neutral party or file a corrective action plan (“CAP”). Id. at (b)-(c), (f). According to the Government, a CAP should “contain[] verifiable evidence of the supplier’s compliance with the Medicare supplier requirements at the time of revocation,” that permits the NSC to reinstate the billing privileges. Def.’s Mot. Summ. J. (“Def.’s Mot.”) 4, Al 19-20, January 14, 2013; 42 C.F.R. § 405.874(f) (2005). After reviewing a CAP, if the NSC determines the supplier is still noncompliant with one or more standards, the revocation will remain in place, although the supplier retains the right to request a hearing within the prescribed time limitations. 42 C.F.R. § 405.874(b) (2005).

If a supplier requests a hearing, the NSC must schedule a hearing within one week of receipt of the request. 42 C.F.R. § 405.874(e) (2005). Within two weeks of the hearing, the hearing officer must issue a decision. Id. Either party may appeal the officer’s decision to an administrative law judge within 60 days. CMS Pub. 100-08, Change Request 3601 (Jan. 14, 2005). 3 A supplier may seek review of the administrative law judge’s decision with the HHS Departmental Appeals Board, and subsequently, may seek judicial review of the full administrative appeal in district court. Id. at (d)(3); 42 U.S.C. § 1395cc(j)(2) (Supp. V 2005); 42 U.S.C. § 405(g) (2000); CMS Pub. 100-08, Change Request 3601 (Jan. 14, 2005); see Anderson v. Sullivan, 959 F.2d 690, 692 (8th Cir.1992); see also Ahmed v. Sebelius, 710 F.Supp.2d 167, 172-73 (D.Mass.2010).

The Revocation of Plaintiff’s Medicare Billing Privileges

Plaintiff, now a defunct business, previously operated in Oklahoma as a licensed phar *390 macy and DMEPOS supplier with Medicare billing privileges. Compl. ¶ 32, Dec. 14, 2011; Def.’s Mot. 7, A15. 4 While Plaintiff “filled prescriptions for private pay individuals, insurance beneficiaries, Medicare beneficiaries, and Medicaid beneficiaries,” Plaintiff alleges that “[t]he vast majority of [its] business was done through Medicare beneficiaries.” Compl. ¶ 5.

Although physically located in Hobart, Oklahoma, Plaintiff conducted a large portion of its business through the mail, doing business in 28 states. Def.’s Mot. Al, A15-A16; Compl. ¶ 9.

On or about February 2005, Plaintiff “moved its license” from 530 Main Street, Hobart, Oklahoma to 304 S. Broadway, Suite C, Hobart, Oklahoma, but continued to maintain its records at the 530 Main Street address. Def.’s Mot. A16.

On March 1, 2005, the CMS “AR/OK Ombudsman” conducted an in-service visit at Plaintiffs 304 S. Broadway address, and according Plaintiff, the Ombudsman determined Plaintiff was in compliance with supplier standards, including requirements imposed by the Americans with Disabilities Act. Id. at A16, A22.

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Bluebook (online)
112 Fed. Cl. 387, 2013 U.S. Claims LEXIS 1245, 2013 WL 4714150, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aaa-pharmacy-inc-v-united-states-uscfc-2013.