American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Official Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, M.D., in His Official Capacity as Secretary, United States Department of Health and Human Services

938 F.2d 216, 290 U.S. App. D.C. 397, 1991 U.S. App. LEXIS 13580
CourtCourt of Appeals for the D.C. Circuit
DecidedJuly 2, 1991
Docket90-5259
StatusPublished
Cited by6 cases

This text of 938 F.2d 216 (American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Official Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, M.D., in His Official Capacity as Secretary, United States Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, in His Official Capacity as Secretary, United States Department of Health and Human Services, American Hospital Association, an Illinois Non-Stock Corporation, Individually and on Behalf of Its Members v. Louis W. Sullivan, M.D., in His Official Capacity as Secretary, United States Department of Health and Human Services, 938 F.2d 216, 290 U.S. App. D.C. 397, 1991 U.S. App. LEXIS 13580 (D.C. Cir. 1991).

Opinion

938 F.2d 216

290 U.S.App.D.C. 397, 60 USLW 2034,
34 Soc.Sec.Rep.Ser. 219,
Medicare&Medicaid Gu 39,465

AMERICAN HOSPITAL ASSOCIATION, an Illinois Non-Stock
Corporation, Individually and on Behalf of its
Members, et al.,
v.
Louis W. SULLIVAN, in his Capacity as Secretary, United
States Department of Health and Human Services, et
al., Appellants.
AMERICAN HOSPITAL ASSOCIATION, an Illinois Non-Stock
Corporation, Individually and on Behalf of its
Members, et al.,
v.
Louis W. SULLIVAN, in his Official Capacity as Secretary,
United States Department of Health and Human
Services, et al., Appellants.
AMERICAN HOSPITAL ASSOCIATION, an Illinois Non-Stock
Corporation, Individually and on Behalf of its
Members, et al.,
v.
Louis W. SULLIVAN, M.D., in his Official Capacity as
Secretary, United States Department of Health and
Human Services, et al., Appellants.

Nos. 90-5259, 90-5301, 90-5327.

United States Court of Appeals,
District of Columbia Circuit.

Argued April 2, 1991.
Decided July 2, 1991.

Appeals from the United States District Court for the District of Columbia (Civil Action No. 88-02027).

Frank A. Rosenfeld, Attorney, Dept. of Justice, with whom Stuart M. Gerson, Asst. Atty. Gen., Jay B. Stephens, U.S. Atty., and Anthony J. Steinmeyer, Attorney, Dept. of Justice, were on the brief, Washington, D.C., for appellants. Jeffrey Clair, Attorney, Dept. of Justice, also entered an appearance, Washington, D.C., for appellants.

Gregory M. Luce, Washington, D.C., for appellees.

Before EDWARDS, D.H. GINSBURG, and SENTELLE, Circuit Judges.

Opinion for the Court filed by Circuit Judge SENTELLE.

Dissenting Opinion filed by Circuit Judge D.H. GINSBURG.

SENTELLE, Circuit Judge:

Appellant Secretary of Health and Human Services ("the Secretary" or "appellant") appeals from two District Court orders allowing attorneys' fees against the Secretary under 28 U.S.C. Sec. 2412(b) on findings that appellant acted in "bad faith." Because we hold that the District Court's finding of bad faith on the part of appellant is not clearly erroneous, we affirm.

I. BACKGROUND

The attorneys' fees issue arises in the context of a lawsuit brought by the American Hospital Association and eleven additional hospital associations (collectively "AHA"), on behalf of their member hospitals, challenging the Department of Health and Human Services's ("HHS" or "appellee") Medicare secondary payer regulations.

In 1980, Congress amended 42 U.S.C. Sec. 1395y(b)(1) to exclude from Medicare coverage services that had been paid for or could reasonably be expected to be paid for by liability insurance. Under Sec. 1395y(b)(1) Medicare was essentially a secondary payer; hospitals were required to pursue payment from liability insurance carriers for services when they reasonably could expect those payments to be made promptly before Medicare payments would be made. In 1988, HHS issued a revised Manual section, see Medicare Intermediary Manual Sec. 3419 (1988), and proposed regulations, see Medicare as Secondary Payer and Recovery Against Third Parties, 53 Fed.Reg. 22,335 (1988) (to be codified as 42 C.F.R. pts. 405, 411 & 489) (proposed June 15, 1988), prohibiting hospitals from pursuing payment from liability insurers under any circumstances and requiring hospitals to accept payment from Medicare. The Secretary pressed for the change because "the hospital's collection of larger sums from insurers than they could collect from Medicare ... allow[ed] providers to invade sums that would otherwise be available to compensate the beneficiary for other items of damages, such as lost earnings or pain and suffering." Brief for the Appellants at 5.

Shortly after HHS's notice of proposed rulemaking, AHA filed a complaint seeking declaratory and injunctive relief from HHS's revised policy. After hearing, and in lieu of a preliminary injunction, the Secretary of HHS entered into a stipulation with AHA specifying that, pending the outcome of the suit, AHA's member hospitals could continue to bill liability insurers directly for services provided and could file liens against recoveries by Medicare beneficiaries from third-party liability insurers, so long as any such sums collected were placed in escrow. Under a Joint Stipulation and Order ("Stipulation"), HHS agreed not to

terminate, institute termination proceedings, or threaten to terminate the Medicare provider agreement of any member hospital, or impose any other sanction ... on grounds that the member hospital has billed willing liability insurance carriers ... under the circumstances as described in 42 U.S.C. Sec. 1395y(b)(1) or any manual provisions, directives, instructions, or rules or regulations, existing or proposed, that interpret or implement 42 U.S.C. Sec. 1395y(b)(1).

Stipulation, Civ. No. 88-2027 at 2, 3 (Aug. 24, 1988).

Despite the existence of the Stipulation, on October 11, 1989, the Secretary published regulations prohibiting hospitals from billing directly liability insurers or placing liens on Medicare beneficiaries' recoveries from third-party insurers. See Medicare as Secondary Payer and Medicare Recovery Against Third Parties, 54 Fed.Reg. 41,716 (1989) (to be codified at 42 C.F.R. pts. 405, 411, 412, and 489) ("Final Rule"). In the Final Rule, which was to become effective November 13, 1989, the Secretary made an express exemption of hospitals involved in a lawsuit against HHS in Oregon, but no exemption for AHA hospitals.

One week after publication of the Final Rule, AHA filed a Second Motion for Preliminary Injunction requesting that the District Court restrain HHS from enforcing the regulation against its member hospitals. The Secretary responded by filing a Renewed Motion to Dismiss and Opposition to the Second Motion for Preliminary Injunction, arguing, inter alia, that the Final Rule was never meant to supersede the Stipulation. On the same day, October 26, 1989, the Secretary issued a directive to his regional administrators requiring them to send letters of clarification to intermediaries (responsible for the initial process of Medicare claims) stating that the regulation would not apply to AHA hospitals.

On November 9, 1989, the District Court ruled that HHS's enforcement of certain provisions of the regulation would be contrary to the Stipulation, enjoined HHS from enforcing the Final Rule against AHA's member hospitals, and required HHS to publish the order granting the injunction along with a copy of the Stipulation in the Federal Register as an exemption to the Final Rule. Order, Civ. No. 88-2027 at 2-3 (Nov. 9, 1989). The court also awarded AHA costs, expenses, and attorneys' fees incurred in preparing and filing the second motion for an injunction. Id. at 3-4.

On May 24, 1990, the District Court denied HHS's motion to reconsider the award of fees, ruling that HHS's publication of the Final Rule without an exception for AHA violated the Stipulation and was done "willfully, and in bad faith." Memorandum Opinion and Order, Civ. No. 88-2027 at 3 (May 24, 1990).

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938 F.2d 216, 290 U.S. App. D.C. 397, 1991 U.S. App. LEXIS 13580, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-hospital-association-an-illinois-non-stock-corporation-cadc-1991.