Archer v. Cirrincione

722 F. Supp. 1118, 1989 U.S. Dist. LEXIS 12373, 1989 WL 125147
CourtDistrict Court, S.D. New York
DecidedOctober 18, 1989
Docket88 Civ. 4015 (PKL)
StatusPublished
Cited by2 cases

This text of 722 F. Supp. 1118 (Archer v. Cirrincione) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Archer v. Cirrincione, 722 F. Supp. 1118, 1989 U.S. Dist. LEXIS 12373, 1989 WL 125147 (S.D.N.Y. 1989).

Opinion

ORDER & OPINION

LEISURE, District Judge:

Plaintiff Yvonne Archer brings this action under the Freedom of Information Act (“FOIA”) requesting documents related to the administration of Part B of the Medicare Program. Plaintiff also asks that the Court hold a hearing to determine if defendant Ross Cirrincione, an employee of defendant Department of Health and Human Services (“HHS”), 1 intentionally blocked and delayed legitimate FOIA requests. Defendants argue in response that the materials demanded by plaintiff are protected against disclosure by a specific statutory exception to the FOIA. Defendant Cirrincione claims that individual administrators are not permissible defendants in FOIA cases, and that in any case his refusal to release the requested documents was legally proper.

Both defendants moved for summary judgment under Fed.R.Civ.P. 56 on the issues of document disclosure and the hearing on defendant Cirrincione. Defendant Cirrincione moved to dismiss the claim against him for lack of subject matter jurisdiction, or, in the alternative, under Fed.R. Civ.P. 12(b)(6). Plaintiff opposed defendants’ motions and filed a cross-motion for summary judgment.

BACKGROUND

Plaintiff Yvonne Archer challenges the propriety of a decision by HHS to cut in half the payment limit for anesthesia during cataract surgery under Part B of the Medicare Program. Archer alleges that HHS failed in its statutory duty to consider public comments submitted in response to the proposed agency action. HHS answers that the documents requested consist primarily of early drafts of the final regulation which would not be available to an opposing party in a standard civil litigation. Thus they are accorded special protection against disclosure under 5 U.S.C. § 552(b)(5) [“Exemption (b)(5)”] of the FOIA. Before discussing in detail the facts and legal issues of this case, a brief overview of the relevant statutes is in order.

The Medicare Act of 1965, 42 U.S.C. § 1395, is divided into two sections, Part A and Part B. Part A establishes major medical insurance for hospital care and related post-hospitalization services. 42 U.S.C. §§ 1395c—1395i. Part B provides additional coverage for persons over 65 and the disabled. 42 U.S.C. §§ 1395j—1395w. Eligible individuals voluntarily enroll in Part B and pay periodic premiums into a federally subsidized fund. Under Part B, the Secretary of HHS is authorized to contract with private insurance companies to administer the claims process. 42 U.S.C. § 1395u. A person enrolled in Part B files a claim with his private carrier for reimbursement for medical expenses. If the carrier determines that the services were “medically necessary,” the expenses “rea *1120 sonable,” and the claims otherwise payable out of Part B, it then satisfies the claimant out of the federally subsidized fund. 42 U.S.C. § 1395u(b)(3).

The Department of Health and Human Services limits coverage for services provided if it determines that the expenses incurred are not reasonable. Section 1395u(b)(8)(C) states in part that “[i]n determining whether to adjust payment rates ..., the Secretary shall consider the potential impacts on quality, access, and beneficiary liability of the adjustment....” For HHS to change what it considers to be a reasonable charge for a particular service, the agency must follow a special notice- and-comment procedure built into the Medicare Act. First, the Secretary of HHS must see to “appropriate consultation with representatives of the physicians likely to be affected by any change_” 42 U.S.C. § 1395u(b)(9)(A). Then the Secretary must publish notice of the proposed limit adjustment in the Federal Register. Id. This notice must contain the “factors and data” relied on in setting the new limit and its “potential impacts.” Id. at 1395u(b)(9)(B). The public is then given an opportunity to submit comments on the suggested change, id. at 1395u(b)(9)(C), and the Secretary must “tak[e] into consideration” these comments in making his final determination. Id. at 1395u(b)(9)(E)(i). The final decision of the Secretary is also published in the Federal Register and must include the factors relied on and responses to the public comments. Id. at 1395u(b)(9)(E)(ii).

In August, 1986, HHS announced in the Federal Register its intention to cut in half the coverage limit for anesthesia during cataract operations. 51 Fed.Reg. 28710 (August 11, 1986); 51 Fed.Reg. 29316 (August 15, 1986). In response to this initial notice, HHS received approximately 300 written comments from the public, most of which opposed the suggested adjustment. The Secretary decided not to change his opinion on the issue, and on October 7, 1986, HHS published its final rule. 51 Fed. Reg. 35693 (October 7, 1986).

In its notice accompanying the final rule, HHS responded to some of the more frequently voiced objections. The public comments addressed such concerns as a potential drop-off in the participation rate of anesthesiologists and the effects of the proposal on the quality of care. Alternate options were put forward, such as reducing the coverage limit by a lesser amount, phasing the new limit in over a period of three years, and retaining the old higher limit for general anesthesia. The agency responded to each of these comments in turn. The answers reflect at least some consideration by HHS of the comments submitted by the public. Finally, the agency projected a fiscal savings of $405 million over five years and an average reduction of 2% in the gross incomes of anesthesiologists. 51 Fed.Reg. 35693, 35695-700 (October 7, 1986).

On June 7, 1988, plaintiff filed a FOIA request with HHS asking for copies of all the public comments received, and all “minutes, memoranda, notes and other documents” relating to the consideration by the agency of the public comments and any consultations with representatives of the physicians likely to be affected by the proposed changes. Complaint ¶ 15. In response to the initial request, HHS produced 685 pages of documents. The agency refused to release an additional 190 pages “because they were predecisional internal agency documents that reflected agency deliberations.” Defendants’ brief at 2. Plaintiff then filed this suit to compel production of the withheld documents.

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Bluebook (online)
722 F. Supp. 1118, 1989 U.S. Dist. LEXIS 12373, 1989 WL 125147, Counsel Stack Legal Research, https://law.counselstack.com/opinion/archer-v-cirrincione-nysd-1989.