Board of Trustees of the University of Alabama v. Becerra

District Court, District of Columbia·Decided August 6, 2025·No. Civil Action No. 2022-3367·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

BOARD OF TRUSTEES OF THE : UNIVERSITY OF ALABAMA et al., :

:

Plaintiffs, : Civil Action No.: 22-3367 (RC)

:

v. : Re Document Nos.: 17, 18 :

XAVIER BECERRA, :

:

Defendant. :

MEMORANDUM OPINION

DENYING PLAINTIFFS’ MOTION FOR SUMMARY JUDGMENT; GRANTING DEFENDANT’S CROSS-

MOTION TO DISMISS

I. INTRODUCTION

The Board of Trustees of the University of Alabama, the Health Care Authority for Baptist Health East, an Affiliate of UAB Health System, and Health Care Authority for Baptist Health South, an Affiliate of UAB Health System (collectively, “Plaintiffs”) filed a consolidated action against Xavier Becerra,1 in his official capacity as Secretary of Health and Human Services (“HHS”) (“Defendant” or the “HHS Secretary”). Plaintiffs initially pursued administrative appeals within the Medicare program to recover underpayments for 340B outpatient drugs. When those appeals proved unsuccessful, Plaintiffs filed separate civil actions under 42 U.S.C. § 405(g) and 42 U.S.C. § 1395ff to recover the underpaid amounts. Although Defendant has since refunded the principal underpayments, Plaintiffs allege that the HHS Secretary has failed to pay interest on those underpayments pursuant to 42 U.S.C. § 1395l(j) and

1 Robert F. Kennedy, Jr. was sworn in as the Secretary of HHS on February 13, 2025 and is automatically substituted for Xavier Becerra as a defendant in this action pursuant to Fed. R. Civ. P. 25(d).

42 C.F.R. § 405.378. In this action, Plaintiffs move for summary judgment seeking an order from this Court directing the HHS Secretary to pay outstanding interest and fully reimburse Plaintiffs. Pls.’ Mem. Supp. Mot. Summ. J. (“Pls.’ Mot.”), ECF No. 17-1. Defendant provides multiple justifications for declining to pay interest on Plaintiffs’ underpaid claims, but ultimately, all of them argue that the language in 42 U.S.C. § 1395l(j) is unclear and that the HHS Secretary’s interpretation of the statute should be given deference. Additionally, the HHS Secretary moves to dismiss for lack of jurisdiction because he argues that Plaintiffs’ claims are moot and Plaintiffs are not entitled to recover interest. Opp’n Pls.’ Mot. Summ. J. & Cross-Mot. Dismiss (“Def.’s Cross-Mot.”), ECF No. 18. Plaintiffs opposed Defendant’s motion, see Pls.’ Mem. Supp. Mot. Summ. J. & Opp’n Def.’s Mot. Dismiss (“Pls.’ Reply”), ECF No. 20, which Defendant subsequently replied to, see Reply Supp. Cross-Mot. Dismiss (“Def.’s Reply”), ECF No. 22, and Plaintiffs responded to Defendant’s reply with an unopposed surreply that the Court granted leave to file, see Pls.’ Surreply to Def.’s Reply Mem. Supp. Cross-Mot. Dismiss (“Pls.’ Surreply”), ECF No. 23-1. For the foregoing reasons, Plaintiffs’ motion for summary judgment is denied and Defendant’s cross-motion to dismiss is granted.

II. FACTUAL AND PROCEDURAL BACKGROUND Plaintiffs are three hospitals that participate in the Medicare program and purchase drugs at discounted rates under section 340B of the Public Health Service Act (“PHSA”) (the “340B Program”). See, Compl. ¶¶ 10, 18, ECF No. 1. In 1992, Congress established the 340B Program to reduce drug costs for certain non-profit and public hospitals and federally funded clinics serving many low-income patients in an effort to maximize the use of limited federal funds to reach more patients. Id. at ¶ 4. “Hospitals participating in the 340B Program purchase 340B drugs at steeply discounted prices, and when those hospitals prescribe the 340B drugs to

Medicare beneficiaries they are reimbursed by HHS at [Hospital Outpatient Prospective Payment System (“]OPPS[“)] rates.” Id. at ¶ 5 (quoting Am. Hosp. Ass’n v. Azar, 348 F. Supp. 3d 62, 69 (D.D.C. 2018) rev’d on other grounds, 967 F.3d 818 (D.C. Cir. 2020), rev’d and remanded, Am. Hosp. Ass’n v. Becerra (“AHA”), 596 U.S. 724 (2022). Prior to Fiscal Year (“FY”) 2018, Medicare reimbursed all hospitals at a rate of 6% above the average sales price (“ASP”) for outpatient drugs. 42 U.S.C. § 1395l(t)(14)(A)(iii)(II) (citing 42 U.S.C. § 1395w–3a). Beginning in FY 2018, the HHS Secretary reduced the payment rate for separately payable 340B-acquired drugs to 22.5% below the ASP, which Plaintiffs alleged was in violation of the explicit statutory requirements for calculating such reimbursements. See 42 U.S.C. § 1395l(t)(14)(A)(iii)(I)–(II); see also Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, 82 Fed. Reg. 52356, 52493–511, 52622–25 (Nov. 13, 2017) (codified at scattered parts of 42 C.F.R.) (“CY 2018 Final Rule”); Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs, 83 Fed. Reg. 58818, 58079– 81 (Nov. 21, 2018) (codified at scattered parts of 42 C.F.R.) (“CY 2019 Final Rule”); Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Revisions of Organ Procurement Organizations Conditions of Coverage; Prior Authorization Process and Requirements for Certain Covered Outpatient Department Services; Potential Changes to the Laboratory Date of Service Policy; Changes to Grandfathered Children's Hospitals-Within-Hospitals; Notice of Closure of Two Teaching Hospitals and Opportunity To Apply for Available Slots, 84 Fed. Reg. 61142, 61317–27 (Nov. 12, 2019) (codified at scattered parts of 42 C.F.R.) (“CY 2020 Final Rule”); Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical

Center Payment Systems and Quality Reporting Programs; New Categories for Hospital Outpatient Department Prior Authorization Process; Clinical Laboratory Fee Schedule: Laboratory Date of Service Policy; Overall Hospital Quality Star Rating Methodology; Physician-Owned Hospitals; Notice of Closure of Two Teaching Hospitals and Opportunity To Apply for Available Slots, Radiation Oncology Model; and Reporting Requirements for Hospitals and Critical Access Hospitals (“CAHs”) To Report COVID-19 Therapeutic Inventory and Usage and To Report Acute Respiratory Illness During the Public Health Emergency (“PHE”) for Coronavirus Disease 2019 (“COVID-19”), 85 Fed. Reg. 85866, 86050 (Dec. 29, 2020) (codified at scattered parts of 42 C.F.R.) (“CY 2021 Final Rule”); and Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Radiation Oncology Model, 86 Fed. Reg. 63458, 63644 (Nov. 16, 2021) (codified at scattered parts of 42 C.F.R.) (“CY 2022 Final Rule”). Id.

The reduction to the 340B reimbursement rate was challenged in the lawsuit AHA. 596 U.S. 724. In AHA, the plaintiff hospital association argued that the HHS Secretary lacked the authority to set such a reduced payment rate, contending that it violated the Social Security Act and the Administrative Procedure Act (“APA”). Pls.’ Mot. at 4; see AHA, 596 U.S. at 734. After years of litigation, the Supreme Court ruled in favor of AHA in 2022, holding that the HHS Secretary’s reduced reimbursement rate for the 340B Program was unlawful. 596 U.S. at 739. The Supreme Court found that the HHS Secretary failed to reimburse 340B hospitals at the statutorily prescribed rate and further determined that changing the reimbursement rate for 340B hospitals in 2018 was impermissible. Id. The Supreme Court remanded the case for further

proceedings, leaving unresolved the issue of how to address the underpayments to the affected hospitals. Id.

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