DaVita Healthcare Partners, Inc. v. United States

125 Fed. Cl. 394, 2016 U.S. Claims LEXIS 205, 2016 WL 1072952
CourtUnited States Court of Federal Claims
DecidedJanuary 21, 2016
DocketNo. 11-297C
StatusPublished
Cited by1 cases

This text of 125 Fed. Cl. 394 (DaVita Healthcare Partners, 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
DaVita Healthcare Partners, Inc. v. United States, 125 Fed. Cl. 394, 2016 U.S. Claims LEXIS 205, 2016 WL 1072952 (uscfc 2016).

Opinion

Motion In Limine; Electronic Discovery; Electronically Stored Information; Amendments to Fed. R. Civ. P. 1 and 37; Rule 37(c); Fed. R. Evid. 1006.

OPINION AND ORDER

WILLIAMS, Judge

This matter comes before the Court on Defendant’s motion in limine, seeking to exclude from the record data produced after the close of discovery and alleged summaries.1 For the reasons stated below, Defendant’s motion is denied.

Background2

In this action, Plaintiffs claim that the United States Department of Veterans Affairs (“VA”) underpaid for dialysis services Plaintiffs provided pursuant to both express contracts and regulations. The instant discovery dispute concerns the VA’s alleged failure to pay Plaintiffs amounts'required under regulation for services rendered pursuant to authorizations.

Under 38 C.F.R. § 17.52(a), the VA may use individual authorizations to furnish medical services when there is infrequent demand for such care or services. Section 17.56 governs payment for dialysis services provided pursuant to authorizations. The version of § 17.56 effective from March 7, 2005 until February 14, 2011, provided:

Payment for non-VA physician and other health care professional services.

(a) Except for anesthesia services ..., payment for non-VA health care professional services associated with outpatient and inpatient care provided at non-VA facilities authorized under § 17.52 or made under § 17.120 of this part, shall be the lesser of the amount billed or the amount calculated using the formula developed by the Centers for Medicare and Medicaid Services’ (CMS) participating physician fee schedule for the period in which the service is provided. This payment methodology is set forth in paragraph (b) of this section. If no amount has been calculated under Centers for Medicare and Medicaid Services’ participating physician fee schedule or if the services constitute anesthesia services, payment for such non-VA health care professional services associated with outpatient and inpatient care provided at non-VA facilities ... shall be the lesser of the actual amount billed or the amount calculated using the 75th percentile methodology set forth in paragraph (c) of this section; or the usual and customary rate if there are [396]*396fewer than 8 treatment occurrences for a procedure during the previous fiscal year.
(c) Payment under the 75th percentile methodology is determined for each VA medical facility by ranking all occurrences (with a minimum of eight) under the corresponding code during the previous fiscal year with charges ranked from the highest rate billed to the lowest rate billed and the charge falling at the 75th percentile as the maximum amount to be paid.
* *
(e) Payments made in accordance with this section shall constitute payment in full. Accordingly, the provider or agent for the provider may not impose any additional charge for any services for which payment is made by VA.

38 C.F.R. § 17.56 (2005) (internal citations omitted).

In 2008, without amending 38 C.F.R. § 17.56, the VA announced that effective January 1, 2009, it would begin reimbursing dialysis providers at Medicare rates, instead of the 75th percentile rate specified in the regulation. Third Am. Compl. ¶ 53, Ex. F. On July 29, 2009, the VA issued a memorandum rescinding its 2008 announcement effective July 24, 2009, because “the decision to implement utilization of Medicare fee schedules to pay for care and services other than physician and non-physician professional services did not comply with provisions of the Administrative Procedure Act.” Id, at Ex. F. On November 18, 2009, the VA’s National Fee Program Office Manager issued a letter to providers stating that in the absence of a contract, pursuant to 38 C.F.R. § 17.56(a), the VA would reimburse providers for claims filed between January 1, 2009, and June 24, 2009, at the lesser of the actual amount billed by the provider or the 75th percentile methodology set forth in 38 C.F.R. § 17.56(c). Id. at Ex. G. The VA informed providers that it would reconsider claims for dialysis services that had been erroneously reimbursed at Medicare rates if submitted to the Financial Services Center within 90 days. Id On December 17, 2010, the VA amended its regulations to allow for providers to be paid at the Medicare rate effective February 15, 2011. Id. at ¶32 (citing 75 Fed.Reg. 78,901 (Dee. 17, 2010)).

DaVita provided dialysis services via authorizations from 2005 through February 15, 2011. Id. at ¶¶ 36, 65. DaVita seeks reimbursement for alleged underpayments for these noncontract services provided from 2005 to January 1, 2009, and from between July 25, 2009, and February 15, 2011. Id. at ¶ 70. For dialysis services between January 1, 2009, and June 24, 2009, DaVita resubmitted its noncontract claims to the Financial Services Center, as advised in the November 18, 2009 letter from the VA, directing dialysis providers to submit prior dialysis claims to be reimbursed at the 75th percentile rate. Id. at ¶ 53. When the Financial Services Center denied the resubmitted claims, DaVi-ta appealed the denials to specific Veterans Affairs Medical Centers, as the Financial Services Center had instructed. DaVita alleges that the VA still owes “substantial sums on these claims.” Id. at ¶ 65, 67.

Procedural History and the Instant Discovery Dispute

On May 12, 2011, after the Contracting Officer denied DaVita’s contract-based claim and the Financial Services Center denied its authorization-based claims, Plaintiffs filed a complaint in this Court. The parties have since engaged in contentious and prolonged discovery and motions practice, spanning multiple years and including 17 proceedings before this Court, totaling over 23 hours. Thirteen motions for enlargement of time have been filed by Defendant, nine by Plaintiffs, as well as two joint motions. On March 28, 2013, the Court denied Defendant’s motion to dismiss. DaVita, Inc. v. United States, 110 Fed.Cl. 71, 75-79 (2013).

This matter comes before the Court on Defendant’s motion in limine to exclude certain data Plaintiffs produced in response to discovery requests. Defendant’s motion relates to two categories of Plaintiffs’ production of documents: (1) all documents produced after the close of fact discovery on December 10, 2014, and (2) alleged summaries. Both the alleged late productions and [397]*397summaries reflect claims submitted to the YA for dialysis services provided to veterans by Plaintiffs under authorizations. The documents themselves are described to be “voluminous datasets” and are not before the Court in their entirety.

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Related

Davita Healthcare Partners, Inc. v. United States
128 Fed. Cl. 584 (Federal Claims, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
125 Fed. Cl. 394, 2016 U.S. Claims LEXIS 205, 2016 WL 1072952, Counsel Stack Legal Research, https://law.counselstack.com/opinion/davita-healthcare-partners-inc-v-united-states-uscfc-2016.