Healey v. Leavitt

485 F.3d 63
Court of Appeals for the Second Circuit·Decided April 17, 2007·No. 06-0525-cv·Published·Cited by 48 cases

Opinion

KATZMANN, Circuit Judge.

This case arises out of a class action suit filed on behalf of home-bound Medicare beneficiaries who rely on Medicare coverage for various in-home services provided by home health agencies (“HHAs”). The merits of the plaintiffs’ action have already been resolved, and we are called upon to determine whether the plaintiffs are entitled to attorneys’ fees under the Equal Access to Justice Act, 28 U.S.C. § 2412 (“EAJA”), and, if so, the scope of that award. We hold that the district court did not abuse its discretion in awarding the plaintiffs attorneys’ fees or in reducing the amount of those fees to reflect them overall success in the litigation. It did, however, abuse its discretion in awarding the plaintiffs fees at an hourly rate above the EAJA statutory cap. The decision of the district court is affirmed in part and reversed in part.

I

In 1998, the plaintiffs, a class of elderly and disabled Medicare beneficiaries who faced the reduction or termination of home health care services provided by HHAs, sued the Department of Health and Human Services (“HHS”). The plaintiffs sought declaratory and injunctive relief that would require HHS to compel HHAs to provide greater procedural protections before reducing or terminating home health services provided to Medicare beneficiaries. Because the facts and procedural posture of this case have already been set out in some detail, see Lutwin v. Thompson, 361 F.3d 146 (2d Cir.2004); Healey v. Thompson, 186 F.Supp.2d 105 (D.Conn.2001) (“Healey II); Healey v. Shalala, No. 98 Civ. 418(DJS), 2000 WL 303439 (D.Conn. Feb.11, 2000) (“Healey I”), we set forth below only such facts as are necessary to resolve this appeal.

When the plaintiffs first brought suit, Medicare beneficiaries confronted with an adverse coverage determination by an HHA could obtain review of that decision only if they satisfied two conditions. First, they had to request that the HHA submit a claim to the Health Care Financing Administration (the “HCFA”), the agency within HHS that then administered Medicare, for those services or items that the HHA believed were not covered. This was commonly known as a “demand bill.” Lut-win, 361 F.3d at 149. Second, they had to agree to pay the HHA for the care provided if the HCFA affirmed the adverse coverage determination. Id. To complicate matters further, there was no procedure in place for providing pre-deprivation notice to beneficiaries that their coverage had been reduced or terminated. Accordingly, many beneficiaries may not have even been aware of the “demand bill” review *66 process. Relying on the Medicare statute, 42 U.S.C. § 1395bbb, the plaintiffs challenged this scheme for failing to provide them with: (1) advance written notification of the reduction or termination of coverage; (2) specific reasons for the reduction or termination; and (3) an explanation of the “demand bill” process. They also argued that they were entitled to pre-depri-vation review under the Due Process Clause. The magistrate judge and district court agreed with the plaintiffs with respect to their challenges under the Medicare statute and found it unnecessary to reach the plaintiffs’ constitutional claim. The district court adopted the magistrate judge’s recommendation that it enter a declaratory judgment, establishing that, inter alia, “plaintiffs have a legal right to a written: (1) pre-deprivation statement why the HHA believes Medicare may not ... cover their services ... (2) explanation of the circumstances in which a beneficiary has the right to have a demand bill submitted, and (3) disclosure of information regarding a patient’s right to appeal.” Healey I, 2000 WL 303439, at * 1 (internal quotation marks omitted), adopted by Healey v. Shalala, No. 98 Civ 418(DJS), 2000 WL 436618 (D.Conn. March 1, 2000).

Four months after the district court’s decision, HCFA implemented a new system which, inter alia, required HHAs to provide mandatory notice to Medicare beneficiaries when making adverse coverage decisions. HCFA made clear, however, that it believed such notice was required only when the HHA determined that the treatment was not within the scope of Medicare’s coverage. Thus, under its view, notice was not required when a beneficiary’s treating physician ordered that the home health care be reduced or terminated. Lutwin, 361 F.3d at 150-52. Following these changes, the plaintiffs renewed their challenges to the notice procedures, arguing that the Medicare statute required that Medicare beneficiaries receive notice when an HHA terminates coverage for any reason, not just because it has determined that Medicare no longer covers the treatment, and that the Due Process Clause requires pre-deprivation review of an HHA’s adverse coverage determination. Id. at 152. This time, the magistrate judge rejected the plaintiffs’ claims, Healey II, 186 F.Supp.2d at 121-22, and the district court adopted his recommendation that plaintiffs were entitled to neither of these forms of additional relief, see id. at 107.

On appeal, a divided panel of this Court held that the Medicare statute unambiguously requires that the HHAs give written notice before they reduce or terminate home health services for any reason, including for lack of physician certification. Lutwin, 361 F.3d at 156; id. at 158 (Winter, J., dissenting). The panel affirmed, however, the district court’s conclusion that pre-deprivation review was not required under either the statute or the Constitution. Id. at 158.

The plaintiffs then sought attorneys’ fees under the EAJA. The district court determined that the Government’s position was not “substantially justified” and awarded fees. Healey v. Leavitt, No. 98 Civ. 418(DJS), 2005 WL 2850163, at *3 (D.Conn. Oct.26, 2005) (‘Healey III”). It further held that the “specialized expertise” of the plaintiffs’ counsel entitled them to an enhanced rate of compensation under the statute, id. at *4, but that a reduction in the amount of the fee was appropriate to reflect the plaintiffs’ lack of success on their claims that they were entitled to pre-deprivation hearings, id. at *5. The Government appealed the district court’s holdings that a fee award was appropriate and that the plaintiffs’ counsel were entitled to an enhanced rate of compensation. The plaintiffs, in turn, appealed the district *67 court’s reduction in the overall amount of the award.

II

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