Larry V. Bishins v. U.S. Secretary Department of Health and Human Services

Court of Appeals for the Eleventh Circuit·Decided July 24, 2025·No. 24-10008·Unpublished

Opinion

[DO NOT PUBLISH]

In the United States Court of Appeals For the Eleventh Circuit

No. 24-10008 Non-Argument Calendar

LARRY V. BISHINS, Plaintiff-Appellant, versus UNITED STATES SECRETARY OF HEALTH AND HUMAN SERVICES, Defendant-Appellee.

Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 6:23-cv-00614-DCI

USCA11 Case: 24-10008 Document: 44-1 Date Filed: 07/24/2025 Page: 2 of 22

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Before LUCK, LAGOA, and WILSON, Circuit Judges. PER CURIAM:

Larry Bishins, proceeding pro se, appeals the district court’s dismissal of his action against the Secretary of the United States Department of Health and Human Services (“HHS”), concerning the denial of Bishins’s Medicare coverage for his Continuous Positive Airway Pressure (“CPAP”) machine equipment and supplies and concerning HHS’s response to his related request under the Freedom of Information Act (“FOIA”).1 After careful review, we affirm the dismissal of Bishins’s actions without leave to amend for the reasons stated below.

I. FACTUAL AND PROCEDURAL BACKGROUND

The facts on appeal are as follows:2 In 2014, Bishins’s doctor diagnosed him with obstructive sleep apnea, ordered a sleep study, and recommended a CPAP machine . Bishins subsequently obtained a CPAP machine from a medical supplies vendor, and Medicare paid for this machine and for Bishins’s CPAP supplies and equipment for the next year.

1 Pursuant to 28 U.S.C. § 636(c), the parties consented to a magistrate judge

conducting all proceedings. 2 “We accept the factual allegations in the complaint as true and construe them

in the light most favorable to the plaintiff.” Myrick v. Fulton Cnty., Georgia, 69 F.4th 1277, 1294 (11th Cir. 2023).

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In August 2015, however, the Center for Medicare and Medicaid Services (“CMS”), which administers the Medicare program, advised Bishins’s medical supplies vendor that it would no longer pay his CPAP-related claims. Medicare had audited Bishins’s file and determined that two documents were missing and one could not be read, so the requirements to continue coverage were not met, and Bishins’s CPAP-related claims were placed in “denied status .” Bishins claims that, strangely, neither CMS nor Bishins’s medical supplies vendor notified him of this unfavorable decision, and the medical supplies vendor continued to provide Bishins with CPAP supplies for the next several years with no request for payment from him.

In 2019, after a second sleep study confirmed Bishins’s obstructive sleep apnea, Bishins’s doctor sent a new prescription for CPAP supplies to a new medical supplies vendor. Sometime thereafter , CMS refused to pay for Bishins’s CPAP supplies, and Bishins was forced to pay out of pocket. In December 2020, Bishins received an e-mail from an HHS health insurance specialist, Desmica Head, notifying him that his CPAP machine was in “denied status” and that any subsequent claims for a CPAP machine or supplies would likely be denied. She informed Bishins that an appeal could be filed with supporting documentation to show that he met requirements . Bishins did not have any notice prior to the e-mail that he had been denied Medicare coverage.

Because Bishins’s health had deteriorated further, his doctor determined that he needed a CPAP machine that produced higher

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air pressure and could transmit information remotely. However, Bishins’s new medical supplies vendor would not supply him with the machine because he was in “denied status,” so Bishins purchased it himself.

Between January and June 2021, Bishins sent letters to Head, Maximus Federal Services, Inc. (the qualified independent contractor administering his Medicare claims), and CMS attempting to appeal the denial.

In February 2021, Bishins wrote a letter to Celerian Group Company (“CGS”), Bishins’s Medicare administrative contractor, attempting to appeal the denial. CGS responded, stating that his appeal was dismissed because more than 120 days had passed since the “initial determination for the items or services in dispute . . . issued on October 10, 2014.” CGS noted that Bishins’s medical supplies vendor was responsible for submitting an appeal and did not do so, adding that it did not find that Bishins had good cause for late filing but that he could request that CMS vacate the dismissal and excuse his late filing within 6 months or that Maximus complete a reconsideration of CGS’s redetermination within 60 days of receiving CGS’s dismissal.

In June 2022, Bishins wrote grievance letters to the Secretary , Maximus, and CMS demanding a hearing as to the denial of Medicare benefits. In each of these letters, he stated that he was unable to appeal from the denial of benefits because no CPAP supplier would provide him with CPAP supplies so that he could lodge

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a claim and requested that HHS grant a hearing and remove him from “denied status.”

In August 2022, CMS health insurance specialist Brett Chambers e-mailed Bishins, explaining that Bishins was in “denied status” because an order was not obtained before delivery of the new CPAP machine, his records were illegible, and his doctor did not assess him for obstructive sleep apnea in a face-to-face clinical evaluation . Chambers stated that Bishins could contest the determination by filling another claim for coverage, having the claim denied, and administratively appealing. Bishins responded with a letter contesting all three reasons.

That same month, Bishins received a Notice of Decision from an administrative law judge (ALJ) affirming the dismissal of his request for reconsideration by Maximus. The ALJ explained that Maximus dismissed his request because there was no redetermination by CGS pursuant to 42 U.S.C. § 405.972(b)(6) that expressly discussed the May 28, 2020, date of service at issue and Bishins’s reconsideration request to Maximus did not contain sufficient information. Bishins requested that the appeal be reopened but never received a response.

On August 15, 2022, Bishins filed a FOIA request with CMS, in which he asked for copies of all records related to the audit of his administrative file; records of his requests for CPAP supplies between January 1, 2014, and August 14, 2022, and associated denials and appeals; copies of his letters to all Medicare offices and contractors ; and copies of all records in his file that did not fall into the

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listed categories. On September 16, 2022, CMS acknowledged Bishins’s FOIA request and noted it may take longer than 20 days to fulfill his request. On September 27, 2022, CMS released all responsive records to Bishins.

On April 3, 2023, Bishins filed a pro se complaint against the HHS Secretary in his official capacity, alleging that Medicare violated his rights under Title VIII of the Social Security Act, 42 U.S.C. § 1395 et seq., by declining to pay for his CPAP machine and supplies . The Secretary filed a motion to dismiss Bishins’s complaint for lack of jurisdiction and failure to state a claim. Bishins sought leave to amend his complaint to add claims for violations of his due process and equal protection rights. The district court dismissed all of Bishins’s claims without prejudice. However, in recognition of Bishins’s pro se status, the district court granted him leave to amend his complaint and granted his motion requesting the addition of his constitutional claims.

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