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

CourtCourt of Appeals for the Eleventh Circuit
DecidedJuly 24, 2025
Docket24-10008
StatusUnpublished

This text of Larry V. Bishins v. U.S. Secretary Department of Health and Human Services (Larry V. Bishins v. U.S. Secretary Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Larry V. Bishins v. U.S. Secretary Department of Health and Human Services, (11th Cir. 2025).

Opinion

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

[DO NOT PUBLISH] In the United States Court of Appeals For the Eleventh Circuit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

2 Opinion of the Court 24-10008

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 De- partment 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 Free- dom 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 ma- chine. 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). USCA11 Case: 24-10008 Document: 44-1 Date Filed: 07/24/2025 Page: 3 of 22

24-10008 Opinion of the Court 3

In August 2015, however, the Center for Medicare and Med- icaid 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 sta- tus.” Bishins claims that, strangely, neither CMS nor Bishins’s med- ical 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 pay- ment from him. In 2019, after a second sleep study confirmed Bishins’s ob- structive sleep apnea, Bishins’s doctor sent a new prescription for CPAP supplies to a new medical supplies vendor. Sometime there- after, CMS refused to pay for Bishins’s CPAP supplies, and Bishins was forced to pay out of pocket. In December 2020, Bishins re- ceived 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 re- quirements. 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 USCA11 Case: 24-10008 Document: 44-1 Date Filed: 07/24/2025 Page: 4 of 22

4 Opinion of the Court 24-10008

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 pur- chased it himself. Between January and June 2021, Bishins sent letters to Head, Maximus Federal Services, Inc. (the qualified independent contrac- tor administering his Medicare claims), and CMS attempting to ap- peal 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 sup- plies 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 com- plete a reconsideration of CGS’s redetermination within 60 days of receiving CGS’s dismissal. In June 2022, Bishins wrote grievance letters to the Secre- tary, 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 sup- plier would provide him with CPAP supplies so that he could lodge USCA11 Case: 24-10008 Document: 44-1 Date Filed: 07/24/2025 Page: 5 of 22

24-10008 Opinion of the Court 5

a claim and requested that HHS grant a hearing and remove him from “denied status.” In August 2022, CMS health insurance specialist Brett Cham- bers 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 eval- uation. Chambers stated that Bishins could contest the determina- tion 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 redeter- mination by CGS pursuant to 42 U.S.C. § 405.972(b)(6) that ex- pressly discussed the May 28, 2020, date of service at issue and Bishins’s reconsideration request to Maximus did not contain suffi- cient 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 be- tween January 1, 2014, and August 14, 2022, and associated denials and appeals; copies of his letters to all Medicare offices and contrac- tors; and copies of all records in his file that did not fall into the USCA11 Case: 24-10008 Document: 44-1 Date Filed: 07/24/2025 Page: 6 of 22

6 Opinion of the Court 24-10008

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 re- sponsive records to Bishins. On April 3, 2023, Bishins filed a pro se complaint against the HHS Secretary in his official capacity, alleging that Medicare vio- lated 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 sup- plies.

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