Morgan v. Azar

CourtDistrict Court, S.D. West Virginia
DecidedJanuary 16, 2020
Docket3:19-cv-00406
StatusUnknown

This text of Morgan v. Azar (Morgan v. Azar) is published on Counsel Stack Legal Research, covering District Court, S.D. West Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morgan v. Azar, (S.D.W. Va. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF WEST VIRGINIA

HUNTINGTON DIVISION

BRETON L. MORGAN, M.D., INC. and BRETON L. MORGAN, M.D.,

Plaintiffs,

v. CIVIL ACTION NO. 3:19-0406

ALEX M. AZAR, Secretary of Department of Health and Human Services,

Defendant.

MEMORANDUM OPINION AND ORDER

Presently pending before the Court is an appeal seeking reversal of the Department of Health and Human Services Departmental Appeals Board’s Final Decision, Breton L. Morgan, M.D., Inc. and Breton L. Morgan, M.D., DAB No. 2933 (2019) (hereinafter “Final Decision”), to revoke Plaintiff Breton L. Morgan’s Medicare billing privileges. See Am. Compl., ECF No. 10. Also pending is Plaintiffs’ motion to refer the instant case to mediation. Mot. to Refer, ECF No. 15. For the reasons set forth herein, the Court DENIES AS MOOT Plaintiffs’ motion, REVERSES and VACATES the Secretary’s Final Decision, ORDERS the immediate reinstatement of Plaintiffs’ Medicare enrollment and billing privileges, ORDERS Defendant to direct CMS to accept for processing and payment all billings for Plaintiffs’ Medicare patients from December 7, 2016 to the present, and DISMISSESS this matter from the Court’s docket. The Court HOLDS IN ABEYANCE Plaintiffs’ request for costs and attorney’s fees pending submission of an application for those fees and any other expenses. I. BACKGROUND Few federal programs impact the lives of most Americans—and the lives of the doctors who treat them—as does Medicare. Established in 1966, Medicare provides health insurance benefits to individuals over sixty-five or to those who are disabled or have been diagnosed with an

end-stage renal disease. 42 U.S.C. § 1395c. In particular, Part B of the Medicare program is responsible for paying physicians and other health care providers for the medical services they render to Medicare-insured patients. Congress tasked the United States Department of Health and Human Services (“HHS”)—and, in turn, the Centers for Medicare and Medicaid Services (“CMS”)—with administering Medicare, and granted HHS the broad authority to promulgate necessary regulations related to the program. See 42 U.S.C. § 1302(a) (“The Secretary shall prescribe such regulations as may be necessary to carry out the administration of the insurance programs under this subchapter.”). Pursuant to these regulations, “provider[s] or supplier[s] must be enrolled in the Medicare program” and obtain billing privileges to receive payments for their services.1 42 C.F.R.

§ 424.500–505. To enroll, medical professionals must complete Form CMS-855I—the “Medicare Enrollment Application for Physicians and Non-Physician Practitioners.” See Form CMS-855I, available at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf (last visited Jan. 14, 2020).2 Applicants are required to list all “final adverse actions” against them, “such as convictions, exclusions, revocations, and suspensions.” Admin. R., ECF No. 5-1, at 292–

1 Confusing though the terminology may be, physicians are considered “suppliers” while “providers” are limited to hospitals and other medical facilities. 42 C.F.R. § 400.202. 2 This current form has been modified from the form used in 2013, which is filed as part of the record. Admin. R., ECF No. 5-1, at 280–313. 93. The form also requires applicants to furnish “complete, accurate, and truthful responses to all information requested.” 42 C.F.R. § 424.510(d)(2)(i). Once attainted, a physician’s enrollment and billing privileges are not permanent. To maintain both, he or she “must resubmit and recertify the accuracy of [one’s] enrollment

information every 5 years.” 42 C.F.R. § 424.515. Pertinent to this case, CMS also possesses relatively wide authority to revoke a provider’s enrollment in Medicare for, inter alia, providing “[f]alse or misleading information” to the agency. 42 C.F.R. § 424.535(a)(4). It is a dispute over precisely what constitutes such a false or misleading statement that has led to this appeal. Plaintiff Breton L. Morgan, M.D., is a physician operating his own practice in Point Pleasant, West Virginia. Am. Compl., at ¶ 7. After a back surgery in 1999, Morgan became dependent on narcotic painkillers and began siphoning samples of opioids from his practice for personal use. Id. at ¶ 8; Pls.’ Br., ECF No. 14, at 3. Morgan overcame his addiction in 2006, successfully completing a fourteen-week residential drug rehabilitation program. Pls.’ Br., at 3. Though he has remained sober since that point, Morgan pled guilty to Obtaining a Schedule III

Controlled Substance by Fraud in violation of 21 U.S.C § 843(a)(3) on December 11, 2006. United States v. Morgan, No. 3:06-00194, ECF No. 18 (S.D.W. Va. Oct. 27, 2006). Three months later, this Court sentenced Morgan to thirty days of imprisonment, ninety days of home confinement, and a $5,000 fine. United States v. Morgan, No. 3:06-00194, ECF No. 3 (S.D.W. Va. Mar. 14, 2007). Of course, consequences stemming from Morgan’s conviction extended well beyond the sentence this Court imposed. Morgan surrendered his West Virginia and Ohio medical licenses, as well as his DEA license. Pls.’ Br., at 3. While his DEA license was returned with a Schedule II restriction in 2009, his state licenses were not restored in full until 2013. Am. Compl., at ¶¶ 9–10. A final consequence of Morgan’s felony conviction was his mandatory five-year exclusion from federal health care programs in 2008 by the HHS Office of Inspector General (“OIG”). Admin. R., at 268–67. CMS revoked Morgan’s Medicare billing privileges around the same time, and imposed a three-year re-enrollment bar. Id. at 270–71. By the close of his five-year exclusion in the summer

of 2013, Morgan’s medical licenses had been restored and the OIG indicated that he was free to re-apply for Medicare billing privileges. See id. at 279. He did so on July 19, 2013, submitting the necessary CMS-855I form to Palmetto GBA (“Palmetto”)—the regional Medicare Administrative Contractor (“MAC”)—for consideration.3 See id. at 280–313. It is this CMS-855I form that lies at the heart of the instant case. At the time, the form was thirty-one pages long and requested a plethora of personal and professional information from potential suppliers. Id. Section Three of the application sought to “capture[] information on final adverse legal actions, such as convictions, exclusions, revocations, and suspensions.” Id. at 292. The form mandated that “[a]ll applicable final adverse actions must be reported, regardless of whether any records were expunged or any appeals are pending.” Id. The next page of the form

provides a small table for applicants to list the details of any such actions. Id. at 293. The form instructs applicants to “report each final adverse legal action, when it occurred, the Federal or State agency or the court/administrative body that imposed the action, and the resolution, if any.” Id. The page is devoid of any other instructions regarding the table. See id. On his form, Morgan provided “Medicare Exclusion” as a final adverse legal action entered against him and a date of May 30, 2008. Id.

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Morgan v. Azar, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morgan-v-azar-wvsd-2020.