National Association of Rehabilitation Facilities, Inc. v. Otis R. Bowen, Secretary, Department of Health & Human Services

840 F.2d 931, 268 U.S. App. D.C. 224, 1988 U.S. App. LEXIS 2630, 1988 WL 15300
CourtCourt of Appeals for the D.C. Circuit
DecidedMarch 1, 1988
Docket87-5165
StatusPublished
Cited by5 cases

This text of 840 F.2d 931 (National Association of Rehabilitation Facilities, Inc. v. Otis R. Bowen, Secretary, Department of Health & Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
National Association of Rehabilitation Facilities, Inc. v. Otis R. Bowen, Secretary, Department of Health & Human Services, 840 F.2d 931, 268 U.S. App. D.C. 224, 1988 U.S. App. LEXIS 2630, 1988 WL 15300 (D.C. Cir. 1988).

Opinions

Opinion for the Court filed by Circuit Judge RUTH BADER GINSBURG.

Concurring opinion filed by Circuit Judge WILLIAMS.

RUTH BADER GINSBURG, Circuit Judge:

Two institutional providers of Medicare program services and three national membership organizations composed of such providers or their employees commenced this action against the Secretary of the Department of Health and Human Services (HHS) seeking: (1) a declaration that the Prompt Payment Act, 31 U.S.C. §§ 3901 et seq., which became effective October 1, 1982, applies to reimbursements to providers of medical services under the Medicare Act, 42 U.S.C. §§ 1395 et seq.; and (2) an injunction ordering the Secretary of HHS to comply with the Prompt Payment Act in his administration of the Medicare program. The complaint predicated subject matter jurisdiction exclusively upon 28 U.S. C. § 1331 (general federal question jurisdiction) and recited 28 U.S.C. § 2201 as the basis for the declaratory relief plea. The district court, denying plaintiffs’ motion for summary judgment and granting defendant’s motion to dismiss, held that the Prompt Payment Act “does not apply to reimbursements to providers under the Medicare Act.” National Ass’n of Rehabilitation Services v. Bowen, No. 86-2386 (D.D.C. Mar. 18, 1987).1

We hold that plaintiffs have presented no “case of actual controversy,” 28 U.S.C. § 2201, properly cognizable under the general federal question jurisdiction of the district court, 28 U.S.C. § 1331. Plaintiffs may not invoke 28 U.S.C. §§ 1331, 2201 for the adjudication of an “issue” and thereby circumvent the prerequisites to judicial review which would attend presentation of that issue in the context of a concrete claim. See Toilet Goods Ass’n v. Gardner, 387 U.S. 158, 164-65, 87 S.Ct. 1520, 1524-25, 18 L.Ed.2d 697 (1967) (adjudication in court generally should await administrative determination in concrete case). Accordingly, we vacate the district court’s order ruling on the merits of the question plaintiffs tendered, and remand the case to that court with an instruction to dismiss the complaint for failure to present a claim for declaratory relief appropriately entertained under 28 U.S.C. §§ 1331, 2201.

Plaintiffs have underscored that their civil action is one in which “no [fact specific] claim is presented.” Brief of Plaintiff-[933]*933Appellants at 31.2 Instead, they wish to litigate an “issue” in isolation: Does the Prompt Payment Act apply to the Medicare program? If the provider plaintiffs had presented “specific reimbursement claims,” then concededly they would have been required to “resort to the process for administrative adjudication of claims under the Medicare Act” before any right to judicial review would accrue. Id.; see also Reply Brief at 9. Similarly, had plaintiffs pressed “express claims under contracts,” they would have been obliged to contend with the claim filing and administrative process requirements of the Contract Disputes Act, 41 U.S.C. §§ 601 et seq. See Brief of Plaintiff-Appellants at 30. By abstracting their Prompt Payment Act “issue,” see id. at 31, for separate airing, plaintiffs believe they may avoid the preliminaries that would attend presentation of a fully fleshed-out case.

As precedent for their position, plaintiffs feature this court’s decision in National Ass’n of Home Health Agencies v. Schweiker, 690 F.2d 932 (D.C.Cir.1982), cert. denied, 459 U.S. 1205, 103 S.Ct. 1193, 75 L.Ed.2d 438 (1983) (NAHHA). See Reply Brief at 5-6. Plaintiffs in that case questioned the validity of a regulation by the Secretary requiring Medicare providers, many of whom had until then dealt directly with the Secretary, to resort instead to intermediaries for reimbursement determinations and payments. Holding the regulation reviewable under 28 U.S.C. § 1331, we rested our decision on two pillars. First, we explained that plaintiffs sought “no money at all,” i.e., monetary recovery was neither their immediate nor their “ultimate goal.” 690 F.2d at 938. Second, and most prominently, we stressed that “no alternative form of judicial review” to test the regulation was available. Id. at 939. Moreover, greater fact particularization would not have advanced the court’s analysis in NAHHA.

Just as it was plain that the NAHHA complainants “d[id] not seek any type of eventual monetary recovery,” id., so it is plain that money eventually is precisely what the providers in this case seek. Appellants themselves assert:

Medicare providers have a right to judicial review of PRRB (Provider Reimbursement Review Board) decisions in the United States District Court for the District of Columbia, 42 U.S.C. § 1395oo(f)(l), and thereby a right to appellate review in this Court. Accordingly, the judgment of this Court on the merits of this case would be a conclusive precedent.

Reply Brief at 9. But “conclusive precedent,” we believe, is best reserved for declaration in an actual, specific, particularized controversy in which the court would be enlightened by the application of the Medicare Act’s own prescriptions regarding payments and payment delays.

At oral argument of the instant appeal, counsel for the Secretary candidly pointed out that in Bowen v. Michigan Academy of Family Physicians, 476 U.S. 667, 106 S.Ct. 2133, 90 L.Ed.2d 623 (1986), the Supreme Court held that 28 U.S.C. § 1331 accommodated a challenge to a regulation that did affect eventual monetary recovery by Medicare providers. The question in Michigan Academy was whether Congress had insulated against any judicial review regulations promulgated under Part B of the Medicare program. The regulation in question authorized payment of benefits in different amounts for similar physicians’ services. The Medicare Act does preclude judicial review “for determinations of the amount of Part B awards.” United States v. Erika, Inc., 456 U.S. 201, 208, 102 S.Ct. 1650, 1654, 72 L.Ed.2d 12 (1982).

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840 F.2d 931, 268 U.S. App. D.C. 224, 1988 U.S. App. LEXIS 2630, 1988 WL 15300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-association-of-rehabilitation-facilities-inc-v-otis-r-bowen-cadc-1988.