Pacific Surgical Institute of Pain Management, Inc v. Xavier Becerra

• Court: Court of Appeals for the Ninth Circuit
• Decided: June 6, 2024
• Docket: 23-55798
• Status: Unpublished

Opinion

NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS JUN 6 2024 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT

PACIFIC SURGICAL INSTITUTE OF No. 23-55798 PAIN MANAGEMENT, INC., a California corporation, D.C. No. 3:22-cv-01521-BAS-WVG Plaintiff-Appellant,

v. MEMORANDUM*

XAVIER BECERRA, Secretary of the United States Department of Health & Human Services,

Defendant-Appellee.

Appeal from the United States District Court for the Southern District of California Cynthia A. Bashant, District Judge, Presiding

Submitted June 4, 2024** Pasadena, California

Before: M. SMITH and BADE, Circuit Judges, and FITZWATER,*** District Judge.

* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. ** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). *** The Honorable Sidney A. Fitzwater, United States District Judge for the Northern District of Texas, sitting by designation. Pacific Surgical Institute of Pain Management, Inc. (Pacific Surgical) is an

ambulatory surgical center that provides medical services to patients suffering from

chronic pain. Centers for Medicare and Medicaid Services (CMS) suspended

Medicare payments to Pacific Surgical during an investigation of credible

allegations of fraud. Pacific Surgical petitioned for mandamus to compel the

Department of Health and Human Services (HHS) to release funds that an

administrative law judge (ALJ) determined were reimbursable. The district court

dismissed the petition for lack of subject matter jurisdiction. Pacific Surgical timely

appealed.

District courts have “original jurisdiction of any action in the nature of

mandamus to compel an officer or employee of the United States or any agency

thereof to perform a duty owed to the plaintiff.” 28 U.S.C. § 1361. “Mandamus is

an extraordinary remedy and is available . . . only if: (1) the individual’s claim is

clear and certain; (2) the official’s duty is nondiscretionary, ministerial, and so

plainly prescribed as to be free from doubt; and (3) no other adequate remedy is

available.” Grondal v. United States, 37 F.4th 610, 620 (9th Cir. 2022) (internal

quotation marks omitted). We review de novo whether the requirements for

mandamus relief have been satisfied. Johnson v. Reilly, 349 F.3d 1149, 1154 (9th

Cir. 2003). Because the parties are familiar with the facts, we do not recount them

here, except as necessary to provide context to our ruling. We have jurisdiction

2 pursuant to 28 U.S.C. § 1291. We affirm.

The district court dismissed the petition because, inter alia, Pacific Surgical’s

claim is “anything but ‘clear and certain’” and Defendant’s “obligation to pay for

reimbursable services is not ‘free from doubt.’” We agree. See Jackson v. S. Cal.

Gas Co., 881 F.2d 638, 643 (9th Cir. 1989) (“In reviewing decisions of the district

court, we may affirm on any ground finding support in the record.”). Pacific Surgical

identifies no authority, let alone “clear and certain” authority, that the agency must

pay claims determined to be reimbursable notwithstanding a pending temporary

suspension of payments. Grondal, 37 F.4th at 620. CMS can suspend Medicare

payments “in whole or in part,” regardless of whether they are otherwise payable.

42 C.F.R. § 405.371(a)(2) (emphasis added). Requiring the agency to pay claims

that are processed during the suspension of payments would undermine the agency’s

ability to recover overpayments once the fraud investigation has concluded. See 42

C.F.R. § 405.372(e) (Suspended payments are “first applied to reduce or eliminate

any overpayments determined by . . . CMS.”).

In addition, or in the alternative, Pacific Surgical argues that the temporary

payment suspension expired on March 9, 2023—i.e., more than six months prior to

the district court’s order—and thus “could not have operated to preclude

enforcement of the ALJ order.” The argument fails for at least two reasons. First,

Pacific Surgical presents no evidence that the payment suspension has expired. See

3 In re Van Dusen, 654 F.3d 838, 841 (9th Cir. 2011) (“The petitioner bears the burden

of showing that its right to issuance of the writ is ‘clear and indisputable.’” (internal

quotation marks omitted)). And HHS asserts that it “has continued the suspension

of payments in accordance with the regulation” and “has actively evaluated the

progress of any investigation to determine if good cause exists to no longer continue

the suspension of payments” (cleaned up). Therefore, Pacific Surgical’s attempts to

shift the burden of proof to Defendant are unavailing.

Second, Pacific Surgical fails to establish that, even if the suspension had

expired, the agency’s duty to disburse the funds immediately is “so plainly

prescribed as to be free from doubt.” Grondal, 37 F.4th at 620. The ALJ merely

identified services performed by Pacific Surgical that were covered by Medicare.

Nothing in the ALJ’s decision requires immediate payment. Indeed, before CMS

can disburse the payment, the agency will need to review the relevant accounting

records, incorporate the ALJ decision, and determine the correct amount, if any, that

is payable to Pacific Surgical. See 42 C.F.R. § 405.372(e). Pacific Surgical offers

no authority that would suggest otherwise.

AFFIRMED.