Texas Health Choice, L.C. v. Office of Personnel Management

400 F.3d 895, 2005 U.S. App. LEXIS 3568, 2005 WL 486773
CourtCourt of Appeals for the Federal Circuit
DecidedMarch 3, 2005
Docket2004-1400
StatusPublished
Cited by31 cases

This text of 400 F.3d 895 (Texas Health Choice, L.C. v. Office of Personnel Management) is published on Counsel Stack Legal Research, covering Court of Appeals for the Federal Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Texas Health Choice, L.C. v. Office of Personnel Management, 400 F.3d 895, 2005 U.S. App. LEXIS 3568, 2005 WL 486773 (Fed. Cir. 2005).

Opinions

MICHEL, Chief Judge.

The Office of Personnel Management (“OPM”) appeals the United States District Court for the Eastern District of Texas’s denial of its motion to dismiss for lack of subject matter jurisdiction and its separate motion to transfer venue to the United States Court of Federal Claims. Tex. Health Choice, L.C. v. Office of Pers. Mgmt., No. 90:03cv14 (E.D.Tex. Mar. 9, 2004) (“March Order”). The appeal was submitted after oral argument on December 8, 2004. Because Texas Health’s suit against OPM is governed exclusively by the dispute resolution scheme set forth in the Contract Disputes Act, (“CDA”) codified at 41 U.S.C. §§ 601-613, under which Texas Health could file suit to contest the denial of its contract claim only in the United States Court of Federal Claims, not in district court, we reverse the district [897]*897court’s decision with respect to venue and remand for transfer to the Court of Federal Claims, which has exclusive jurisdiction.

BACKGROUND

A. Texas Health’s Contract with OPM

OPM contracted with Texas Health, a health management organization, to provide health care services to federal employees and retirees in Texas under the Federal Employees Health Benefits Act, codified at 5 U.S.C. §§ 8901-8914 (“FEH-BA”). As a services contract with the United States government, the FEHBA contract is governed by the CDA. Under the terms of the FEHBA contract, OPM annually negotiates the compensation rates and benefits with each contractor. Each May, a contractor proposes interim compensation rates to OPM for the upcoming contract year. The interim compensation rates represent a contractor’s estimate of the amounts it will charge a similarly-sized subscriber group.

The following April, the contractor and OPM reconcile the estimated interim compensation rates with the rates that the contractor actually charged to the similarly-sized subscriber group. If the interim compensation rates were lower than the rates actually charged to the similarly-sized subscriber group, then OPM pays the difference to the contractor. If, however, the interim compensation -rates were higher than the rates actually charged to the similarly-sized subscriber group, then the contractor reimburses the difference to OPM.

The FEHBA contract further provides that in the final year of the contract, the reconciliation process occurs in line with an OPM-promulgated regulation (“Final Year Regulation”). See 48 C.F.R. § 1652.216-70(b)(6). Clause 3.2(b)(6) of the FEHBA contract mirrors the language of the Final Year Regulation and specifically provides:

In the event this contract is not renewed, neither the Government nor the Carrier shall be entitled to any adjustment or claim for the difference between the subscription rates prior to rate reconciliation and the actual subscription rates.

The rationale behind this regulation and the corresponding contract provision is that “it is difficult to get adequate data from plans when they have terminated.” 55 Fed.Reg. 27406 (1996).

In 2001, the interim compensation rates paid by OPM to Texas Health were $622,246 lower than the rates actually charged to a similarly-situated subscriber group. OPM thus paid Texas Health $622,246 following reconciliation. After receiving this payment, Texas Health decided to exit the FEHBA program and gave notice to OPM. In response, OPM requested Texas Health to return the reconciliation payment of $622,246, invoking Clause 3.2(b)(6). Texas Health refused. OPM then reduced its premium payment to Texas Health for December 2001 by $622,246.

In January 2002, Texas Health submitted a certified claim to the OPM contracting officer demanding payment of the $622,246 withheld from the December 2001 premium payment. OPM did not respond and, as a result, the claim was deemed denied pursuant to the CDA.

B. Prior Court Proceedings

In January 2003, Texas Health filed suit against OPM in the United States District Court for the Eastern District of Texas, alleging that it was entitled to a declaratory judgment that the Final Year Regulation was invalid on its face or as applied to Texas Health. Specifically, Texas [898]*898Health complained that the Final Year Regulation conflicts with a particular section of the FEHBA, 5 U.S.C. § 8902(i), which provides that health plans are to be compensated at rates that “reasonably and equitably reflect the cost of the benefits provided.”

In April 2003, OPM filed a motion to dismiss the complaint for lack of subject matter jurisdiction pursuant to Fed.R.Civ.P. 12(b)(1). In June 2003, OPM filed a separate motion to transfer venue to the Court of Federal Claims pursuant to 28 U.S.C. § 1631 based upon a want of jurisdiction.

The district court delegated the issue of jurisdiction and venue to a magistrate judge for consideration. The magistrate judge ultimately issued an amended report and recommendation, concluding that federal question jurisdiction existed in the district court under 28 U.S.C. § 1331 and that the United States waived immunity from suit under the Administrative Procedure Act. Tex. Health Choice, L.C. v. U.S. Office of Pers. Mgmt., No. 9:03CV14, slip op. at 13 (E.D.Tex. Feb. 10, 2004). Accordingly, the magistrate judge recommended that the district court deny both OPM’s motion to dismiss and its motion to transfer. Id.

The district court adopted the magistrate judge’s amended report and recommendation and issued a brief order denying both of OPM’s motions. March Order, slip op. at 2. OPM appeals that order. We have jurisdiction over the district court’s denial of OPM’s motion to transfer venue to the Court of Federal Claims pursuant to 28 U.S.C. § 1292(d)(4)(A). We do not have jurisdiction to address the district court’s denial of OPM’s motion to dismiss for lack of subject matter jurisdiction because that denial is not an appealable interlocutory order under 28 U.S.C. § 1292. See 28 U.S.C. § 1295(a)(1). We note, however, that OPM’s motion to transfer venue is premised on a want of jurisdiction, the same substantive ground presented in OPM’s motion to dismiss.

DISCUSSION

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Bluebook (online)
400 F.3d 895, 2005 U.S. App. LEXIS 3568, 2005 WL 486773, Counsel Stack Legal Research, https://law.counselstack.com/opinion/texas-health-choice-lc-v-office-of-personnel-management-cafc-2005.