United States ex rel. Rahman v. Oncology Associates, P.C.

201 F.3d 277, 1999 U.S. App. LEXIS 32409, 1999 WL 1215725
Court of Appeals for the Fourth Circuit·Decided December 14, 1999·No. No. 99-1905·Published·Cited by 2 cases

Opinion

Affirmed in part, reversed in part and remanded by published opinion. Judge NIEMEYER wrote the opinion, in which Judge WIDENER and Senior Judge MICHAEL joined.

OPINION

NIEMEYER, Circuit Judge:

The defendants in this case, who are radiation oncology service providers, obtained a writ of mandamus from the district court, compelling the United States (the Health Care Financing Administration (“HCFA”)) and its administering contract carriers to proceed promptly with the administrative process established for processing providers’ Medicare Part B reimbursements. The United States had suspended the administrative process pending judicial determination in this case of whether the oncology service providers defrauded HCFA and whether they are entitled to reimbursement.

We affirm the district court’s writ of mandamus insofar as it requires HCFA and its contract carriers to proceed with the administrative process established by regulation without regard to the progress of this action, but we reverse the district court’s requirement that they accomplish [281]*281the next step in the administrative process — that of making overpayment determinations as provided by 42 C.F.R. § 405.372(c) — within 20 days.

I

The United States filed its complaint in this case against Dr. Douglas Colkitt; his wife; his business partner, Dr. Jerome Derdel; and more than 80 healthcare entities owned, operated, or controlled by Colkitt, which provide diverse healthcare services in the field of radiation oncology. The complaint, as amended, alleges that the defendant oncology service providers engaged in fraudulent billing schemes involving the Medicare Part B program during the 1992-1997 period and the CHAM-PUS program (the Medicare counterpart for the uniformed services) during the 1992-1996 period, causing losses to these programs in excess of $12 million. Specifically, the United States alleges that the defendants claimed reimbursement on bills for radiation oncology services that were neither provided nor ordered by the physician and on bills for unnecessary radiation oncology services, and that the defendants misrepresented the medical services rendered in order to obtain both higher and double reimbursements for services.

Before this action was commenced, some of these oncology service providers had applied to the Medicare Part B program for reimbursement of more than $2 million in services that HCFA had directed its carriers to suspend because of HCFA’s suspicion of fraud. In particular, HCFA suspended various reimbursement payments to some 23 of the defendant Medicare providers on October 8, 1998, December 18, 1998, and March 16, 1999, totaling approximately $2.2 million. The Department of Justice (“DOJ”), which filed this action on behalf of the United States, took the position that the administrative process should be suspended until judgment was reached in this action because the administrative forum was neither intended nor sufficient to deal with cases of Medicare fraud. As a result, the contract carriers — private insurance companies under contract with HCFA to process claims for Medicare reimbursement, see infra Part IV.A — took no further steps in the administrative process, which includes the critical determination of the amount of overpayment, a step that is a condition precedent to the providers’ right to challenge HCFA’s position through the administrative process. See 42 C.F.R. § 405.801. The administrative process has accordingly come to a halt. At oral argument, the United States conceded that it has stayed the administrative proceedings pending the outcome of this litigation. The United States also took this position before the district court (“It is the Agency’s position that to make [the overpayment determinations] requires information that’s coming out in this False Claims Act case”).

On April 28, 1999, the defendants filed a motion for a writ of mandamus in this action, then pending before the district court, to compel HCFA and its contract carriers to lift the reimbursement payment suspensions, or alternatively, to issue overpayment determinations. The defendants also requested that the DOJ “immediately cease all interference in any audits by Medicare carriers which involve Defendants.” Following a hearing on June 11, 1999, the district court issued an order dated June 21, 1999, granting in part and denying in part the defendants’ motion for a writ of mandamus. The court concluded that “Defendants are entitled to the entry of an order directing the HCFA and the carriers- to promptly make overpayment determinations mandated by § 405.372(c) so that defendants may go forward with the administrative process to which they are entitled under the applicable regulations.” The court reasoned that there are no exceptions to the administrative procedures applicable when a suit under the False Claims Act is pending in federal court and that there is no reason why parallel administrative and judicial pro[282]*282ceedings cannot go forward at the same time. The court concluded that, by suspending the administrative process, the United States was merely “expressing its disagreement with the administrative procedures mandated by the regulation.” The court directed the United States and its contract carriers “to make said overpayment determinations within 20 days from the date of this Order.”

The United States filed this appeal, and we stayed the district court’s writ of mandamus pending its resolution. On appeal, the United States contends that (1) the defendants failed to satisfy procedural requirements for issuance of the writ of mandamus; and (2) in any event, the defendants have not satisfied the conditions for issuance of the writ by demonstrating that they have a clear right to the relief sought and that they have no other adequate remedy. The defendants moved to dismiss this appeal, contending that we lack jurisdiction to review the writ of mandamus as an interlocutory order.

II

At the outset, we must address the defendants’ motion to dismiss this appeal, alleging that we are without jurisdiction to review an interlocutory mandamus order. The defendants contend that 28 U.S.C. § 1292(a)(1), on which the United States relies, provides no basis for the appeal of an order that is not an injunction.

Section 1292(a)(1) confers jurisdiction on courts of appeals to review interlocutory orders “granting, continuing, modifying, refusing or dissolving injunctions, or refusing to dissolve or modify injunctions.” Thus, the statutory language does not in haec verba authorize the interlocutory appeal of orders granting a writ of mandamus. But this does not mean that a writ of mandamus does not, in particular circumstances, amount to an injunction reviewable under § 1292(a)(1). An order entitled “injunction” must, by definition, prohibit or command specific conduct. A writ of mandamus may serve the same office, commanding the performance of a specified official act or duty; indeed, the Latin word “mandamus” means “we command.” But, of course, not all orders commanding conduct are injunctions of the type that Congress intended to make appealable under § 1292(a)(1).

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United States ex rel. Rahman v. Oncology Associates, P.C., 201 F.3d 277, 1999 U.S. App. LEXIS 32409, 1999 WL 1215725 (4th Cir. 1999).

201 F.3d 277 (United States ex rel. Rahman v. Oncology Associates, P.C.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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