United States v. Memorial Sloan-Kettering Cancer Center

Court of Appeals for the Second Circuit·Decided March 25, 2009·No. 07-0926-cv(L) & 07-0949-cv(Con)·Published

Opinion

07-0926-cv(L) & 07-0949-cv(Con) United States of America v. Memorial Sloan-Kettering Cancer Center

UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT

August Term, 2007

(Argued: July 8, 2008 Decided: March 25, 2009)

Docket Nos. 07-0926-cv(L), 07-0949-cv(Con)

UNITED STATES OF AMERICA , Plaintiff-Appellee,

-v.-

MEMORIAL SLOAN -KETTERING CANCER CENTER , Defendant-Appellant.

ALBANY MEDICAL CENTER ,

Plaintiff-Appellant,

-v.-

UNITED STATES OF AMERICA , Defendant-Appellee.

These two cases, Albany Medical Center v. United States (“AMC”) and United States v.

Memorial Sloan-Kettering Cancer Center (“Sloan-Kettering”), decided respectively by the United States District Courts for the Northern and Southern Districts of New York, both raise the

question of whether post-graduate medical residents can invoke the Federal Insurance Contributions Act (“FICA”) tax exemption for “students.” In each case, the district court ruled that, as a matter of law, post-graduate medical residency programs are not “schools” and medical residents are not “students.” Sloan-Kettering raises the further question of whether the monies that the Cancer Center pays to its residents are “scholarships” and therefore exempt from FICA taxes. The district court answered “no” to that question.

We hold that both district courts erred in ruling as a matter of law that medical residents are categorically ineligible for the FICA tax exemption for students. We affirm the United States District Court for the Southern District of New York, however, insofar as it determined that the monies paid by the Cancer Center to medical residents are not scholarships. We remand both cases to the respective district courts for further proceedings consistent with this opinion.

MARK H. CHURCHILL, McDermott Will & Emery LLP, Washington, D.C. (Joel E.

Cohen, McDermott Will & Emery LLP, New York, New York, Christopher Kliefoth, Sarah E. Hancur, McDermott Will & Emery LLP, Washington, D.C., on the brief), for Plaintiff-Appellant Albany Medical Center.

MARK H. CHURCHILL, McDermott Will & Emery LLP, Washington, D.C.

(Christopher Kliefoth, Teresa M. Goody, McDermott Will & Emery LLP, Washington, D.C., Joel E. Cohen, McDermott Will & Emery LLP, New York, New York, on the brief), for Defendant-Appellant Memorial Sloan-Kettering Cancer Center.

TERESA E. MCLAUGHLIN , Attorney, Tax Division, Department of Justice, Washington, D.C. (Richard T. Morrison, Acting Assistant Attorney General, Gilbert S. Rothenberg, Acting Deputy Assistant Attorney General, Michelle B.

Smalling, Attorney, Tax Division, Department of Justice, Washington, D.C., on the brief, Glenn T. Suddaby, United States Attorney for the Northern District of New York, of counsel), for Defendant-Appellee United States of America.

ROSS E. MORRISON , Assistant United States Attorney (David S. Jones, Assistant United States Attorney, on the brief), for Michael J. Garcia, United States Attorney for the Southern District of New York, New York, New York, for Plaintiff-Appellee United States of America.

BEFORE: POOLER, HALL, Circuit Judges, and TRAGER, District Judge.* Judge TRAGER dissents in a separate opinion.

HALL, Circuit Judge:

These two cases, Albany Medical Center v. United States (“AMC”) (Scullin, J.) and United States v. Memorial Sloan-Kettering Cancer Center (“Sloan-Kettering”) (Hellerstein, J.), decided respectively by the United States District Courts for the Northern and Southern Districts of New York, both raise the question of whether post-graduate medical residents can invoke the Federal Insurance Contributions Act (“FICA”) tax exemption for “students.” In each case, the district court ruled that, as a matter of law, post-graduate medical residency programs are not “schools” and medical residents are not “students.” Sloan-Kettering raises the further question of whether the monies that the Cancer Center pays to its residents are “scholarships” and therefore exempt from FICA taxes. The district court answered “no” to that question.

We hold that both district courts erred in ruling as a matter of law that medical residents are categorically ineligible for the FICA tax exemption for students. We affirm the District Court for the Southern District of New York, however, insofar as it determined that the monies paid by

*

The Honorable David G. Trager, of the United States District Court for the Eastern District of New York, sitting by designation.

the Cancer Center to medical residents are not scholarships. We remand both cases to their respective district courts for further proceedings consistent with this opinion.

BACKGROUND 1

I. Overview of Post-Graduate Medical Residency Programs After completing medical school and receiving a doctor of medicine (“M.D.”) degree, prospective physicians commence the graduate phase of their medical education. Generally, graduate medical education consists of a residency or fellowship. Most states, including the State of New York, require physicians to complete a residency program of at least one year before becoming eligible for a medical license. Residency programs typically last between three and five years.

These residency programs are accredited by organizations such as the Accreditation Council for Graduate Medical Education (“ACGME”). The ACGME requires residency programs to be organized educational programs that combine a didactic curriculum with direct exposure to patient care under the supervision of attending physicians. Accordingly, these programs include classroom lectures, daily rounds with an attending physician, Grand Rounds in which experts present research, morbidity and mortality conferences, and reading assignments. Residents are tested and evaluated at times, and those residents who have not mastered necessary skills are given remedial instruction or required to repeat the program. Both Memorial Sloan- Kettering Cancer Center (“the Cancer Center”) and the Albany Medical Center (“AMC”) (collectively, “the Hospitals”) claim that residents participate in patient care only as a way of

1 Most of the facts are not in dispute, and those facts that are in dispute are noted.

learning how to care for patients; that any benefit to the hospitals resulting therefrom is entirely incidental; that the hospitals do not meet staffing needs through their residents; and that the hospitals cannot bill for care provided by a resident.

Residents receive funds from the hospital. The Hospitals characterize these monies as “a scholarship or fellowship to aid in the pursuit of their graduate medical education” or as a “stipend.” The Government characterizes these monies as compensation for the provision of services. The Hospitals point out that the ACGME requires, as a condition of accreditation, that the Hospitals provide residents with the financial support needed to ensure the residents’ participation in the residency programs.

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