02a0258p.06

01-1201Court of Appeals for the Sixth Circuit31 lug 2002

Testo completo

7KLV GHFLVLRQ ZDV RULJLQDOO\ LVVXHG DV DQ ³XQSXEOLVKHG GHFLVLRQ´
ILOHG RQ -XQH 2Q -XO\ WKH FRXUW GHVLJQDWHG WKH
RSLQLRQ DV RQH UHFRPPHQGHG IRU IXOOWH[W SXEOLFDWLRQ

5(&200(1'(' )25 )8//7(;7 38%/,&$7,21
3XUVXDQW WR 6L[WK &LUFXLW 5XOH
(/(&7521,& &,7$7,21 )(' $SS 3 WK &LU
)LOH 1DPH DS
81,7('67$7(6&28572)$33($/6
)257+(6,;7+&,5&8,7
BBBBBBBBBBBBBBBBB
2$./$1' 0(',&$/ *5283
3& +$52/' 0$5*2/,6
'2
3ODLQWLIIV$SSHOODQWV
Y
6(&5(7$5< 2) +($/7+ $1'
+80$1 6(59,&(6 +($/7+
&$5( ),1$1&,1*
$'0,1,675$7,21
'HIHQGDQW$SSHOOHH
;!

1
1R
$SSHDOIURPWKH8QLWHG6WDWHV'LVWULFW&RXUW
IRUWKH(DVWHUQ'LVWULFWRI0LFKLJDQDW'HWURLW
1R²-RKQ&RUEHWW2¶0HDUD'LVWULFW-XGJH
6XEPLWWHG-XQH
'HFLGHGDQG)LOHG-XQH
%HIRUH0$57,1&KLHI&LUFXLW-XGJH.(,7+DQG
.(11('<&LUFXLW-XGJHV

-- 1 of 4 --

2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV
1R
BBBBBBBBBBBBBBBBB
&2816(/
21 %5,() )UHGHULFN % %HOODP\ .HLWK - 6ROWLV
9$1'(5 0$/( %(//$0< *,/&+5,67 9$1'(
9866( &$))(57<'HWURLW0LFKLJDQIRU$SSHOODQWV
%DUEDUD)$OWPDQ81,7('67$7(6'(3$570(172)
+($/7+$1'+80$16(59,&(6&KLFDJR,OOOLQRLVIRU
$SSHOOHH
BBBBBBBBBBBBBBBBB
23,1,21
BBBBBBBBBBBBBBBBB
%2<&()0$57,1-5&KLHI&LUFXLW-XGJH2DNODQG
0HGLFDO*URXS3&LVD0LFKLJDQFRUSRUDWLRQWKDWSURYLGHV
D UDQJH RI PHGLFDO VHUYLFHV LQFOXGLQJ FOLQLFDO ODERUDWRU\
VHUYLFHV DW PXOWLSOH ORFDWLRQV 'U +DUROG 0DUJROLV LV DQ
2DNODQGVKDUHKROGHU7KH6HFUHWDU\RI+HDOWKDQG+XPDQ
6HUYLFHVWKURXJKWKH+HDOWK&DUH)LQDQFLQJ$GPLQLVWUDWLRQ
UHYRNHG2DNODQG¶VFHUWLILFDWLRQWRSHUIRUPODERUDWRU\WHVWLQJ
WKHUHE\ UHQGHULQJ 2DNODQG LQHOLJLEOH WR UHFHLYH 0HGLFDUH
SD\PHQWV%HIRUHH[KDXVWLQJWKHLUDGPLQLVWUDWLYHUHPHGLHV
2DNODQG DQG 0DUJROLV EURXJKW D ODZVXLW LQ WKH (DVWHUQ
'LVWULFW RI 0LFKLJDQ FKDOOHQJLQJ WKH VXEVWDQFH RI WKH
GHFLVLRQWRUHYRNH2DNODQG¶VFHUWLILFDWLRQDQG FODLPLQJ
WKDWWKH6HFUHWDU\¶VIDLOXUHWRFRQWLQXH0HGLFDUHSD\PHQWV
ZKLOH 2DNODQG VRXJKW UHYLHZ RI WKH UHYRFDWLRQ GHFLVLRQ
YLRODWHG WKH 'XH 3URFHVV &ODXVH RI WKH )LIWK $PHQGPHQW
7KHGLVWULFWFRXUWGLVPLVVHGWKHLUODZVXLWIRUODFNRIVXEMHFW
PDWWHUMXULVGLFWLRQ:H$)),50
,
7KH &OLQLFDO /DERUDWRU\ ,PSURYHPHQW $PHQGPHQWV RI
86&†DDQGLPSOHPHQWLQJUHJXODWLRQV
&)53DUWUHJXODWHDOOFOLQLFDOODERUDWRU\VHUYLFHVLQWKH
8QLWHG6WDWHV2QO\ODERUDWRULHVWKDWKDYHDYDOLGODERUDWRU\
1R 2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV

(additional citation and internal punctuation omitted).
Second, "the risk of erroneous deprivation of provider status
is quite manageable." Cathedral Rock, 223 F.3d at 365
(quoting Northlake, 654 F.2d at 1242). Finally, the
government has a strong interest in expediting provider-
termination procedures because: (1) "[t]he Secretary’s
responsibility for insuring the safety and care of elderly and
disabled Medicare patients is of primary importance," and
(2) ³WKHJRYHUQPHQWKDVDVWURQJLQWHUHVWLQPLQLPL]LQJWKH
H[SHQVHVRIDGPLQLVWHULQJWKH0HGLFDUHSURJUDP´&DWKHGUDO
5RFN)GDW TXRWLQJ1RUWKODNH)GDW
%HFDXVH2DNODQGGRHVQRWKDYHDGXHSURFHVVULJKWWRDSUH
WHUPLQDWLRQ KHDULQJ SODLQWLIIV GR QRW VWDWH D FRORUDEOH
FRQVWLWXWLRQDOFODLP
,9
)RUWKHIRUHJRLQJUHDVRQVZH$)),50WKHMXGJPHQWRIWKH
GLVWULFWFRXUW

-- 2 of 4 --

2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV
1R
benefits awarded in a post-deprivation hearing. 0DWWKHZVY
(OGULGJH424 U.S. 319, 330-32, 96 S.Ct. 893, 47 L.Ed.2d 18
(1976); see also Cathedral Rock, 223 F.3d at 361-62.
In Cathedral Rock, a nursing facility challenged the
Secretary’s determination that it was not in compliance with
Medicare regulations and claimed that the Fifth Amendment’s
Due Process Clause mandated a hearing before the
cancellation of its Medicare payment eligibility. This court
found that the plaintiff’s procedural due process claim was
entirely collateral and, therefore, turned to the issue of
whether the nursing facility made "a colorable claim that full
relief would not be possible if it was awarded retroactive
relief through a post-deprivation hearing." Id. at 364.
Relying on the factors articulated by the Supreme Court in
Eldridge for determining whether procedural due process
requires a pre-termination hearing, the Cathedral Rock court
determined that the nursing facility did not state a cognizable
due process claim. See id. at 365-66 (concluding that the
nursing facility was not constitutionally entitled to a pre-
termination hearing). The Eldridge factors are: (1) "the
private interests that will be affected by the official action";
(2) "the risk of an erroneous deprivation of such interest
through the procedures used, and the probable value, if any,
of the additional or substitute procedural safeguards"; and
(3) "the Government’s interest, including the function
involved and the fiscal and administrative burdens that the
additional or substitute procedural requirement would entail."
Eldridge, 424 U.S. at 335.
Application of the Eldridge factors here reaffirms the
soundness of the Cathedral Rock decision: First, although the
economic impact of canceling Medicare eligibility is
significant, "a provider’s financial need to be subsidized for
the care of its Medicare patients is only incidental to the
purpose and design of the [Medicare] program." Cathedral
Rock, 223 F.3d at 364-65 (quoting Northlake Community
Hosp. v. United States, 654 F.2d 1234, 1242 (7th Cir. 1981))
1R 2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV

WHVWLQJFHUWLILFDWHXQGHUWKH$PHQGPHQWVPD\SHUIRUP
ODERUDWRU\WHVWLQJ86&†[ V :HVW
0RUHRYHUXQGHUWKH0HGLFDUH$FWDODERUDWRU\¶VFHUWLILFDWLRQ
XQGHUWKH$PHQGPHQWVLVDSUHFRQGLWLRQWRLWVHOLJLELOLW\
WRUHFHLYH0HGLFDUHSD\PHQWVIRUGLDJQRVWLFWHVWLQJ6HH
&)5 † D :HVW VHH DOVR 86&
†Z
7KURXJK WKH +HDOWK &DUH )LQDQFLQJ $GPLQLVWUDWLRQ WKH
6HFUHWDU\ RI +HDOWK DQG +XPDQ 6HUYLFHV PD\ LPSRVH
VDQFWLRQVLQFOXGLQJVXVSHQVLRQRI0HGLFDUHSD\PHQWVRQDQ\
ODERUDWRU\WKDWGRHVQRWFRPSO\ZLWKWKH$PHQGPHQWV
86&†Z
%HIRUH FDQFHOLQJ D ODERUDWRU\¶V DSSURYDO WR UHFHLYH
0HGLFDUHSD\PHQWVWKH6HFUHWDU\SURYLGHVZULWWHQQRWLFHRI
WKH UDWLRQDOH IRU KLV DFWLRQ DQG WKH HIIHFWLYH GDWH 6HH
&)5† E :HVW 0RUHRYHUWKH6HFUHWDU\
RIIHUV WKH ODERUDWRU\ DQ ³>R@SSRUWXQLW\ WR VXEPLW ZULWWHQ
HYLGHQFH RU RWKHU LQIRUPDWLRQ´ WKDW ZRXOG DUJXH DJDLQVW
FDQFHOODWLRQRILWVDSSURYDOWRUHFHLYH0HGLFDUHSD\PHQWV,G
7KHUHJXODWLRQVIRUWKH$PHQGPHQWVSURYLGHWKDWD
ODERUDWRU\GLVVDWLVILHGZLWKDFHUWLILFDWHUHYRFDWLRQGHFLVLRQ
PD\DSSHDO6HH&)5† D I :HVW
*HQHUDOO\ VXFK DQ DSSHDO IRUHVWDOOV FHUWLILFDWH
UHYRFDWLRQ ZKLFK ³LV QRW HIIHFWLYH XQWLO DIWHU D KHDULQJ
GHFLVLRQ E\ DQ $GPLQLVWUDWLYH /DZ -XGJH LV LVVXHG´
&)5 † G L VHH DOVR &)5
† H :HVW $ UHTXHVW IRU D KHDULQJ
KRZHYHUGRHVQRWGHOD\ZLWKGUDZDORIDSSURYDOIRU0HGLFDUH
SD\PHQWV&)5† E ³This sanction may be
imposed before the hearing that may be requested by a
laboratory, in accordance with the appeals procedures set
forth in §§ 493.1844." &)5† G

-- 3 of 4 --

2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV
1R
,,
(IIHFWLYHSXUVXDQWWRDQ$GPLQLVWUDWLYH/DZ-XGJHGHFLVLRQ
RQ-XO\WKH6HFUHWDU\UHYRNHGWKHODERUDWRU\WHVWLQJ
FHUWLILFDWH RI RQH RI 2DNODQG¶V ODERUDWRULHV $IWHU
GHWHUPLQLQJ 2DNODQG¶V RZQHUVKLS RI WKH ODERUDWRU\ WKH
6HFUHWDU\UHYRNHGWKHODERUDWRU\WHVWLQJFHUWLILFDWHVRIDOOWKH
2DNODQGRZQHGODERUDWRULHV7KH6HFUHWDU\DOVRZLWKGUHZLWV
0HGLFDUH SD\PHQW DSSURYDO IRU DOO 2DNODQGRZQHG
ODERUDWRULHV
%HIRUHH[KDXVWLQJWKHLUDGPLQLVWUDWLYHUHPHGLHV2DNODQG
DQG 0DUJROLV ILOHG D ODZVXLW LQ WKH (DVWHUQ 'LVWULFW RI
0LFKLJDQWRHQMRLQWKH6HFUHWDU\IURPZLWKGUDZLQJ2DNODQG¶V
SHUPLVVLRQWRUHFHLYH0HGLFDUHSD\PHQWV7KHGLVWULFWFRXUW
GLVPLVVHG WKH FRPSODLQW IRU ODFN RI VXEMHFW PDWWHU
MXULVGLFWLRQ
,,,
:HUHYLHZGHQRYRWKHGLVWULFWFRXUW¶VGHWHUPLQDWLRQWKDWLW
ODFNHGVXEMHFWPDWWHUMXULVGLFWLRQRYHUSODLQWLIIV¶FODLP6HH
Agrawal v. Paul Revere Life Ins. Co., 205 F.3d 297, 299 (6th
Cir. 2000)
$
8QGHUWKH0HGLFDUH$FWDQLQVWLWXWLRQ³Gissatisfied with a
determination by the Secretary [to cancel its eligibility to
receive Medicare payments] . . . shall be entitled to a hearing
thereon by the Secretary . . . and to judicial review of the
Secretary’s final decision after such hearing as is provided in
section 405(g)." 42 U.S.C.A. § 1395cc(h)(1). Section 405(g)
provides: "Any individual, after any final decision of the
[Secretary] . . . may obtain a review of such decision by a
civil action commenced within sixty days after the mailing to
him of notice of such decision or within such further time as
the [Secretary] may allow." 86&$ † J :HVW
1R 2DNODQG0HGLFDO*URXSHWDOY
6HFUHWDU\RI+HDOWKDQG+XPDQ6HUYV

LQFRUSRUDWHG LQWR WKH 0HGLFDUH $FW SXUVXDQW WR
86&†LL
7KH0HGLFDUH$FWOLPLWVMXGLFLDOUHYLHZRIWKH6HFUHWDU\¶V
GHFLVLRQVXQGHUHLWKHU86&† IHGHUDOTXHVWLRQ RU
86&† 8QLWHG6WDWHVDVGHIHQGDQW WRWKHPHWKRGV
DUWLFXODWHGLQVHFWLRQ J
No findings of fact or decision of the Commissioner of
Social Security shall be reviewed by any person, tribunal,
or governmental agency except as herein provided. No
action against the United States, the Commissioner of
Social Security, or any officer or employee thereof shall
be brought under section 1331 or 1346 of Title 28 to
recover on any claim arising under this subchapter.
42 U.S.C.A. § 405(h) (West 2002) (incorporated into the
Medicare Act pursuant to 42 U.S.C. § 1395ii). Thus, section
405(h) "‘channels most, if not all, Medicare claims through
the special review system’ of an administrative hearing and
‘purports to make exclusive the judicial review method set
forth in section 405(g).’" Cathedral Rock of North College
Hill, Inc. v. Shalala, 223 F.3d 354, 358-59 (6th Cir. 2000)
(quoting Shalala v. Illinois Council on Long Term Care, Inc.,
529 U.S. 1, 8-9, 120 S.Ct. 1084, 146 L.Ed.2d 1 (2000))
(internal punctuation omitted).
Here, Oakland and Margolis challenge the Secretary’s
decision to cancel Oakland’s eligibility for Medicare
payments. Thus, absent an applicable exception, section
405(h) precludes the district court from exercising subject
matter jurisdiction over their claim.
%
Section 405(g)’s exhaustion requirement may be waived
where a plaintiff’s claim is "entirely collateral" to his
substantive claim of entitlement and he makes a colorable
claim that he could not obtain full relief through retroactive

-- 4 of 4 --

Continua la tua ricerca in ChatGPT o Claude

Collega Omnilex per cercare nel corpus legale dal tuo assistente IA.