Florida Health Sciences Center, Inc. v. Secretary of Health & Human Services
2016 U.S. App. LEXIS 13547
| D.C. Cir. | 2016Background
- Tampa General Hospital (Tampa General) challenged HHS’s 2014 DSH-payment calculation under the Affordable Care Act, which shifted payments toward hospitals’ uncompensated care.
- HHS estimated each hospital’s share of national uncompensated care using hospitals’ Medicaid and Medicare-SSI patient days as a proxy, relying on 2010/2011 reports and March 2013 updates as the cutoff.
- Tampa General submitted revised data in April 2013 showing it should receive about $3 million more; HHS refused to use the April updates.
- Tampa General sued under the APA and the Medicare statute asserting HHS used “obsolete” data and failed to use the most recent available data.
- The district court dismissed for lack of subject-matter jurisdiction, concluding 42 U.S.C. § 1395ww(r)(3) bars judicial review of the Secretary’s estimates and choices related to them.
- The D.C. Circuit affirmed, holding the statutory bar on review of the Secretary’s “estimate” precludes review of the underlying data when the data are integral to the estimate.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 1395ww(r)(3) bars judicial review of HHS’s choice of data underlying its estimate of a hospital’s uncompensated care | Tampa General: The statute bars review of the Secretary’s estimate but not the underlying data; data are inputs distinct from the barred output | HHS: The bar precludes review of the estimate and any decisions integral to making that estimate, including data selection | Held: Bar on review of estimates precludes review of underlying data because the data are integral and inextricably intertwined with the estimate |
| Whether Tampa General may recast its challenge as a challenge to general rules rather than the barred estimate | Tampa General: The claim targets HHS’s refusal to accept updated data as a general rule, not the estimate itself | HHS: The hospital seeks merely to undo a shielded individual determination; such relabeling is impermissible | Held: Plaintiff cannot sidestep the bar by framing the claim as a challenge to general rules when the aim is to reverse the individual estimate |
| Whether the claim is reviewable as an ultra vires action (agency exceeded statutory authority) | Tampa General: Using inappropriate data violates statutory command to use “appropriate” data, making the action ultra vires | HHS: Selecting March cutoff over April is not an obvious, patent exceedance of authority; ultra vires exception does not apply | Held: No patent statutory violation shown; ultra vires exception does not restore jurisdiction |
| Whether the statute’s separate bar on review of the Secretary’s selected period implies data remain reviewable | Tampa General: Explicitly barring periods but not data implies Congress left data reviewable | HHS: Period-bar serves broader functions and does not imply data are reviewable; overlap or redundancy is permissible | Held: Court rejects plaintiff’s expressio unius argument; overlap does not render the estimate bar inoperative |
Key Cases Cited
- Texas Alliance for Home Care Servs. v. Sebelius, 681 F.3d 402 (D.C. Cir. 2012) (statutory language precluding "administrative or judicial review" bars challenges integral to the barred action)
- ParkView Med. Assocs. v. Shalala, 158 F.3d 146 (D.C. Cir. 1998) (hospitals may challenge general rules leading to an action but not when the challenge merely seeks to reverse a shielded individual decision)
- El Paso Nat. Gas Co. v. United States, 632 F.3d 1272 (D.C. Cir. 2011) (statutory bars on review should be read narrowly but not circumvented by attacking integral parts of barred actions)
- Amgen, Inc. v. Smith, 357 F.3d 103 (D.C. Cir. 2004) (courts should avoid case-by-case review of reasonableness where Congress has foreclosed review)
- Southwest Airlines Co. v. TSA, 554 F.3d 1065 (D.C. Cir. 2009) (ultra vires exception permits review where agency action patently exceeds statutory authority)