Florida Health Sciences Center, Inc. v. Secretary U.S. Department of Health & Human Services
2015 U.S. Dist. LEXIS 42650
| D.D.C. | 2015Background
- Tampa General Hospital challenges HHS’s FY2014 DSH payment calculation under the ACA regime, focusing on factor three’s uncompensated care estimate.
- The DSH adjustment now consists of an empirically justified portion plus an additional payment based on the hospital’s uncompensated care, among other factors.
- Factor three uses the amount of uncompensated care “as estimated by the Secretary” based on data selected by the Secretary.
- The final rule (Aug. 2013) used March 2013 data instead of April 2013 data for factor three, prompting Tampa General to sue.
- The Secretary moved to dismiss, arguing Congress precludes judicial review of any Secretary estimate or any period selected for determining the factors under 42 U.S.C. § 1395ww(r)(3).
- The court granted the motion to dismiss, finding the claims fall within the statutory preclusion and that it lacks jurisdiction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the preclusion provision bars review. | Tampa General argues the challenge targets data choice, not an estimate or period. | Secretary contends claims challenge an estimate/period, thus precluded. | Precluded: claims target an estimate/period under §1395ww(r)(3). |
| Whether Tampa General challenges a period selected by the Secretary. | Plaintiff says it challenges data-source choices, not period. | Court precluded from reviewing any period selected for determining factors. | Precluded: period selection falls within the preclusion clause. |
| Whether Tampa General challenges the Secretary’s estimate of uncompensated care. | Plaintiff asserts data accuracy/appropriateness, not the estimate itself. | Statute bars review of any estimate used to determine the factors. | Precluded: cannot review the Secretary’s estimate itself. |
| Whether the data timing (March 2013 vs April 2013) falls within the preclusion. | Argues data timing is a data-source issue, not a period/estimate. | Timing is equivalent to the selection of a period for factor calculation. | Precluded: timing is within the scope of the preclusion provision. |
| Whether other preclusion provisions alter the outcome. | Argues narrower preclusion provisions do not bar review. | Catches all review of estimates/periods for factor calculation. | No; §1395ww(r)(3) governs and forecloses review here. |
Key Cases Cited
- Ford v. Mabus, 629 F.3d 198 (D.C. Cir. 2010) ('Any' has expansive meaning; preclusion applies broadly)
- American Academy of Cataract & Refractive Surgery v. Thompson, 279 F.3d 447 (7th Cir. 2002) (challenge to methodology cannot override statutory preclusion)
- Skagit County Pub. Hosp. Dist. No. 2 v. Shalala, 80 F.3d 379 (9th Cir. 1996) (rationale on preclusion of wage-data corrections in reclassifications)
- Painter v. Shalala, 97 F.3d 1351 (10th Cir. 1996) (preclusion when challenge targets how a factor is determined)
- Universal Health Servs. of McAllen, Inc. v. Sullivan, 770 F. Supp. 704 (D.D.C. 1991) (review limited to broader preclusion of certain determinations)
- Palisades General Hospital v. Leavitt, 426 F.3d 400 (D.C. Cir. 2005) (preclusion in wage-data related determinations; narrow review)