Fresenius Medical Care Holdings, Inc. v. Tucker
2013 U.S. App. LEXIS 716
11th Cir.2013Background
- Constitutional challenge to Florida’s Patient Self-Referral Act (Fla. Stat. § 456.053) prohibiting physician self-referrals to labs with financial interests.
- Appellants Fresenius, DVA Renal, and Davita sue Florida Secretary of Health and state medical boards seeking declaratory and injunctive relief.
- Florida Act bans referrals to associated laboratories and prohibits claims for related services; amended in 2002 to repeal ESRD exemption.
- Appellants operate ESRD dialysis clinics in Florida and wish to vertically integrate with labs, which the Act forbids.
- District court granted summary judgment for Florida; appellate court reviews de novo the constitutionality of the statute under preemption, dormant Commerce Clause, and substantive due process grounds.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Stark preempts Florida Act | Stark exemptions preclude state prohibitions; conflict exists | Stark does not preempt because no actual conflict; state may restrict self-referral | Preemption not found; Florida Act not conflict-preempted |
| Whether Florida Act violates dormant Commerce Clause | Act imposes discriminatory burden on out-of-state ESRD providers | Law serves legitimate local interests; burden not clearly excessive | Act does not violate dormant Commerce Clause |
| Whether Florida Act violates substantive due process | Law lacks rational basis; targets innocent business activity | Rational basis supported by reducing conflicts of interest and costs | Act passes rational basis review; no substantive due process violation |
Key Cases Cited
- Exxon Corp. v. Governor of Maryland, 437 U.S. 117 (Supreme Court 1978) (dormant Commerce Clause burden on interstate commerce permissible when local benefits justify means)
- Hunt v. Wash. Apple Adver. Comm’n, 432 U.S. 343 (Supreme Court 1977) (state law neutral on its face may burden interstate commerce; strict scrutiny not always required)
- Gade v. Nat’l Solid Wastes Mgmt. Ass’n, 505 U.S. 88 (Supreme Court 1992) (conceptual framework for conflict preemption and state regulation of professional practice)
- Oregon Waste Sys., Inc. v. Dep’t of Envtl. Quality of Ore., 511 U.S. 93 (Supreme Court 1994) (discrimination and balancing test for dormant Commerce Clause challenges)
- Clover Leaf Creamery Co., 449 U.S. 456 (Supreme Court 1981) (rational basis scrutiny and local benefits balancing in commerce clause analysis)
- Wyeth v. Levine, 555 U.S. 555 (Supreme Court 2009) (preemption principles and congressional intent in federal-state regulation interplay)