Full Life Hospice, LLC v. Sebelius
2013 U.S. App. LEXIS 3974
9th Cir.2013Background
- Full Life Hospice, a Medicare hospice provider, sought reimbursement for hospice services from HHS and was contested by a fiscal intermediary.
- Full Life challenged the intermediary’s final determinations in administrative appeals, which were time-barred as untimely under 180 days.
- Board determinations found no good cause to excuse late filings; Full Life tried to proceed in district court after Board decisions.
- District court dismissed for lack of subject matter jurisdiction due to untimely Board appeals and lack of exhaustion under § 1395oo(f)(l).
- Court held that § 1395oo(f)(l) precludes jurisdiction if prerequisites (timely Board hearing) are not met, and mandamus relief was improper.
- Court affirmed dismissal and rejected attempt to amend, noting amended claims would be time-barred and could not relate back.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 1395oo(f)(l) provides jurisdiction here | Full Life argued jurisdiction via § 1395oo(f)(l) for EJR review. | HHS argued preconditions not met due to untimely Board requests. | No jurisdiction; § 1395oo(f)(l) not satisfied. |
| Whether mandamus under 28 U.S.C. § 1361 provides an alternative basis for jurisdiction | Full Life claimed mandamus could compel review. | Mandamus unavailable because other avenues existed and exhaustion required. | Mandamus not available; failure to exhaust under statutory scheme bars relief. |
| Whether the district court erred in denying amendment to challenge good-cause determinations | Full Life sought to amend to attack Board’s good-cause rulings. | amendment would be futile and time-barred; did not relate back. | Amendment properly denied; would be time-barred and fail the relation-back test. |
Key Cases Cited
- Sebelius v. Auburn Regional Med. Ctr., 133 S. Ct. 817 (2013) (180-day deadline nonjurisdictional; tolling not applied; good-cause extension possible)
- Bethesda Hosp. Ass’n v. Bowen, 485 U.S. 399 (1988) (case cited regarding statutory interpretation of review procedures)
- Minnesota Hosp. Ass’n v. Bowen, 703 F. Supp. 780 (D. Minn. 1988) (district court decision cited on timing of appeals)
- Affinity HealthCare Servs., Inc. v. Sebelius, 746 F. Supp. 2d 106 (D.D.C. 2010) (cited for Board review and timing framework)
- Los Angeles Haven Hospice, Inc. v. Sebelius, 638 F.3d 644 (9th Cir. 2011) (cited for challenges to § 418.309 and related authority)
- Lion Health Servs., Inc. v. Sebelius, 635 F.3d 693 (5th Cir. 2011) (cited alongside other circuits challenging regulation)