649 F.3d 1153
9th Cir.2011Background
- Kaiser filed an appeal with the PRRB challenging its NPR for FYE 2001 after receiving the NPR from Mutual of Omaha.
- The PRRB dismissed Kaiser’s appeal for failure to file a preliminary position paper by the due date.
- Kaiser petitioned the Board for reinstatement; the Board denied reinstatement and Kaiser filed suit.
- District court granted summary judgment for Sebelius; Kaiser appeals to circuit court.
- PRRB Instructions required a preliminary and a final position paper; failure to file timely papers triggers dismissal.
- The court weighs whether the Board’sprocedural rules comply with the Medicare Act and whether dismissal was reasonable.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Validity of preliminary position paper rule | Kaiser: rule not necessary or appropriate under Medicare Act | Sebelius: Board may set reasonable procedures to manage its docket | Rule is valid and reasonable; not arbitrary or capricious |
| Arbitrary or capriciousness of dismissal | Kaiser: dismissal was an overbroad sanction for a technical violation | Sebelius: dismissal followed clear Board procedure and warnings | Not arbitrary or capricious; Board proper to dismiss for missing due dates |
| Excusable neglect standard | Kaiser: excusable neglect should apply due to equity and complexity | Sebelius: APA standard governs; no excusable neglect standard applied | No excusable neglect standard applied; review under arbitrary and capricious standard |
| Judicial reviewability of Board decisions | Kaiser: Board decision reviewable under 42 U.S.C. § 1395oo(f)(1) | Sebelius: Board decisions are subject to APA review and deference | Court has jurisdiction to review final Board decision |
Key Cases Cited
- High Country Home Health, Inc. v. Thompson, 359 F.3d 1307 (10th Cir. 2004) (upholds dismissal for failure to timely file position papers)
- UHI, Inc. v. Thompson, 250 F.3d 993 (6th Cir. 2001) (procedural requirements reasonable and necessary to agency process)
- Rapid City Reg’l Hosp. v. Sebelius, 681 F. Supp. 2d 56 (D.D.C. 2010) (procedural rules to control docket; dismissal proper)
- Inova Alexandria Hosp. v. Shaldla, 244 F.3d 342 (4th Cir. 2001) (procedural rules upheld; dismissal not arbitrary)
- County of Los Angeles v. Leavitt, 521 F.3d 1073 (9th Cir. 2008) (APA review standard for agency decisions)
- Providence Yakima Med. Ctr. v. Sebelius, 611 F.3d 1181 (9th Cir. 2010) (requirement of reasoned basis; deference to agency interpretation)
- Loma Linda Univ. Med. Ctr. v. Leavitt, 492 F.3d 1065 (9th Cir. 2007) (judicial review of final Board decisions under Medicare Act)