684 F.3d 527
5th Cir.2012Background
- Paladin, a Medicare-certified CMHC, challenges the 2011 partial hospitalization payment rate set by the Secretary, alleging use of both hospital and CMHC data violated the statute.
- The 2011 rule calculated relative payment weights using mixed cost data; hospitals’ weights relied on hospital data, CMHCs used both hospital and CMHC data.
- Paladin filed suit in December 2010 seeking injunctive relief and a declaration of unlawfulness without pursuing an administrative remedy.
- The district court dismissed, holding that Congress precluded review of the Secretary’s payment-rate determinations and that the Secretary acted within statutory authority.
- The Fifth Circuit reviews jurisdiction de novo and affirms the dismissal, holding Congress expressly precluded judicial review of the establishment and adjustment of relative payment weights and related rate determinations.
- Kyne’s narrow exception to preclusion does not apply; the Secretary acted within her authority, and review of the final rate would impermissibly amount to reviewing its component parts.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does §1395i(t)(12) preclude judicial review of the 2011 payment-rate determinations? | Paladin argues judicial review should be allowed. | Secretary argues Congress precluded review. | Yes, precluded. |
| Does the Leedom/ Kyne exception permit judicial review despite preclusion? | Paladin relies on Kyne to challenge an excess of authority. | Secretary contends Kyne does not apply because authority was not exceeded. | No, Kyne exception does not apply. |
| Was exhaustion of administrative remedies required before filing suit? | Paladin might need to exhaust. | Not reached; district court dismissed for lack of jurisdiction. | Not reached. |
Key Cases Cited
- Am. Soc’y of Cataract & Refractive Surgery v. Thompson, 279 F.3d 447 (7th Cir.2002) (no judicial review of relative values and related adjustments)
- Bowen v. Mich. Acad. of Family Physicians, 476 F.3d 667 (6th Cir.1986) (presumption of judicial review subject to statutory exceptions)
- Kirby Corp. v. Pena, 109 F.3d 258 (5th Cir.1997) (Kyne exception not triggered without facial statutory violation)
- Hanauer v. Reich, 82 F.3d 1304 (4th Cir.1996) (cursory review for clear statutory mandate outside narrow exception)
- Leedom v. Kyne, 358 U.S. 184 (U.S. 1958) (origin of narrow administrative-excessive-authority review)
- Mich. Acad. of Family Physicians v. Bowen, 476 U.S. 667 (1986) (statutory preclusion and judicial review considerations)
- Sierra Club v. EPA, 356 F.3d 296 (D.C. Cir.2004) (ambiguity in statutory phrases like 'based on')
- McDaniel v. Chevron Corp., 203 F.3d 1099 (9th Cir.2000) (interpretation of statutory phrases and deference to agency)