Southern Rehabilitation Group v. Sebelius
874 F. Supp. 2d 733
E.D. Tenn.2012Background
- SRG and Dr. Little sue the Secretary, Cigna, CSC, and Q2 over Medicare Part B claim processing and alleged downcoding/denial,
- Court converted defendants’ partial dismissal motion to summary judgment after remand and payment of $107,171.07 for Groups 2–4,
- Group 1 claims lack final Secretary decision; exhaustion required under 405(g) and regulations,
- Court previously granted the Secretary’s Partial Remand motion; payment on remand completed February 24, 2012,
- Court concludes all Counts III–IX lack jurisdiction; Group 1 claims unexhausted; Groups 2–4 moot; no interest awarded; relief sought through injunctive relief unavailable.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Subject matter jurisdiction over state-law claims | Inextricably intertwined with payment claims; exhausted remedies | Jurisdiction lacking; 405(g) channels review | Lacks jurisdiction over Counts IV–IX |
| Subject matter jurisdiction over constitutional claims | Constitutional claims are exhausted and reviewable | Constitutional claims inseparable from benefits disputes | Lacks jurisdiction over Count III |
| Injunctive relief availability | Court should grant injunctive relief to reform guidelines | Salfi/§405(g) provides only review of final decision | No jurisdiction for injunctive relief |
| Group 1 claims exhaustion | Group 1 review blocked by carrier inaction; exhaustion waived | Exhaustion required; waiver not shown | Lacks jurisdiction over Group 1 claims |
| Mootness of Groups 2–4 claims | Remand payment insufficient; still due relief | Remittance satisfies claim; no further relief available | Groups 2–4 moot; Counts moot |
Key Cases Cited
- Bodimetric Health Services, Inc. v. Aetna Life & Casualty, 903 F.2d 480 (7th Cir. 1990) (Medicare remedies are limited; relief must follow statutory scheme)
- Weinberger v. Salfi, 422 U.S. 749 (U.S. 1975) (Salfi governs exclusive jurisdiction under §405(g) for social security/benefits claims)
- Heckler v. Ringer, 466 U.S. 602 (U.S. 1984) (§405(g) exclusive; asylum for constitutional challenges tied to benefits denial)
- Schweiker v. Chilicky, 487 U.S. 412 (U.S. 1988) (Constitutional claims not implied when relief is intertwined with denial of benefits)