Sunshine Haven Nursing Operations, LLC v. United States Department of Health & Human Services, Centers for Medicare & Medicaid Services
742 F.3d 1239
10th Cir.2014Background
- Sunshine operates a 67-bed nursing home in Lordsburg, NM and challenges CMS remedies after surveys found noncompliance.
- CMS issued DPNA and terminated Sunshine’s provider agreement based on six months of noncompliance beginning Nov 5, 2008.
- CMS imposed four per‑instance CMPs totaling $14,000 for deficiencies causing immediate jeopardy or actual harm.
- DAB affirmed ALJ findings; Sunshine sought judicial review in this circuit court.
- Court held CMP challenges are within exclusive circuit jurisdiction; non‑CMP remedies belong in district court and should be transferred under 28 U.S.C. § 1631.
- Court transferred non‑CMP issues to the District of New Mexico and denied Sunshine’s petition with respect to the four CMPs.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the court has initial jurisdiction over CMP challenges. | Sunshine argues § 1320a‑7a(e) gives circuit court jurisdiction over CMPs. | CMS and government contend CMPs fall under § 1320a‑7a(e) and are reviewable in circuit court. | Yes for CMPs; court has exclusive jurisdiction over CMP challenges. |
| Whether the court has jurisdiction over non‑CMP remedies. | Sunshine argues § 1395cc(h)(1)(A) allows review in circuit court. | CMS asserts non‑CMP remedies go to district court under § 1395cc(h)(1)(A) and § 405(g). | No; non‑CMP issues belong in district court; transfer to district court appropriate. |
| Whether the CMPs are supported by substantial evidence. | Sunshine contends the ALJ/DAB misapplied facts or burden of proof. | CMS's findings of noncompliance are supported by substantial evidence. | Substantial evidence supports the two $5,000 CMPs and two $2,000 CMPs. |
| Whether transfer under 28 U.S.C. § 1631 is proper to cure lack of jurisdiction. | Sunshine argues in good faith it filed petition in correct court; transfer unnecessary. | District court must hear the non‑CMP issues; transfer serves the interest of justice. | Transfer of non‑CMP issues to the district court was proper. |
Key Cases Cited
- Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 (U.S. 2000) (definitive interpretation of OBRA and review rights under Medicare statute)
- St. Anthony Hosp. v. U.S. Dept. of HHS, 309 F.3d 686 (10th Cir. 2002) (substantial evidence review for CMPs; deference to agency findings)
- S. Valley Health Care Ctr. v. Health Care Fin. Admin., 223 F.3d 1221 (10th Cir. 2000) (jurisdictional framework for review of noncompliance determinations)
- Bernstein v. Sullivan, 914 F.2d 1395 (10th Cir. 1990) (early precedent on Medicare administrative review)