Bp Care, Inc. v. Tommy Thompson, Secretary, United States Department of Health and Human Services Department of Health and Human ServicesBp Care, Inc. v. Tommy Thompson, Secretary, United States Department of Health and Human Services Department of Health and Human Services
In this case, BP Care, Inc., contests the Department of Health and Human Services’ policy of imposing successor liability for money penalties incurred because of a violation of a Medicare provider agreement. The Department of Health and Human Services assessed civil money penalties (“CMPs”) against West Chester Management Company, doing business as Barbara Parke Care Center (“Barbara Parke”), because of inadequate patient care at a nursing home Barbara Parke leased and operated under a Medicare provider agreement. The agency issued Barbara Parke a notice of its right to a hearing to contest the CMPs. Over the ensuing two years, Barbara Parke (1) requested a hearing before an administrative law judge on the charges, (2) ceased operating the facility and assigned its provider agreement to another company, (3) declared bankruptcy, and (4) withdrew its request for a hearing on the CMPs. The Department of Health and Human Services seeks to collect the CMPs from BP Care, the new lessee/operator of the nursing home, under a successor liability theory. BP Care sued in federal district court, alleging that the successor liability scheme violated the Medicare Act’s CMP provisions, denied BP Care procedural due process, and constituted arbitrary and capricious agency action under the Administrative Procedure Act. The district court found that it lacked subject-matter jurisdiction over some claims but reached the merits of one: it found that BP Care failed to state a claim in alleging that successor liability for CMPs denied successor Medicare providers due process of law. We affirm, but on different grounds. The district court lacked subject-matter jurisdiction over all of BP Care’s claims and therefore should not have reached the due process issue.
I. Background
Barbara Parke operated the nursing home under a lease until August of 1999. In February 1999, a Department of Health and Human Services (“HHS”) inspector surveyed the nursing home and found that the facility did not meet Medicare requirements concerning quality of care, quality of life, provision of services, and staff treatment of patients. As Medicare regulations require, HHS served Barbara Parke with a notice of its intent to assess CMPs totaling $35,650.00 on the basis of the deficiencies found in the survey. Regulations require HHS to explain in the notice that the facility has the option of requesting a hearing regarding the CMPs, or accepting the penalty and receiving a thirty-five percent reduction in the amount due.
In August 1999, Barbara Parke became insolvent and was unable to continue lease payments. Meanwhile, BP Care, Inc., formed on July 16, 1999. The same attorney who represented Barbara Parke in the early stages of the CMP proceedings, Geoffrey Webster, also incorporated and represented BP Care. In August 1999, Barbara Parke assigned both its lease and its Medicare provider agreement to BP Care. Because BP Care used Barbara Parke’s Medicare provider number, it was able to continue operating the nursing home without interruption. This continuity, however, also carried a downside: under HHS policy, BP Care became liable for the outstanding CMPs when it assumed the lease. 1
CMS responded by moving to vacate the order of remand and dismissal. In its motion, CMS signaled for the first time its intent to impose successor liability, stаting that a stay of proceedings pending termination of the bankruptcy matter would “not only [delay CMS’s] ability to recover any sums from the bankruptcy estate, but ... also [delay CMS’s] ability to exercise its right to recover from [Barbara Parke’s] successor, BP Care, Inc., to whom it appears the provider agreement has been automatically assigned.” J.A. at 237. CMS served this motion on both Barbara Parke’s bankruptcy trustee and BP Care’s president. The ALJ granted the motion, reinstating the proceedings before him, on January 22, 2001. In vacating his previous decision to remand to CMS, the ALJ concluded that Barbara Parke’s bankruptcy created no new issues in the case, since the bankruptcy did not automatically stay the CMP proceedings, and since CMS was authorized to impose successor liability for the CMPs on BP Care. In May 2001, Barbara Parke’s bankruptcy trustee withdrew Barbara Parke’s request for a hearing in the CMP proceeding.
Rather than appealing the Secretary’s decision to impose CMPs through the narrow means provided in the Medicare and Social Security Acts, see
The complaint seeks a declaratory judgment and injunction ordering HHS to issue a notice to BP Care affording it the right to a hearing on the CMPs. It prays the court to void the ALJ’s January 22, 2001 findings that the automatic stay in bankruptcy did not apply to the CMP proceedings, and that CMS may properly impose successor liability for the CMPs on BP Care. BP Care’s parent company, the King Entities, also cross-claimed in Barbara Parke’s bankruptcy proceedings, seeking a declaration that any liability for the CMPs be paid out of the bankruptcy estate or paid from an escrow account established at the time of the Barbara Parke-BP Care transaction to cover Medicare overpayments. The district court consolidated that cross-claim with the declaratory judgment action. The Secretary of Health and Human Services moved to dismiss the complaint for lack of jurisdiction and for failure to state a claim.
The district court grouped BP Care’s claims into two categories, finding that the first lacked subject-matter jurisdiction and the second failed to state a claim. First, the court addressed BP Care’s claim that HHS violated procedural due process by failing to issue BP Care a new “right to hearing” notice and by permitting Barbara Parke unilaterally to withdraw its request for a hearing. The district court found that BP Care could have contested these actions within the administrative process because it was a provider with the right to appeal a hearing decision to the agency’s Depаrtmental Appeals Board (“DAB”) pursuant to
II. Jurisdiction Under
The district court did not have jurisdiction under
a. Statutory Framework
This conclusion is required by a group of nested jurisdictional provisions that narrowly limits avenues for contesting CMPs assessed for violations of a Medicare provider agreement. Section 1395Í-3 of the Social Security Act sets forth substantive requirements for care in Medicare-participating skilled nursing facilities. That section allows HHS to conduct surveys of nursing homes to determine whether they are compliant, and to impose CMPs for non-compliancе.
b. Reliance on Deerbrook Pavilion
None of the recognized exceptions to
The district court found that BP Care’s second claim, its challenge to HHS’s successor liability policy, was “entirely apart from the proceedings by which the civil money penalty was imposed.”
BP Care,
However, the Eighth Circuit’s decision in
Deerbrook Pavilion
does not support the district court’s exercise of jurisdiction in this case. First,
Deerbrook Pavilion
is distinguishable, and it may also convey the false impression that Medicare providers may choose whether to press their claims in the first instance in an administrative proceeding or in a federal court case. The
Deerbrook Pavilion
court stated conclu-sorily that “[i]t is questionable whether Deerbrook even had the standing (or the incentive) to intervene in contesting the imposition of CMPs on its predecessor.”
Even more cоmpelling is the manifest tension between the holding of
Deerbrook Pavilion
and the holding of the Supreme Court in
Illinois Council.
The Eighth Circuit in
Deerbrook Pavilion
held that the plaintiffs general objection to HHS’s successor liability scheme for CMPs formed a “separate issue” from more specific allegations that a provider’s conduct did not warrant CMPs; the latter would be reviewable in an HHS adjudication, while the former was not.
foreclose[s] distinctions based upon the “potential future” versus the “actual present” nature of the claim, the “general legal” versus the “fact-specific” nature of the challenge, the “collateral” versus “noncollateral” nature of the issues, or the “declaratory” versus “injunctive” nature of the relief sought.... Claims for money, claims for other benefits, ... and claims that contest a sanction or remedy may all similarly rest upon individual fact-related circumstances, ... or may all similarly involve the application, interpretation, or constitutionality of interrelated regulations or statutory provisions. There is no reason to distinguish among them in terms of thelanguage or in terms of the purposes of § 405(h) .
By characterizing the factual aspects of a challenge to CMPs as intertwined with the agency adjudication and the broader legal aspects of the challenge as separate from the adjudication, the Eighth Circuit in
Deerbrook,
and the district court in this case, relied on the “entirely сollateral” exception to
c. Application of the Michigan Academy Exception
In
Illinois Council,
the Supreme Court limited its earlier decision in
Michigan Academy
to hold that
First, HHS did have the authority to consider the subject matter of BP Care’s core challenge — i.e., its claim that it should not be liable for CMPs. In contrast, in
Michigan Academy,
the agency was unable to review the subject matter of the plaintiffs claim, and therefore the application of
Both
Illinois Council
and this case, on the other hand, involve Medicare Part A. The Court held in
Illinois Council
that
Michigan Academy’s
broad exception to
Second, requiring strict adherence to
It is true that in
Buchanan v. Apfel,
Buchanan
is inapposite herе because BP Care was a party to the agency proceedings. HHS regulations require CMS to issue a notice of right to hearing to a
facility
assessed with CMPs, not to the business operating it.
Nonetheless, BP Care would arguably not be a party if it did not know that it was “affected” — i.e., if it had no notice of HHS’s practice of imposing successor liability for CMPs. The district court did not commit clear error when it concluded, however, on the basis of the аdministrative record, that BP Care was served with motions filed by CMS in the CMP proceedings.
8
Finally, viewing the administrative scheme as BP Care’s exclusive recourse does not preclude effective rеview because the procedural posture of the agency adjudication permitted BP Care to seek agency review at each stage, even after the ALJ dismissed the proceedings. BP Care argues that after Barbara Parke withdrew its request for a hearing, BP Care was left in a procedural limbo in which it could not appeal to the DAB because no “hearing before an ALJ” had occurred. Appellant’s Reply Br. at 7;
see
III. Mandamus Jurisdiction
BP Care also seeks a writ of mandamus under
IV. Conclusion
For the foregoing reasons, we AFFIRM, on different grounds, the decision of the district court.
Notes
. Neither the Medicare Act nor the relevant regulations set forth a policy of successor
. The name of this arm of the Department of Health and Human Services changed from Health Care Financing Administration to Centers for Medicare and Medicaid Services while the CMP proceeding was pending. For simplicity, we refer to that office as "CMS.”
. The facts here are in some respects similar to those of
Mathews v. Eldridge,
. The district court opinion does not use the word "collateral," but instead uses the phrases "completely isolated," "entirely apart,” and "separate question.”
. Part B of the Act wаs amended in 1986; under the current law, claimants must pursue administrative challenges to agency's method of determining benefits.
Cathedral Rock,
. A Departmental Appeals Board case,
CarePlex of Silver Spring v. Health Care Financing Administration,
Docket No. A-98-94, CR536, DAB No. 1683,
. Medicare regulations do not state whether more than one provider may be “the affected party" in the adjudication. The Secretary on appeal argues not only that HHS imposes successor liability on businesses assuming a previous operator's provider agreement, but also that the predecessor and the successor are jointly and severally liable for CMPs. The regulations do not provide explicitly for either successor liability or joint and several liability for predecessor and successor organizations under a Medicare provider agreement. Given the significant financial liabilities at stake and the risk of sham provider agreement transfers to avoid CMPs if the successor liability policy is not adequately enforced, thе agency would be well-served by amending its regulations to address these issues.
. Whether BP Care had notice of the CMP proceedings forms the only factual issue in this case; therefore it is the only determination of the district court that we review for clear error.
See Cathedral Rock,
. It is possible that a business could assume a Medicare provider agreement before its predecessor has paid CMPs, but after its predecessor has exhausted all administrative remedies, as well as its right of appeal in a federal appeals court. We neеd not decide here whether a federal district court would have jurisdiction under
. The administrative record does not contain a notice of dismissal; however, the Secretary and BP Care agree that the ALJ dismissed the proceedings at Barbara Parke's motion. Ap-pellee's Br. at 14; Appellant’s Br. at 6.
See
. The literal wording of
In 1976, the Office of Law Revision Counsel " ‘revised’
Since