Excel Home Care, Inc. v. United States Department of Health & Human ServicesExcel Home Care, Inc. v. United States Department of Health & Human Services
ORDER
Order entered Order Adopting Report and Recommendation. No objection having been received, after review the Report and Recommendation is adopted. The motion to dismiss is Granted and the action is Dismissed.
REPORT AND RECOMMENDATION ON DEFENDANT’S MOTION TO DISMISS (#3)
I. INTRODUCTION
On September 15, 2003, Excel Home Care, Inc. (“Excel” or “plaintiff’) filed a two-count complaint against the United States Department of Health and Human Services (“DHHS” or “defendant”). (# 1) In Count I the рlaintiff alleges that by ignoring the terms and provisions of Excel’s confirmed Chapter 11 Plan of Reorganization, DHHS breached its contractual obligations to Excel. (# 1, ¶¶ 16, 17) For the same reason DHHS is alleged to have violated the provisions of Title
In lieu of answering the complaint, on November 24, 2003, the DHHS filed a motion to dismiss pursuant to
II. FACTS
From all that appears, the facts of this case are undisputed. Excel, a Massachusetts corporation, is home health care provider that receives reimbursement for services provided to Medicare beneficiaries from the DHHS under Part A of the Medicare Program. (# 1, ¶ 1; #4 at 1) On November 5, 2001, Excel filed a Chapter 11 bankruptcy petition with the United States Bankruptcy Court for the District of Massachusetts, Case No. 01-46770-JBR. (# 1, ¶ 5) The DHHS, as a creditor in the bankruptcy proceedings, filed a proof of claim. (# 1, ¶ 6) Thereafter the parties reached an agreement to the effect that Excel owed the DHHS a total of $438,236.68 at the time that it filed the bankruptcy petition. (#1, ¶ 7 and Exh. A, 4.3)
On May 29, 2002, Excel filed its First Amended Plan of Reorganization (“Plan”). (#1, ¶ 8 and Exh. A) Approximately nine months later on February 20, 2003, the Bankruptcy Court confirmed the Plan. (# 1, ¶ 9 and Exh. B) As stated within the
According to the terms of the Plan, DHHS’s claims are designated as Class 3 claims. (# 1, ¶ 10 and Exh. A at 5) The Plan provides in section 4.3 that Excel will pаy the DHHS in full for the amount owed plus interest over a period not to exceed seven years with payments to be made in monthly installments of $7,000.00. (# 1, ¶ 10 and Exh. A, section 4.3) The plaintiff alleges that the parties “mechanistically” agreed that “the sum of $7,000.00 per month would be withheld by DHHS from its ongoing and continuing payments otherwise to be made to Excel for services rendered to Medicare patients serviced by Excel.” (# 1, ¶ 11)
In May of 2003 after the Bankruptcy Court had confirmed the Plan, the DHHS’s fiscal intermediary calculated that Excel had been underpaid by $127,001.00 for Medicare reimbursement payments during the year 2000. (# 1, ¶ 12 and Exh. C) In a letter dated May 6, 2003, the intermediary informed Excel of the underpayment. (# 1, Exh. C) However, instead of paying Excel the $127,001.00, the DHHS withheld the funds and deducted the amount of the underpayment from the amount Excel otherwise owed the DHHS for past overpayments pursuant to the Plan. (# 1, ¶ 13)
On July 21, 2003, Excel sent the DHHS a letter to advise that, in its view, withholding the underpaid funds violated the confirmed Chapter 11 Plan. (# 1, ¶ 14 and Exh. D) Excel demanded that the total amount due be turned over to it within 14 days of the letter’s issuance. (# 1, ¶ 14 and Exh. D). Having received no response to its demand letter, on September 15, 2003, Excel instituted the present litigation. (# 1, ¶ 15)
III. DISCUSSION
A. Standard Under
Pursuant to
Once a defendant challenges the jurisdictional basis for a claim under
In ruling on a motion to dismiss for lack of jurisdiction, “the district court must construe the complaint liberally, treating all well-pleaded facts as true and indulging all reasonable inferences in favor of plaintiff.”
Aversa,
B. Federal Question Jurisdiction
In the complаint, Excel alleges that the Court may properly exercise jurisdiction pursuant to Title
The threshold issue presented is whether jurisdiction is proper because this is a matter arising under the bankruptcy law or whether the Court is precluded from exercising jurisdiction because this is a Medicare dispute.
1. The Medicare Act: An Overview
In 1965, Congress enacted Title XVIII of the Social Security Act, 79 Stat. 291, as amended,
Because Excel, as a Part A Medicare service provider, challenges the method by which the DHHS disseminates its reimbursement payments, the DHHS argues that the dispute arisеs under the Medicare Act. The contention is that the particular limitations set forth in the Medicare regulations govern and supersede any provision of the Bankruptcy Code conferring jurisdiction over this matter to the Court.
As the First Circuit noted in
Kechijian v. Califano,
Finality of [Secretary’s] decision.
The findings and decision of the [Secretary] after a hearing shall be binding upon all individuals who were parties to such hеaring. No finding of fact or decision of the [Secretary] shall be reviewed by any person, tribunal, or governmental agency, except as herein provided. No action against the United States, the [Secretary] or any officer or employee thereof shall be brought undersection 1331 or 1316 of Title 28 to recover on any claim arising under this sub-chapter.
Title
Title
Although
Weinberger v. Salfi, et al.,
Moreover, if the third sentence is construed to be nothing more than a requirement of administrative exhaustion, it would be superfluous. This is because the first two sentences of§ 405(h) , which appear in the margin, assure that administrative exhaustion will be required. Specifically, they prevent review of decisions of the Secretary save as provided in the Act, which provision is made in§ 405(g) . The latter provision prescribes typical requirement for review of matters before an administrative agency, including administrative exhaustion.
Salfi,
Applying this logic,
To summarize, unless the plaintiff has exhausted the administrative review prоcess and the Secretary of the DHHS has rendered a final decision, Section 205(h) of the Social Security Act,
There is no allegation in the complaint that Excel ever presented its claim to the Secretary of the Department of Health and Human Services. Given thе strict limitations on judicial review of Medicare disputes, this failure is fatal to its claim. Although judicial review of Medicare claims may be permitted where “the Act provided no available administrative process leading to judicial review,”
Hospital San Jorge,
According to Excel, the fact that it never filed an apрlication with the Secretary of the DHHS does not preclude the Court from exercising subject matter jurisdiction. Because its claims involve a confirmed Chapter 11 plan of reorganization, the plaintiff contends that the Medicare Act’s limitations on judicial review fail to apply. Although the Plan provides the method by which Class 3 creditors, namely the DHHS, disburse Medicare reimbursement payments to Excel, the plaintiff characterizes the underlying dispute as arising from the DHHS’ alleged violation of a confirmed Chapter 11 Plan of Reorganization.
In Excel’s view, because its complaint is essentially a bankruptcy matter, Chapter 11 supersedes the jurisdictional bar of the Medicare Act. Although the complaint only asserts jurisdiction under
Despite Excel’s characterization of the dispute as a bankruptcy matter, in reality, the сore issue at stake is whether the DHHS may permissibly withhold Medicare
Courts broadly construe the phrase “arising under” to include claims that are “inextricably intertwined” with benefits determinations,
Ringer,
The broad reading of “arising under” comports with the legislative intent. Claims involving Medicare and Medicaid payments require an interpretation of the DHHS’ complex reimbursement regulations and manuals.
University of Massachusetts Memorial Medical Center,
3. The Medicare Act as Applied to Bankrupt Providers
In sum, Congress intended the Medicare Act to provide the “exclusive means” to resolve claims that “arise under” it.
Noonan,
In
Noonan
the District Court held that the Bankruptcy Court could not properly grant a Chapter 7 Trustee an extension of
As the third sentence of
However, this logic contradicts the majority view that bankruptcy jurisdiction under
This analysis of the amendment which substituted “
... the following language: “Section 205(h) of such Act is amended by striking out ‘section 24 of the Judicial Code of the United States’ and inserting in lieu thereof ‘
[T]he amendments made by section 2663 shall be effective on the date of the enactment of this Act; bid none of such amendments shall be construed as changing or affecting any right, liability, status, or interpretation which existed (under the provisions of law involved) before that date.
Id., § 2664(b) (emphasis supplied). In this section, Congress clearly expressеd its intent not to alter the substantive scope ofsection 405(h) . Because the previous version ofsection 405(h) precluded judicial review of diversity actions, so too must newly revisedsection 405(h) bar these actions. Any other interpretation of this section would contravene section 2664(b) by “changing or affecting [a] right, liability, status, or interpretation” ofsection 405(h) that existed before the Technical Corrections were enacted.
Bodimetric,
Just six years ago, the Eighth Circuit found “...the Seventh Circuit’s analysis [in Bodimetric] persuasive...” and “h[e]ld [that] the jurisdictional bar imposed by sentence three of
In the absence of any First Circuit precedent to the contrary and the fact that the Seventh and Eighth Circuits have analyzed the issue in the same manner as was done in the
St. Johns Home Health Agency
case, I am of the view that the
St. Johns Home Health Agency
case accurately states the law. I am further of the opinion that the Ninth Circuit’s decision in the case of
In re Town & Country Nursing Home Services, Inc.,
In sum, plaintiffs claims in this case “arise under” the Medicare Act for the purposes of invoking
TV. RECOMMENDATION
I RECOMMEND that the Defendant’s Motion To Dismiss (#3) be ALLOWED and that judgment shall enter fоr the defendant.
V. REVIEW BY THE DISTRICT JUDGE
The parties are hereby advised that pursuant to
September 30, 2004.
Notes
.
In re Healthback, L.L.C.,