This appeal raises the issue of whether a private insurance company is entitled to official immunity when acting as a fiscal intermediary or a carrier on behalf of the United States in the administration of a Medicare program. We hold that a fiscal intermediary or carrier is immune from suit for torts that arise out of the performance of its duty to investigate and report possible Medicare fraud.
BACKGROUND
Plaintiff-appellant Kailash C. Pañi, M.D., a neurosurgeon and sole principal in plaintiff-appellant Kailash C. Pañi, M.D., P.C. (collectively “Pani”), maintained a medical practice in Tarrytown, New York. Defendant-appellee Empire Blue Cross Blue Shield (“Empire”) was the Medicare carrier for Westchester County under contract to the Department of Health and Human Services (“HHS”). Under the Medicare Act, 42 U.S.C. § 1395 et seq., a “carrier” is a private insurance company that contracts with HHS to administer claims submitted, under the Medicare “Part B” program, a voluntary supplemental- medical insurance program, *70 while a “fiscal intermediary” is a private insurance company that contracts with HHS to administer major medical claims under the Medicare “Part A” program. See 42 U.S.C. §§ 1395h(a), 1395u(a). As a carrier, Empire was responsible for processing Medicare claims submitted by health-care providers, including assigning authorization codes, making payments, and reviewing claims for possible fraud. Id.
Between September 1981 and February 1983, Pani submitted Medicare claims to Empire for a procedure Pani called a “facet rhizotomy.” At first Pani submitted claims that did not contain a procedure code. After Empire’s claims department assigned the code “5211,” a code for rhizotomy, to these claims based on the procedure described by Pani, Pani submitted several more claims using that code number.
Sometime in 1983, Empire reported to HHS that it suspected Pani had submitted claims for procedures he had not performed or for procedures that were not “facet rhizo-tomies.” Following an investigation by the United States Attorney’s Office, Pani was indicted on nine counts of mail fraud, in violation of 18 U.S.C. §§ 1341-42; 63 counts of filing false claims against the government, in violation of 18 U.S.C. § 287; and 50 counts of conversion of government funds, in violation of 18 U.S.C. § 641.
See United States v. Pani,
In October of 1993, Pani filed suit in New York state court against Empire. Pani’s complaint sought $10 million based on claims for (1) negligence; (2) tortious interference with contractual relations; and (3) breach of contract arising out of Empire’s report to the United States government of possible fraud by Pani. Empire removed the action to federal" district court pursuant to 28 U.S.C. §§ 1441(b) and 1442(a)(1), which permits removal by “[t]he United States or any agency thereof or any officer (or any person acting under that officer) of the United States or of any agency thereof, sued in an official or individual capacity for any act under color of such office.”
Empire’s initial answer asserted that Pani had failed to state a claim and that Pani’s claims were barred by the statute of limitations. On April 18, 1995, the United States moved to be substituted as the proper party defendant, or, alternatively, to be allowed to intervene pursuant to Fed.R.Civ.P. 24. The United States also moved to dismiss Pani’s complaint under Fed.R.Civ.P. 12(b)(1) and (6) for lack of subject matter jurisdiction, for failure to state a claim, and because Pani’s claims were barred by the statute of limitations, or, in the alternative, for summary judgment. On the same day, Empire sought leave to file an amended answer in order to assert official immunity as an additional defense and moved to dismiss the complaint for the reasons submitted in the government’s brief.
The United States District Court for the Southern District of New York (Sidney H. Stein,
Judge)
granted Empire’s motion to dismiss and denied the government’s motion as moot.
Pani v. Empire Blue Cross Blue Shield,
No. 93 Civ. 8215,
On appeal Pani challenges the dismissal of his negligence and tortious interference claims, but not the dismissal of his breach of contract claim. Pani contends, inter alia, that Empire is not entitled to official immunity and that even if it is, it was procedurally improper for the district court to dismiss his complaint on that basis under Rule 12(b)(6). He also argues that the district court abused its discretion in dismissing his complaint without granting him leave to amend.
DISCUSSION
We review the dismissal of a complaint under Rule 12(b)(6)
de novo,
taking as true the material facts alleged in the compláint and drawing all reasonable inferences in favor of the plaintiff.
See Bernheim v. Litt,
A. Official Immunity
The district court dismissed Pani’s claim for negligence on the ground that Empire was entitled to official immunity for acts taken in its capacity as a Medicare carrier. In doing so, however, the district court re-characterized — and enlarged — Pani’s claim for negligence, probably based on Pani’s own recharacterization of that claim at oral argument. Pani’s complaint confined Empire’s alleged wrongdoing to investigating and reporting Pani for fraud. It alleged that Empire had “duly assigned a procedure code” of 5211 to the facet rhizotomy claims submitted by Pani and not that the code assigned was improper or that Empire had failed to follow proper administrative procedures in assigning the code.
1
The district court, however, described Pani’s claim as one for negligence “for assigning [Pani] an improper billing code, for failing to verify that code with HHS, and for subsequently reporting to HHS that Pani had filed fraudulent reimbursement claims using that same code.”
Pani,
We limit our review, as we must, to the allegations contained within the four corners of Pani’s complaint.
See Newman & Schwartz v. Asplundh Tree Expert Co.,
Several circuits have held that a fiscal intermediary or carrier is entitled to sovereign immunity on the rationale that the suit
*72
at issue is really one against the United States because the fiscal intermediary or carrier is a government agent that “act[s] on behalf of the [Medicare] Administrator in carrying out certain administrative responsibilities that the law imposes” and is entitled to indemnification from the United States, which, therefore, is “the real party of interest.” 42 C.F.R. 421.5(b);
see, e.g., Brooks v. Blue Cross and Blue Shield,
Fewer circuit courts have decided the issue of whether fiscal intermediaries and carriers are entitled to official immunity for discretionary acts taken within the scope of their authority under the Medicare Act.
See, e.g., Bushman v. Seiler,
In
Westfall v. Erwin,
The application of the
Westfall
test to federal officials was superseded by Congress’s passage in 1988 of the Federal Employees Liability Reform and Tort Compensation Act, also known as the Westfall Act, which eliminated the requirement that the acts be discretionary.
See
28 U.S.C." § 2679(d). However, the
Westfall
test remains the framework for determining when nongovernmental persons or entities are entitled to the same immunity.
See Mangold v. Analytic Servs., Inc.,
If Empire had been an actual federal official, it unquestionably would have been entitled to official immunity for investigating and reporting possible fraud.
See Peterson v. Weinberger,
The policy considerations underlying the extension of official immunity to a federal official’s duty to investigate and report suspected fraud apply with equal force to a fiscal intermediary or carrier. “The complexities and magnitude of governmental activity have become so great that there must of necessity be a delegation and redelegation of authority as to many functions, and we cannot say that these functions become less important simply because they are exercised by officers of lower rank' in the executive hierarchy” or by private contractors.
Barr v. Matteo,
The investigation and reporting of possible Medicare fraud is precisely the type of delegated discretionary function that the public interest requires to be protected by immunity. Medicare fraud exacts an enormous toll on the public fisc — estimated losses from fraud and other improper Medicare payments exceed $20 billion a year.
See
Department of Health and Human Services,
CFO Audit Action,
Pani’s reliance on
Rochester Methodist Hosp. v. Travelers Ins. Co.,
We also reject Pani’s contention that the recent Supreme Court case of
Richardson v. McKnight,
— U.S. -,
act on behalf of the Administrator in carrying out certain administrative responsibilities that the law imposes. Accordingly, their agreements and contracts contain clauses providing for indemnification with respect to actions taken on behalf of HCFA and HCFA is the real party of interest in any litigation involving the administration of the program.
42 C.F.R. § 421.5(b).
We are, of course, mindful that “absolute immunity ... has its costs, since illegal and even offensive conduct may go unredressed,”
Mangold,
B. Propriety of 12(b)(6) Dismissal on Grounds of Official Immunity
Pani argues that even if a fiscal intermediary might be shielded by official immunity, it was improper for the district court to dismiss the case at the pleading stage on the basis of official immunity. We disagree.
An affirmative defense may be raised by a pre-answer motion to dismiss under Rule 12(b)(6), without resort to summary judgment procedure, if the defense appears on the face of the complaint.
See ALA, Inc. v. CCAIR, Inc.,
We reject Pani’s assertion that nothing in his complaint supports Empire’s affirmative defense of official immunity. Pani’s complaint makes clear that all his allegations against Empire arise out of its role as a carrier for the Medicare “Part B” program.
See
Compl. ¶¶4-6, 9. Despite Pani’s conclu-sory allegations that Empire’s conduct was negligent and fraudulent, it is also clear, as discussed above, that the acts Pani complains of — investigating and referring possible fraud to the authorities — were discretionary and within the scope of Empire’s duties.
See Group Health,
Pani contends that the district court relied on extrinsic evidence to determine that immunity should apply and therefore was required to convert the motion to dismiss into a motion for summary judgment under Fed.R.Civ.P. 56, allowing Pani the opportunity to present extrinsic evidence in opposition to the motion. Specifically, Pani points to the district court’s reference to the Medicare Carriers’ Manual (an exhibit attached to the government’s motion papers) for the proposition that Empire was required to investigate and report instances of suspected fraud. This argument lacks merit. The district court referred to
C. Jack Friedman, Ph.D. & Assocs., P.C. v. Pennsylvania Blue Shield,
Even if the district court had impermissibly relied on extrinsic material on a motion to dismiss, and therefore properly should have converted the 12(b)(6) motion to a motion for summary judgment, we would still conclude that Pani was not prejudiced. The government moved for summary judgment in the alternative. Thus, Pani had sufficient notice that summary judgment was possible and ample opportunity to submit supporting affidavits and evidence.
See Groden v. Random House, Inc.,
C. Failure to Grant Leave to Amend
Finally, we reject Pani’s argument that the district court erred in dismissing his claims without granting him leave to amend his complaint. Pani never requested leave to amend from the district court, and on appeal he has made no showing that he would be able to amend his complaint in a manner that would survive dismissal.
See Cinel v. Connick,
Because we are confined to the four corners of the complaint in assessing whether Empire’s alleged wrongdoing was covered by official immunity, we do not reach the issue of whether Empire’s acts in approving Pani’s claims for facet rhizotomy and assigning a code number without first checking with HHS are also subject to official immunity. However, for a number of reasons, we do not believe that an amended complaint that included this conduct would survive dismissal. First, it is virtually certain that Pani’s claims would be barred by the statute of limitations. Under New York law, the statute of limitations is three years for tort claims and six years for contract claims. N.Y. C.P.L.R. §§ 213, 214 (McKinney’s 1990). All of the tortious conduct alleged by Pani, whether in the complaint or in subsequent motion papers, occurred prior to November 1983, and Pani had notice of the injurious nature of this conduct no later than the time of his November 1983 indictment. Pani waited nearly ten years, until October 1993, to file his claim in state court, well beyond both the three-year and six-year limitations periods cited above.
Moreover, even if Pani’s claim were not barred by the statute of limitations, it is extremely doubtful that there would be subject matter jurisdiction to consider such a complaint in light of the express limitations Congress placed on judicial review of agency determinations of Medicare “Part B” claims filed before 1987.
See
42 U.S.C. §§ 405(h), 405(g), 1395ff(b), and 1395ii;
Heckler v. Ringer,
In light of Pani’s failure to request leave to amend and failure to show any meritorious basis upon which he could amend his complaint, we conclude that the district court did not abuse its discretion when it dismissed Pani’s complaint without leave to amend. We need not reach Pani’s remaining arguments because a determination that Empire’s investigation and report of suspected fraud was shielded by official immunity is sufficient to dispose of Pani’s entire complaint.
CONCLUSION
We hold that a private insurance company acting as a fiscal intermediary or carrier on behalf of the United States in the administration of a Medicare program is entitled to official immunity for claims that arise out of *77 the performance of its duty to investigate and report possible fraud. Accordingly, the judgment of the district court dismissing claims brought against Empire for investigating and reporting Pani for fraud is AFFIRMED. ,.
Notes
. Pani’s complaint, in pertinent part, reads as follows:
8. That claims for reimbursement were submitted by PANI for the performance of the said facet rhizotomy procedure regarding which EMPIRE duly assigned a procedure code thereto, namely code no. “5211”.
9. That following payment of said claims, EMPIRE improperly, intentionally, carelessly, recklessly and/or negligently sought repayment from and sanctions against PANI, wherein defendant represented that the said claims were fraudulent and fictitious, when EMPIRE knew or should have known that such claims were valid, due and owing.
10.That the said representations by EMPIRE which were made to HHS regarding the validity ■ of the aforestated claims submitted by PANI, were wholly false and untrue.
