The Tenth Circuit published its opinion in Full Life Hospice, LLC v. Sebelius on Friday, February 26, 2013.
Full Life Hospice is a hospice care provider participating in the federal Medicare program. Over a number of years, it provided hospice care services to terminally ill Medicare beneficiaries and sought reimbursement for these services from the Department of Health and Human Services (HHS). A fiscal intermediary, acting on behalf of HHS, contested some of the reimbursements and demanded repayment of funds that it claimed were distributed in excess of a spending cap. Full Life then unsuccessfully challenged the intermediary’s determination through an administrative appeal, which was denied as untimely. On appeal to the district court, the court found no basis to excuse Full Life’s untimely appeal. Full Life appealed.
If a provider such as Full Life “is dissatisfied with a final determination” made by a fiscal intermediary and the amount in controversy exceeds $10,000, the provider can request a hearing on the matter with the Provider Reimbursement Review Board (the Board). 42 U.S.C. § 1395oo(a)(1)(A)(i), (a)(2). A provider is required to file a request for such a hearing with the Board “within 180 days after notice of the intermediary’s final determination.” Id. § 1395oo(a)(3). Under limited circumstances, the Board can extend the 180-day time period upon a “good cause showing by the provider.” 42 C.F.R. § 405.1836(a).
In this case, Full Life conceded it filed an administrative challenge to the notices more than 180 days after Full Life received the notices from the fiscal intermediary. Accordingly, the Tenth Circuit agreed that the district court lacked subject matter jurisdiction because of Full Life’s failure to file a timely administrative appeal.
Full Life also appealed the district court’s denial of the motion to amend its complaint. However, granting the amendment would have been futile because the amended complaint would have also been subject to dismissal as time-barred under the 180-day rule.