Filed: Mar. 07, 2016
Latest Update: Mar. 02, 2020
Summary: PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 15-1393 CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., d/b/a Cape Fear Valley Health System, Plaintiff - Appellant, v. SYLVIA MATHEWS BURWELL, in her official capacity as Secretary of Health and Human Services, Defendant - Appellee. - FUND FOR ACCESS TO INPATIENT REHABILITATION, Amicus Supporting Appellant. Appeal from the United States District Court for the Eastern District of North Carolina, at Raleigh. W. Earl Britt, Senior Distri
Summary: PUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 15-1393 CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., d/b/a Cape Fear Valley Health System, Plaintiff - Appellant, v. SYLVIA MATHEWS BURWELL, in her official capacity as Secretary of Health and Human Services, Defendant - Appellee. - FUND FOR ACCESS TO INPATIENT REHABILITATION, Amicus Supporting Appellant. Appeal from the United States District Court for the Eastern District of North Carolina, at Raleigh. W. Earl Britt, Senior Distric..
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PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 15-1393
CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., d/b/a Cape Fear
Valley Health System,
Plaintiff - Appellant,
v.
SYLVIA MATHEWS BURWELL, in her official capacity as
Secretary of Health and Human Services,
Defendant - Appellee.
-----------------------------------
FUND FOR ACCESS TO INPATIENT REHABILITATION,
Amicus Supporting Appellant.
Appeal from the United States District Court for the Eastern
District of North Carolina, at Raleigh. W. Earl Britt, Senior
District Judge. (5:14-cv-00508-BR)
Argued: January 26, 2016 Decided: March 7, 2016
Before TRAXLER, Chief Judge, and WILKINSON and NIEMEYER, Circuit
Judges.
Affirmed by published opinion. Judge Niemeyer wrote the
opinion, in which Chief Judge Traxler and Judge Wilkinson
joined.
ARGUED: Kathryn Frances Taylor, K&L GATES LLP, Morrisville,
North Carolina, for Appellant. Joshua Marc Salzman, UNITED
STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellee.
ON BRIEF: Benjamin C. Mizer, Principal Deputy Assistant Attorney
General, Mark B. Stern, Civil Division, UNITED STATES DEPARTMENT
OF JUSTICE, Washington, D.C.; Thomas G. Walker, United States
Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Raleigh, North
Carolina; William B. Schultz, General Counsel, Janice L.
Hoffman, Associate General Counsel, Susan Maxson Lyons, Deputy
Associate General Counsel, Kirsten Friedel Roddy, Attorney,
UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES, Washington,
D.C., for Appellee. Ronald S. Connelly, POWERS PYLES SUTTER &
VERVILLE, PC, Washington, D.C., for Amicus Curiae.
2
NIEMEYER, Circuit Judge:
Cumberland County Hospital System, Inc., d/b/a Cape Fear
Valley Health System (“Cape Fear Health System” or “the Hospital
System”), commenced this action to obtain a writ of mandamus
compelling the Secretary of the Department of Health and Human
Services (“HHS”) to adjudicate immediately its administrative
appeals on claims for Medicare reimbursement. With over 750 of
its appeals on such claims awaiting assignment to an
Administrative Law Judge (“ALJ”) for more than 90 days, the
Hospital System asserts that the Secretary’s delay violates the
congressional mandate that its appeals be heard and decided by
ALJs within 90 days. See 42 U.S.C. § 1395ff(d)(1)(A).
The parties agree that, as of February 2014, the Secretary
had 480,000 appeals awaiting assignment to an ALJ, and the
Secretary conceded in her brief that the number had by then
climbed to more than 800,000 appeals, creating a ten-year
backlog. While acknowledging the unacceptability of the
backlog, the Secretary attributes it to an increased number of
appeals within the Medicare system and inadequate funding by
Congress to hire additional personnel.
The district court dismissed the Hospital System’s
complaint, relying on two independent grounds. It held (1)
that the Hospital System does not have a clear and indisputable
right to an ALJ hearing within a 90-day time frame, as required
3
for issuance of a mandamus order, and (2) that the political
branches, rather than the courts, are best suited to address the
backlog in the administrative process. We affirm.
While we agree that the delay in the administrative process
for Medicare reimbursement is incontrovertibly grotesque, the
Medicare Act does not guarantee a healthcare provider a hearing
before an ALJ within 90 days, as the Hospital System claims.
Rather, it provides a comprehensive administrative process --
which includes deadlines and consequences for missed deadlines
-- that a healthcare provider must exhaust before ultimately
obtaining review in a United States district court. Indeed,
within that administrative process, a healthcare provider can
bypass administrative reviews if such reviews are delayed,
“escalating” for review by a United States district court within
a relatively expeditious time. The issuance of a judicial order
now, however, directing the Secretary to hear the Hospital
System’s claims in the middle of the administrative process,
would unduly interfere with the process and, at a larger scale,
the work of the political branches. Moreover, such intervention
would invite other healthcare providers suffering similar delays
to likewise seek a mandamus order, thereby effectively causing
the judicial process to replace and distort the agency process.
4
I
Cape Fear Health System operates a number of facilities in
eastern North Carolina, delivering medical services to, among
others, beneficiaries of Medicare. The Medicare Act establishes
a federally subsidized health insurance program for the elderly
and disabled that is administered by the Secretary. See 42
U.S.C. § 1395 et seq.
In 2012 and 2013, the Secretary denied payment to the
Hospital System on over 900 claims for reimbursement for
Medicare services that she had initially authorized. By
September 2014, the Hospital System had over 750 appeals on
these claims that had been pending for more than 90 days before
the Office of Medicare Hearings and Appeals (“OMHA”) within HHS.
Those appeals related to claims for some $12.3 million in
reimbursement. The Secretary has not even acknowledged receipt
of some of the appeals, and with respect to others, she has
reported a delay of over two years in assigning them to an ALJ.
Because reimbursement of such a large sum is essential to the
Hospital System’s operations, the Hospital System commenced this
action for a writ of mandamus, ordering the Secretary to docket,
assign to an ALJ, and decide its appeals within 90 days, as
required by the Medicare Act. See 42 U.S.C. § 1395ff(d)(1)(A).
It also seeks a declaratory judgment that the Secretary’s “delay
in adjudication of Medicare appeals violates federal law.”
5
In its complaint, the Hospital System alleged that the
number of appeals to ALJs quintupled during the two years of
2012 and 2013, increasing from 92,000 to 460,000, and that the
ALJs’ workload increased by almost 300% from fiscal year 2012 to
fiscal year 2013. It alleged that, as of February 2014, 480,000
appeals were awaiting assignment to ALJs. The Secretary does
not deny the existence of the backlog, nor its size, as the
figures alleged by the Hospital System are those published by
HHS. Indeed, in her brief, the Secretary acknowledged that the
backlog has grown rapidly to more than 800,000 appeals and that,
with OMHA’s current staffing of ALJs, it would take over ten
years for the ALJs to dispose of those appeals. The allegations
of the parties do, however, attribute the backlog to different
causes.
The Secretary asserts that the backlog is the result of an
increased utilization of Medicare-covered services; the
additional appeals from audits conducted under the Recovery
Audit Program instituted in 2010; and additional Medicaid State
Agency appeals of Medicare coverage denials for beneficiaries
enrolled in both Medicare and Medicaid. She notes that she has
been unable to reduce or even stabilize the backlog because
congressional funding has remained relatively stagnant during
the last five years and additional ALJs therefore could not and
cannot be hired. She states, however, that the President’s 2016
6
budget proposes more than tripling the funding for OMHA and, in
addition, proposes new processes that would facilitate the
resolution of appeals at earlier stages in the administrative
process. Finally, the Secretary points out that Congress has
been aware of the existing backlog for some time, has recognized
the need for a legislative solution, and, indeed, is working on
a solution.
Cape Fear Health System does not disagree completely, but
it contends that the backlog is mainly due to the Secretary’s
mismanagement of HHS resources. The Hospital System points out
that, while the agency has proposed pilot programs for
alternative dispute resolution with respect to some types of
reimbursement, it has not made those programs available for the
types of reimbursement being claimed by the Hospital System.
Furthermore, the Hospital System contends that the increase in
appeals from audits conducted pursuant to the Recovery Audit
Program is attributable to the perverse incentives of that
program, which pays contractors contingency compensation based
on monies they recover in denying improper or excessive claims.
Regardless of the cause, however, the parties agree, and
the district court found, that appeals have “skyrocketed” and
have “overwhelmed” the Medicare reimbursement process.
The district court granted the Secretary’s motion to
dismiss the Hospital System’s complaint under Federal Rule of
7
Civil Procedure 12(b)(6), relying on two independent grounds for
doing so. First, the court concluded that the Hospital System’s
complaint failed to state a plausible claim for a mandamus order
because (1) it failed to demonstrate a “clear and indisputable
right” to relief, as Congress did not grant the Hospital System
“an absolute right to an ALJ hearing . . . within the 90-day
timeframe,” and (2) it failed to demonstrate that the Secretary
has “a clear duty to provide such a hearing” within the 90-day
time frame. Second, as a matter of discretion, the court
concluded that to grant mandamus relief would inappropriately
“intermeddle” with the agency’s problem-solving efforts and
would fail to recognize “HHS’s comparative institutional
advantage in crafting a solution to the delays in the
adjudication of appeals.” The court explained that “the
political branches are best-suited to alleviate OMHA’s crippling
delays.” The court also noted in this regard that putting the
Hospital System “at the head of the queue,” where doing so would
simply move all others back one space and would produce no net
gain, should be avoided as a matter of equity.
The district court also denied the Hospital System’s claim
for declaratory relief, reasoning that, because the Declaratory
Judgment Act does not supply a right of action in the absence of
a valid substantive claim, dismissal of the Hospital System’s
8
declaratory judgment must necessarily follow dismissal of its
mandamus claim.
Cape Fear Health System filed this appeal.
II
Mandamus is a “drastic” remedy that must be reserved for
“extraordinary situations” involving the performance of official
acts or duties. Kerr v. U.S. Dist. Court for the N. Dist. of
Cal., 426 U.S. 394, 402 (1976). Accordingly, to show that it is
entitled to mandamus relief, a plaintiff must show, among other
things, that it has a “clear and indisputable right to the
relief sought” and that the responding party has a “clear duty
to do the specific act requested.” United States ex rel. Rahman
v. Oncology Assocs., P.C.,
198 F.3d 502, 511 (4th Cir. 1999).
In this case, Cape Fear Health System contends that the
Medicare Act gives it a clear and indisputable right to have its
appeals decided within 90 days and that it imposes on the
Secretary a clear duty to accomplish that. In support of this
contention, it emphasizes the mandatory language of the Act,
which provides that an ALJ “shall conduct and conclude a hearing
. . . and render a decision on such hearing by not later than
the end of the 90-day period beginning on the date a request for
hearing has been timely filed.” 42 U.S.C. § 1395ff(d)(1)(A)
(emphasis added). It also points to the Chief ALJ’s recent
9
testimony before a congressional committee that the deadlines
for ALJs’ decisions were set and OMHA was created to “reduce the
average . . . waiting time for a hearing decision” that occurred
under the prior scheme. It argues that the escalation mechanism
in the Medicare Act -- a mechanism whereby healthcare providers
can bypass ALJ review if they are delayed and proceed to the
Departmental Appeals Board and ultimately to the courts, see id.
§ 1395ff(d)(3) -- does not diminish its right to an ALJ hearing
because escalation is not mandatory but may be employed at the
“discretion of the appellant.” And, in any event, it maintains
that electing to bypass the ALJ hearing would result in its
foregoing its right to create an administrative record at the
ALJ hearing, thus forcing it to make a “terrible choice”:
either “waive its right to due process” (i.e., to make a record)
or “suffer interminably until the Secretary feels like affording
[it] a hearing.”
The Secretary, by contrast, maintains that “the Medicare
statute does not confer on [the Hospital System] a right to a
hearing within 90 days that is enforceable through mandamus,”
emphasizing that the statute provides that “the consequence of
failing to adjudicate an appeal within 90 days is that the
provider may escalate that appeal to the [Departmental Appeals
Board].” The Secretary argues that, while the statute
establishes a time frame for decisions, “it also recognizes that
10
the time frame may not be satisfied and provides persons seeking
review with a specific avenue of relief.” Because, as the
Secretary argues, such escalation “is the remedy Congress
provided,” the Hospital System “cannot show indisputable
entitlement to any other,” regardless of whether escalation
adequately ensures the particular administrative review that the
Hospital System seeks.
We begin by noting that the process that Congress has
provided for obtaining Medicare reimbursement and administrative
review of reimbursement decisions is comprehensive and specific
-- a “coherent regulatory scheme,” Gustafson v. Alloyd Co., 513
U.S. 561, 569 (1995) -- which begins with the submission of a
claim for reimbursement, continues through a detailed and
multistep administrative process, and concludes with the
provision for judicial review. Accordingly, understanding the
full process is necessary to address the Hospital System’s
argument that a court should enforce a specific, discrete
element of the process through a writ of mandamus.
To obtain reimbursement for Medicare services, a healthcare
provider must, in the first instance, submit a claim to a
Medicare Administrative Contractor, a private contractor
retained by HHS to make an initial determination regarding
whether and in what amount the claim should be paid. See 42
U.S.C. §§ 1395ff(a), 1395kk-1(a). That determination by the
11
Medicare Administrative Contractor may, under a program that
Congress established in 2010, be audited by a different third-
party government contractor, known as a Recovery Audit
Contractor. See id. § 1395ddd(h)(3). Congress created that
audit program to serve “the purpose of . . . recouping
overpayments,” and it incentivized the Recovery Audit
Contractors by paying them “on a contingent basis for collecting
overpayments.”
Id. § 1395ddd(h)(1). Healthcare providers
wishing to challenge these initial claim determinations by the
Medicare Administrative Contractor or the Recovery Audit
Contractor must pursue a comprehensive, four-step administrative
review process before seeking review in court.
At the first step, a healthcare provider dissatisfied with
either the initial determination or the results of an audit may
seek a redetermination from the original Medicare Administrative
Contractor. See 42 U.S.C. § 1395ff(a)(3). At the second step,
if the healthcare provider is dissatisfied with the
redetermination, it may seek reconsideration by a Qualified
Independent Contractor (“QIC”), another third-party government
contractor retained to independently “review the evidence and
findings upon which the [previous determination was] based.” 42
C.F.R. § 405.968(a)(1); 42 U.S.C. § 1395ff(c). In doing so, the
QIC may receive and consider “any additional evidence the
parties submit or that the QIC obtains on its own.” 42 C.F.R.
12
§ 405.968(a)(1). At the third step, the healthcare provider may
challenge the QIC’s decision by requesting a hearing before an
ALJ. See 42 U.S.C. § 1395ff(d)(1); 42 C.F.R. § 405.1000. The
ALJ hearing process is administered by OMHA, a division within
HHS that is independent of and funded through an appropriation
separate from the division that oversees the contractors’ review
during the first two steps of the administrative review process.
See Medicare Prescription Drug, Improvement, and Modernization
Act of 2003, Pub. L. No. 108-173, § 931, 117 Stat. 2066, 2396-
99; Statement of Organization, Functions, and Delegations of
Authority, 70 Fed. Reg. 36386-04 (June 23, 2005). At the fourth
step, the healthcare provider may appeal the ALJ’s decision to
the Departmental Appeals Board for de novo review. See 42
U.S.C. § 1395ff(d)(2). The Departmental Appeals Board’s
decision becomes the final decision of the Secretary, which may
then be reviewed in court. See id. § 1395ff(b)(1)(A); 42 C.F.R.
§ 405.1130.
The Medicare Act establishes deadlines for each step in the
administrative review process and specifies the consequences
when such deadlines are not met. The Act directs that the first
two steps of administrative review be completed by the Medicare
Administrative Contractor and the QIC, respectively, within 60
days. 42 U.S.C. §§ 1395ff(a)(3)(C)(ii), 1395ff(c)(3)(C)(i). If
the QIC fails to meet this deadline, the healthcare provider may
13
bypass the QIC determination and “escalate” the process by
requesting a hearing before an ALJ, even though a decision by
the QIC is ordinarily a prerequisite to such a hearing. Id.
§ 1395ff(c)(3)(C)(ii). With respect to the adjudication by an
ALJ, the Medicare Act provides that an ALJ “shall conduct and
conclude a hearing on a decision of a [QIC] . . . and render a
decision on such hearing by not later than the end of the 90-day
period beginning on the date a request for hearing has been
timely filed.”
Id. § 1395ff(d)(1)(A); see also 42 C.F.R.
§ 405.1016(c) (providing a 180-day deadline if the appeal had
been escalated past the QIC level). If the ALJ does not render
a decision before the deadline, the healthcare provider may
bypass the ALJ and again escalate the process by “request[ing] a
review by the Departmental Appeals Board . . . , notwithstanding
any requirements for a hearing for purposes of the party’s right
to such a review.” 42 U.S.C. § 1395ff(d)(3)(A). Finally, if
the Departmental Appeals Board does not conclude its review
within 90 days,
id. § 1395ff(d)(2)(A), or within 180 days if the
appeal had been escalated past the ALJ level, 42 C.F.R. §
405.1100(d), the healthcare provider “may seek judicial review
[in a United States district court], notwithstanding any
requirements for a hearing for purposes of the party's right to
such judicial review,” 42 U.S.C. § 1395ff(d)(3)(B); see also 42
C.F.R. § 405.1132.
14
In sum, in order to exhaust the administrative process for
reimbursement of Medicare services, a healthcare provider must
present the claim in the first instance to a Medicare
Administrative Contractor and thereafter engage the process of
review and appeal set forth in § 1395ff. While the statute
imposes deadlines for completion at each step of the process, it
also anticipates that the deadlines may not be met and thus
gives the healthcare provider the option of bypassing each step
and escalating the claim to the next level, ultimately reaching
judicial review by a United States district court within a
relatively prompt time.
The order that Cape Fear Health System seeks would have the
judiciary enforce an isolated deadline and thereby impose a
process not contemplated by the Medicare Act -- indeed, in
conflict with it. Instead of having a delayed claim continue by
escalation through the steps of the administrative process and
ultimately to the courts, the Hospital System would have a court
order the Secretary to address its claims without escalation, to
the detriment of all other appeals then pending. The precedent
established by this judicial intrusion would surely invite every
other delayed claimant into the courts, converting the agency
process into a hybrid process involving judicial action in
medias res. There is no evidence that Congress ever entertained
such an idea. More importantly, the Hospital System’s argument
15
that the Secretary must provide an ALJ hearing within 90 days or
risk judicial intervention and supervision is grounded in a
myopic reading of the Medicare Act.
The Medicare Act directs the Secretary in mandatory terms
-- as the Hospital System stresses -- to comply with a 90-day
deadline for ALJ decisionmaking:
Except [when waived], an administrative law judge
shall conduct and conclude a hearing on a decision of
a qualified independent contractor under subsection
(c) of this section and render a decision on such
hearing by not later than the end of the 90-day period
beginning on the date a request for hearing has been
timely filed.
42 U.S.C. § 1395ff(d)(1)(A) (emphasis added). But the next
question is the more important one for addressing the Hospital
System’s argument -- what consequences follow if the deadline is
not met? Congress answered this explicitly, providing:
In the case of a failure by an administrative law
judge to render a decision by the end of the period
described in paragraph (1), the party requesting the
hearing may request a review by the Departmental
Appeals Board of the Department of Health and Human
Services, notwithstanding any requirements for a
hearing for purposes of the party’s right to such a
review.
Id. § 1395ff(d)(3)(A). Consequently, instead of creating a
right to go to court to enforce the 90-day deadline, Congress
specifically gave the healthcare provider a choice of either
waiting for the ALJ hearing beyond the 90-day deadline or
continuing within the administrative process by escalation to
16
the next level of review. The Hospital System’s argument
focuses on only the provision creating the 90-day time frame and
fails to account for its context in the comprehensive
administrative process. Our reading of the statute cannot be so
restricted. See King v. Burwell, 135 S. Ct. 2480, 2492 (2015)
(noting that it is a “fundamental canon of statutory
construction that the words of a statute must be read in their
context and with a view to their place in the overall statutory
scheme” (quoting Util. Air Regulatory Grp. v. EPA,
134 S. Ct.
2427, 2441 (2014) (internal quotation marks omitted))); FDA v.
Brown & Williamson Tobacco Corp.,
529 U.S. 120, 132 (2000)
(noting that “a reviewing court should not confine itself to
examining a particular statutory provision in isolation”).
Thus, when taken in context, § 1395ff(d) must be understood
to provide a 90-day deadline for an ALJ’s decision, thereby
encouraging the process to proceed expeditiously, and to give
the healthcare provider two options if the deadline is not met:
bypassing the ALJ hearing and obtaining review by the
Departmental Appeals Board, or waiting beyond the 90-day period
for the ALJ to conduct a hearing and render a decision. In
giving the healthcare provider these options, Congress
anticipated that the 90-day deadline might not be met and
provided its chosen remedy. But Congress clearly did not
authorize healthcare providers to go to court at this stage of
17
the administrative process. Rather, it required, before going
to court, that the healthcare provider obtain a final decision
of the Secretary -- the decision of the Departmental Appeals
Board. See 42 U.S.C. §§ 1395ff(b)(1)(A), 1395ff(d)(2)(A); see
also Heckler v. Ringer, 466 U.S. 602, 605-06 (1984). Only if
the Departmental Appeals Board also fails to meet its deadline
in reviewing the healthcare provider’s claim can the healthcare
provider, again in a similar manner, bypass that level of review
and proceed to court, all within a relatively expeditious time
frame. See
id. §§ 1395ff(d)(2)(A), 1395ff(d)(3)(B).
The Hospital System argues that this interpretation of the
administrative process is unreasonable as it results in a
process that provides it the “terrible choice” of deciding
whether to “waive its right to due process” or to “suffer
interminably until the Secretary feels like affording [it] a
hearing.” Its due process argument is based on its presumption
that, in bypassing the ALJ hearing, it would be denying itself
the opportunity to create a full administrative record at the
ALJ hearing, thereby leaving itself without a record for
judicial review. See 42 U.S.C. § 1395ff(b)(1)(A) (incorporating
42 U.S.C. § 405(g), which requires that judicial review be
conducted on the administrative record).
The Medicare Act, however, does not support the Hospital
System’s presumptions. The implementing regulations provide
18
that a healthcare provider may submit “any” evidence it wishes
at the QIC redetermination stage, an earlier stage at which the
Hospital System has not claimed delay. 42 C.F.R.
§ 405.968(a)(1); 42 U.S.C. § 1395ff(c). Thus, healthcare
providers could, in anticipation of delays at the ALJ stage and
beyond, create their record at the QIC stage and thereafter
escalate their claims to the courts within a period of months.
See 42 U.S.C. § 1395ff(d)(3). Moreover, it is not clear that
the Hospital System would have, as it assumes, a right to
introduce new evidence during an ALJ hearing even if it had the
benefit of the hearing. See id. § 1395ff(b)(3) (providing that
healthcare providers “may not introduce evidence in any appeal
under this section that was not presented at the reconsideration
conducted by the [QIC] . . . unless there is good cause”).
Properly understood, therefore, the Medicare Act
establishes a multilevel, “coherent regulatory scheme,”
Gustafson, 513 U.S. at 569, which authorizes a healthcare
provider to bypass levels of review that are not completed in
accordance with specified time frames and, at the same time, to
create a record that it can ultimately use for judicial review.
While the Act gives the Hospital System the clear and
indisputable right to this administrative process, it does not
give it a clear and indisputable right to adjudication of its
appeals before an ALJ within 90 days.
19
Moreover, were we to interfere at the ALJ stage, as the
Hospital System would have us do, we would be undermining
important separation-of-powers principles, as the district court
recognized in denying the Hospital System’s request for a
mandamus order. In the Medicare Act, Congress required
healthcare providers to engage an Executive Branch
administrative process in making claims for Medicare
reimbursement, thus precluding court suits in the first instance
that would bypass the process. But, in doing so, it did not
deny healthcare providers judicial review; indeed, it guaranteed
such review, but only after the Secretary is given the
opportunity to grant or deny the claims in accordance with the
specified process.
A writ of mandamus, as requested by the Hospital System,
would have courts interrupt the specified administrative process
and cross the lines of authority created by statute. Even if
the backlog were fully attributable to the Secretary’s
mismanagement, as the Hospital System maintains, our “respect
for the autonomy and comparative institutional advantage of the
executive branch” must make us mighty “slow to assume command
over an agency’s choice of priorities.” In re Barr Labs., Inc.,
930 F.2d 72, 74 (D.C. Cir. 1991). And if the backlog were
attributable to Congress’ failure to fund the program more fully
20
or otherwise to provide a legislative solution, it would
likewise be a problem for Congress, not the courts, to address.
Moreover, we have no reason to believe that any judicial
intervention into HHS’s administrative process, as urged by the
Hospital System, would improve anything. The courts surely do
not have greater competence to administer the Medicare
reimbursement claims process than does HHS. And, in addition,
judicial intervention as requested by the Hospital System would
simply put each of its claims “at the head of the queue,” moving
“all others back one space and produc[ing] no net gain.” In re
Barr Labs., 930 F.2d at 75. We thus share the district court’s
belief that “the political branches are best-suited to alleviate
OMHA’s crippling delays.”
One can hardly dispute that HHS’s procedural arteries are
seriously clogged and that its backlog of ten years is risking
its procedural vitality. Put simply, its administrative process
is in grave condition. While the Secretary laments this and
Congress recognizes it, both are presently attempting to revive
the process. As bleak as these circumstances appear to be,
however, we are unpersuaded that Article III treatment of the
ailing Article II patient in the manner the Hospital System
urges is the answer or, indeed, even possible or desirable.
Despite the legitimacy of the Hospital System’s frustration, we
21
are convinced that the district court acted correctly in leaving
treatment to the political branches.
For the reasons given, we affirm the district court’s
decision to dismiss the Hospital System’s claim for a writ of
mandamus.
III
Cape Fear Health System also sought “a declaratory judgment
in its favor that HHS’s delay in adjudication of Medicare
appeals violates federal law.” Because we affirm the district
court’s conclusion that the Hospital System failed to state a
claim upon which mandamus relief could be granted, it follows
that we must also affirm the district court’s dismissal of the
Hospital System’s declaratory judgment claim. See Medtronic
Inc. v. Mirowski Family Ventures, LLC, 134 S. Ct. 843, 849
(2014) (recognizing that the Declaratory Judgment Act is only
“procedural” and does not create “substantive rights” (internal
quotation marks and citations omitted)).
* * *
The judgment of the district court is
AFFIRMED.
22
