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Nature of Suit Code: 151
Nature of Suit: Overpayments under the Medicare Act
Cause of Action: 

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United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued March 6, 2009 Decided May 19, 2009 

No. 08-5159 

BAPTIST MEMORIAL HOSPITAL - GOLDEN TRIANGLE, ET AL., 

APPELLANTS

v. 

KATHLEEN SEBELIUS, IN HER OFFICIAL CAPACITY AS 

SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN 

SERVICES, 

APPELLEE

Appeal from the United States District Court 

for the District of Columbia 

(No. 1:06-cv-01413-CKK) 

Leslie D. Alderman III argued the cause for appellants. 

With him on the briefs was Kenneth R. Marcus. 

Jeffrey A. Lovitky was on the brief for amicus curiae

Quality Reimbursement Services in support of appellants. 

Bridgette L. Kaiser, Attorney, U.S. Department of Health 

& Human Services, argued the cause for appellee. With her 

on the brief were Gregory G. Katsas, Acting Assistant 

Attorney General, U.S. Department of Justice, Jeffrey A. 

USCA Case #08-5159 Document #1181324 Filed: 05/19/2009 Page 1 of 9
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Taylor, U.S. Attorney, Michael S. Raab, Attorney, and Janice 

L. Hoffman, Attorney, U.S. Department of Health & Human 

Services. R. Craig Lawrence, Assistant U.S. Attorney, and 

Robert W. Balderston, Attorney, U.S. Department of Health 

& Human Services, entered appearances. 

Before: KAVANAUGH, Circuit Judge, and EDWARDS and 

WILLIAMS, Senior Circuit Judges. 

Opinion for the Court filed by Circuit Judge

KAVANAUGH. 

 KAVANAUGH, Circuit Judge: The Provider 

Reimbursement Review Board is a governmental tribunal 

within the Department of Health and Human Services. It 

adjudicates disputes regarding hospitals’ Medicare 

reimbursements. In this case, the Board denied 

reimbursement claims submitted by three hospitals – Golden 

Triangle, St. Joseph, and DeSoto. The hospitals contend that 

the Board, in denying the claims, incorrectly interpreted and 

enforced its own procedural rules. The District Court ruled 

that the Board permissibly applied the relevant procedural 

directives. The court therefore granted summary judgment to 

the Board. Because the Board’s procedural rules mean what 

they say and say what they mean, and because the hospitals 

did not follow them, we affirm. 

I 

Three hospitals – Golden Triangle in Columbus, 

Mississippi; St. Joseph in Memphis, Tennessee; and DeSoto 

in Southaven, Mississippi – appealed to the Provider 

Reimbursement Review Board regarding certain Medicare 

decisions denying reimbursement for inpatient hospital 

services. (We will spare the reader the numbing details of the 

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reimbursement dispute, as they are not relevant to the 

procedural issue here.) In 2003, the Board dismissed the 

hospitals’ appeal because the hospitals had violated one of the 

Board’s procedural rules, or “Instructions.” In particular, the 

hospitals had failed to file their “preliminary position papers” 

in a timely manner. See Instruction II.B.I., reprinted in Joint 

Appendix (“J.A.”) 1322. 

The Instructions allowed parties to try to reinstate 

previously dismissed appeals by submitting explanations for 

their failures to comply with Board procedures. Yet the 

hospitals in this case did not seek reinstatement of their 

dismissed appeal through that authorized route. Instead, the 

hospitals simply attempted to raise the same issues anew in 

separate appeals. The Board rejected the hospitals’ efforts to 

circumvent the Instructions’ reinstatement procedures in this 

way. 

The hospitals then filed a civil action against the Board 

pursuant to 42 U.S.C. § 1395oo(f)(1). The hospitals argued 

that the Board’s Instructions permitted them to raise issues 

from dismissed appeals in new appeals to the Board. In 

response, the Board contended that the hospitals were 

required to follow the Instructions’ reinstatement process but 

failed to do so. In a thorough opinion, the District Court 

granted summary judgment to the Board, finding that it had 

permissibly applied its own procedures in rejecting the 

hospitals’ appeals. The hospitals now appeal. Our review of 

the District Court’s summary judgment decision is de novo. 

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II 

A 

 The parties agree that this case turns on the Board’s 

interpretation of its procedural rules, known as Instructions. 

As an initial matter, the hospitals contend that we should 

afford no deference to the Board’s interpretation of its own 

Instructions. Cf. Auer v. Robbins, 519 U.S. 452, 461 (1997). 

We need not tackle the question of deference: We agree with 

the Board’s interpretation of its Instructions regardless of 

what, if any, deference we owe it in this case. 

We begin with the text of the Instructions. Instruction 

II.B.I provides: “If you fail to meet the preliminary position 

paper due date and fail to supply the Board with the required 

documentation, the Board will dismiss your appeal for failure 

to follow Board procedure.” J.A. 1322 (emphasis added). 

Under this provision, the Board dismissed the hospitals’ 

original appeal because – as all parties agree – the hospitals 

did not timely file their position papers. 

The Instructions also provide guidance about how to 

reinstate a dismissed appeal. The reinstatement provision, or 

Instruction I.C.XIII, states that the Board “may consider 

provider requests to reinstate an appeal that it has dismissed. 

These fall into two categories, both of which require you to 

follow specific Board procedures.” J.A. 1309. The second 

category – “Reinstatement of Appeal Dismissed by the 

Board” – is relevant here. It states in part: “If you are 

requesting reinstatement because the Board dismissed your 

appeal for failure to comply with its procedures, you must 

explain in detail the reasons why you failed to comply. In 

general, this means the reasons you missed a position paper 

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due date . . . .” Instruction I.C.XIII.b, J.A. 1309 (emphasis 

added). 

For whatever reason, the hospitals in this case did not 

follow the authorized avenue for reinstating their appeal. 

Their failure to do so poses a serious problem because the two 

Instructions at issue here – one regarding dismissal and the 

other relating to reinstatement – are textually and functionally 

interrelated. The first provides a basis for the Board to 

dismiss a hospital’s claim, and the second provides the means 

for a hospital to reinstate its previously dismissed appeal. The 

most natural reading of Instructions II.B.I and I.C.XIII 

together is that a hospital must follow this precise procedure 

in order to reinstate dismissed appeals. Indeed, the 

Instructions bluntly reinforce the point, warning: “Your 

appeal . . . must follow Board procedures.” See Instruction 

II.B.I.a, J.A. 1296. 

Notwithstanding the clear directions in the Instructions, 

the hospitals gamely argue that they did not need to follow the 

Instructions to reinstate a previously dismissed appeal. The 

hospitals rely on a version of the expressio unius canon and 

point to a separate provision, Instruction III.B.I.d. That 

Instruction cautions that failure to appear at a Board hearing 

without good cause will lead the Board to “dismiss your case 

with prejudice.” Instruction III.B.I.d, J.A. 1331. According 

to the hospitals, that Instruction’s use of the phrase “with 

prejudice” means that the use of “dismiss” in the dismissal 

Instruction at issue here means “dismiss without prejudice.” 

The hospitals therefore contend that they were free to re-file a 

new appeal bringing the same claims that had been raised and 

dismissed in a previous appeal. 

The hospitals cannot so easily evade the plain meaning of 

the Instructions. The relevant reinstatement provision quite 

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clearly explains how to reinstate appeals for failure to file a 

timely position paper and lists certain requirements for doing 

so – including that the party “explain in detail” its reason for 

non-compliance. Instruction I.C.XIII.b, J.A. 1309. We do 

not find it at all plausible to interpret the Instructions to allow 

a party to ignore the reinstatement provision and instead just 

file a new appeal raising the same claims. 

 The hospitals relatedly suggest that the reinstatement 

provision does not apply to the kind of procedural violation 

committed by the hospitals in this case – failure to file timely 

position papers. That argument again flouts the plain text of 

the Instructions. The reinstatement provision employs 

expansive language and applies to parties “requesting 

reinstatement because the Board dismissed your appeal for 

failure to comply with its procedures.” Instruction I.C.XIII.b, 

J.A. 1309. Furthermore, the reinstatement provision 

specifically covers dismissals resulting, as in this case, from 

failure to comply with a “position paper due date.” Id. It’s 

hard to imagine language more directly on point. 

The hospitals also note that the Secretary of Health and 

Human Services has recently replaced these Instructions and 

promulgated a new procedural rule, which states that if “a 

provider fails to meet a filing deadline or other requirement 

established by the Board in a rule or order, the Board may . . . 

Dismiss the appeal with prejudice.” 42 C.F.R. § 405.1868(b). 

Another new Board rule states that that “Once an issue is 

dismissed or withdrawn, the issue may not be appealed in 

another case.” Provider Reimbursement Review Board Rule 

4.7 (2008). According to the hospitals, those new regulations 

show that a dismissal under the previous Instructions was not 

a dismissal with prejudice. But when a legislative or 

executive body adopts a new clarifying law or rule, it does not 

necessarily follow that an earlier version did not have the 

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same meaning. Cf. Brown v. Thompson, 374 F.3d 253, 259 

(4th Cir. 2004) (A “change in statutory language need not 

ipso facto constitute a change in meaning or effect. Statutes 

may be passed purely to make what was intended all along 

even more unmistakably clear.”) (internal quotation marks 

and alteration omitted); Piamba Cortes v. American Airlines, 

Inc., 177 F.3d 1272, 1283 (11th Cir. 1999) (An “amendment 

containing new language may be intended to clarify existing 

law, to correct a misinterpretation, or to overrule wrongly 

decided cases. Thus, an amendment . . . does not necessarily 

indicate that the unamended statute meant the opposite of the 

language contained in the amendment.”) (internal quotation 

marks omitted). 

This case is a good example. Even though the new Board 

regulations are clearer and remove any possible ambiguity, 

the earlier Instructions are nonetheless best read as the Board 

interpreted them: A party whose appeal is dismissed for 

failure to timely file a position paper must follow the 

reinstatement provision in order to bring that same claim back 

before the Board. 

B 

The hospitals raise a number of additional contentions 

that warrant only brief discussion. 

 First, the hospitals insist that the administrative record in 

this case is inadequate because it does not shed light on how 

the Board has resolved similar cases. According to the 

hospitals, the District Court therefore should have permitted 

discovery into the Board’s treatment of analogous situations. 

This argument misunderstands the proper judicial role in 

reviewing administrative action under the Administrative 

Procedure Act. See Fla. Power & Light Co. v. Lorion, 470 

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U.S. 729, 744 (1985) (“The reviewing court is not generally 

empowered to conduct a de novo inquiry into the matter being 

reviewed and to reach its own conclusions based on such an 

inquiry.”); Camp v. Pitts, 411 U.S. 138, 142 (1973) (“the 

focal point for judicial review should be the administrative 

record already in existence, not some new record made 

initially in the reviewing court”); see also FED. R. APP. P. 16. 

Although limited discovery in agency cases may be 

appropriate “when there has been a strong showing of bad 

faith or improper behavior or when the record is so bare that it 

prevents effective judicial review,” those narrow exceptions 

do not apply here. Commercial Drapery Contractors, Inc. v. 

United States, 133 F.3d 1, 7 (D.C. Cir. 1998) (internal 

quotation marks omitted). Therefore, the District Court 

properly refused to grant discovery to the hospitals. 

Second, the hospitals argue that the Board’s ruling 

contravenes a decision by the Secretary of Health and Human 

Services in a separate case, Rhode Island Hospital v. Leavitt, 

No. 06-260, 2007 WL 294026 (D.R.I. Jan. 26, 2007). There, 

the Secretary settled a suit involving whether certain issues 

were part of a previously dismissed appeal. Here, by contrast, 

it is quite clear that the issue the hospitals are seeking to raise 

anew was part of their previously dismissed appeal. We see 

no inconsistency between the Secretary’s decision in the 

Rhode Island case and the Board’s action in this case. In any 

event, the Rhode Island settlement does not create a binding 

precedent that the Board must follow in this case. Cf. High 

Country Home Health, Inc. v. Thompson, 359 F.3d 1307, 

1314-15 (10th Cir. 2004) (“settlement agreements have no 

precedential weight, and the mere fact that the Secretary has 

settled other cases does not make it arbitrary and capricious 

for him not to settle this one”). 

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Third, the hospitals contend that the Board’s original 

dismissal decision did not apply to the DeSoto Hospital 

because DeSoto had withdrawn from the dismissed appeal. 

But DeSoto did not comply with the withdrawal procedures 

set out in Instruction I.C.XII, J.A. 1308-09. Therefore, the 

Board appropriately deemed DeSoto part of the dismissed 

appeal. 

Fourth, the hospitals suggest that the original dismissals 

should not apply to Golden Triangle and St. Joseph because 

they had complied with relevant deadlines in earlier filed 

appeals. However, satisfying one deadline obviously does not 

excuse the violation of another. 

 Fifth, the hospitals argue that the dismissals were 

improper because the Board’s decisions to dismiss were 

rendered by one Commissioner and not by a quorum of the 

Commission, as allegedly required under regulations then in 

effect. See 42 C.F.R. § 405.1845(d) (2003). The hospitals 

did not raise these arguments in the District Court, and we do 

not consider them here. See District of Columbia v. Air Fla., 

Inc., 750 F.2d 1077, 1084 (D.C. Cir. 1984). 

Finally, the Quality Reimbursement Services as amicus 

curiae raises several contentions not raised in the District 

Court or by the parties to this appeal. We will not consider 

them. See id.; see also Lamprecht v. FCC, 958 F.2d 382, 389 

(D.C. Cir. 1992). 

* * * 

 We affirm the judgment of the District Court. 

So ordered. 

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