[ DO NOT PUBLISH] 

## In the 

# United States Court of Appeals For the Eleventh Circuit

____________________
No. 21

- 11529

Non

- Argument Calendar

____________________
JORG BOBER, Dr., FIRST COAST PODIATRIC SURGERY AND WOUND CARE, LLC,
Plaintiffs

- Appellants,

versus SAFE GUARD SERVICES, LLC,

Defendant

- Appellee. USCA11 Case: 21-11529 Date Filed: 10/15/2021 Page: 1 of 42 Opinion of the Court 21

- 11529

____________________ Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 3:19

- cv

- 01093

- BJD

- PDB

______________ ______
Before B RANCH , L UCK , and B RASHER , Circuit Judges.

PER CURIAM: The question in this appeal is whether a medical practice’s lawsuit against a federal contractor arises under the Medicare Act. See 42 U.S.C. § 405(h). The Centers for Medicare and Medicaid (CMS), the federal agency that runs Medicare, contracted Safe Guard Services, LLC
, to audit Dr. Jorg Bobe r’s podiatry practice forpotential fraud. Bober and his practice sued Safe Guard for its conduct during that audit, including its decision to suspend Medicarereimbursements and its treatment of Bober’s appeal of that decision. Specifically, Bober brought five causes of action: (i) tortiousinterference with business relationships; (ii) defamation; (iii) negligence; (iv) negligent hiring, retention, training, and supervision; and (v) violations of Florida’s Deceptive and Unfair Trade Practices
Act.
Under 42 U.S.C. § 405(h), the courts are stripped of subject matter jurisdiction over claims “arising under” the Medicare Act. Dial v. Healthspring of Ala., Inc. , 541 F.3d 1044 (11th Cir. 2008). Instead, claimants must exhaust administrative remedies before USCA11 Case: 21-11529 Date Filed: 10/15/2021 Page: 2 of 421

- 11529 Opinion of the Court 3

seek ing judicial review. Id

. (citing Heckler v. Ringer , 466 U.S. 602, 614 (1984)). The district court dismissed Bober’s claims without prejudice under the Medicare Act because Bober did not exhaust available administrative remedies before seeking relief in fed eral court. 42 U.S.C. § 405(g). We agree that Bober’s claims arise under the Medicare Act and, because he did not exhaust administrative remedies, we affirm the district court. We review a district court’s dismissal for lack of jurisdiction de novo

. Miccos ukee Tribe of Indians v. U.S., EPA , 105F.3d 599, 602 (11th Cir. 1997). We must construe the “arising under” language broadly. Heckler , 466 U.S. at 615. A claim arises under the Medicare Act when it is “inextricably intertwined” with the Medicare Act or where “both the standing and the substantive basis for presentation” is the Medicare Act. Id. at 615 , 624 . Accordingly, “[a] claim may arise under the Medi care Act even though, as pleaded, it also arises under some other law.” Midland Psychiatric Assocs., Inc. v. United State s

, 145 F.3d 1000, 1004 (8th Cir. 1998) (citing Weinberger v. Salfi , 422 U.S. 749, 760

- 61 (1975)). Bober argues that his claims “ are who lly independent of either reimbursements or eligibility
, ” and thus do not arise under the
Act. We disagree. A s the district court explained, Bober’s claims arise under the Medicare Act because “[b]ut for the Medicare Act, [Safe Guard] would not have perfor med the investigatory functions complained of.” Bober’s claims are based entirely on the work that Safe Guard performed on behalf of CMS

— auditing past Medicare payments, suspending future payments, addressing Bober’s appeal USCA11 Case: 21-11529 Date Filed: 10/15/2021 Page: 3 of 44 Opinion of the Court 21

- 11529
of the suspension, and the like. Accordingly, we agree with the district court that Bober’s claims arise under the Medicare Act and that he was required to administratively exhaust his claims before seeking judicial relief. Heckler
, 466 U.S. at 615. Because he did not administratively ex haust his claims, the district court correctly dismissed his complaint for lack of subject matter jurisdiction.

AFFIRMED

. USCA11 Case: 21-11529 Date Filed: 10/15/2021 Page: 4 of 4