United States District Court

EASTERN DISTRICT OF TEXAS

SHERMAN DIVISION

SANA HEALTHCARE CARROLLTON, 

LLC, d/b/a CARROLTON REGIONAL 

MEDICAL CENTER,

 Plaintiff, 

v. 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES, et al.,

 Defendants.

§

§

§

§

§

§

§

§

§

§

§

§

Civil Action No. 4:23-cv-738

Judge Mazzant

MEMORANDUM OPINION AND ORDER

Pending before the Court is Plaintiff’s Application for Preliminary Injunction (Dkt. #6). 

Having considered the motion and the relevant pleadings, the Court finds that Plaintiff’s 

Application for Preliminary Injunction (Dkt. #6) should be DENIED. 

BACKGROUND

I. Factual History

A. The Hospital

This case arises in the context of whether Defendant Health Resources and Services 

Administration (“HRSA”) properly refused to provide Sana Healthcare Carrollton, LLC (the 

“Hospital”) with a reimbursement for COVID-19 treatment and testing services to uninsured 

patients (Dkt. #1 ¶¶ 1–5). The Hospital operates a 216-bed acute care hospital in Carrollton, Texas 

that serves Carrollton, Farmers Branch, Lewisville, the Colony, and other surrounding 

communities near Dallas, Texas (Dkt. #1 ¶ 10). The Hospital provided care for patients with 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 1 of 19 PageID #: 370
2

COVID-19, conducted COVID-19 testing, and delivered COVID-19 vaccinations to many 

members of the communities in and surrounding Dallas (Dkt. #1 ¶ 1).

B. The Government

HRSA is a United States government agency to which Defendant United States 

Department of Health and Human Services (“DHHS”) delegated authority to administer certain 

programs relating to COVID legislation, discussed further below. Defendant Xavier Becerra is the 

United States Secretary of DHHS (Dkt. #1 ¶ 14). Defendant Carole Johnson is the Administrator 

of HRSA (Dkt. #1 ¶ 16). The Hospital is only suing Becerra and Johnson in their official capacities 

(Dkt. #1 ¶¶ 14, 16). The Court refers to the defendants collectively as the “Government.”

C. Framework of the Uninsured Program

To ensure the availability of COVID-19 testing, treatment, and vaccination for the 

approximately 29 million Americans without health insurance, Congress appropriated funds to 

reimburse health care providers for providing these services to the uninsured (Dkt. #14 at pp. 3–

4). Congress appropriated initial funds through the Families First Coronavirus Response Act. PUB.

L 116-127, 134 STAT. 178 (2020). Subsequently, Congress appropriated additional funds through 

the Coronavirus, Aid, Relief, and Economic Security Act; the Paycheck Protection Program and 

Health Care Enhancement Act, and the American Rescue Plan Act of 2021. PUB. L. NO. 116-136,

134 STAT. 281 (2020); PUB. L. 116-139, 134 STAT. 620 (2020); PUB. L. 117-2, 135 STAT. 40 (2021).

DHHS has delegated the responsibility for processing claims and making payments to healthcare 

providers to HRSA (Dkt. #14, Exhibit 1 ¶ 3).

This legislation created and funded the COVID-19 Claims Reimbursement to Health Care 

Providers and Facilities for Testing, and Vaccine Administration for the Uninsured Program (the 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 2 of 19 PageID #: 371
3

“UIP”) (Dkt. #14, Exhibit 1 ¶ 3).1 The UIP provided reimbursement to eligible healthcare 

providers and facilities for the testing, treatment, and vaccine administration to uninsured 

individuals (Dkt. #14, Exhibit 1 ¶ 17). HRSA contracted with UnitedHealth Group 

(“UnitedHealth”) to help administer the UIP (Dkt. #14, Exhibit 1 ¶ 18). The UIP existed entirely 

in an electronic format and required healthcare providers to use two systems, the UIP Portal and 

the Medicare Electronic Data Interchange (“MEDI”) (Dkt. #14, Exhibit 1 ¶ 19). The primary 

factual disputes in this case relate to the UIP Portal. HRSA has provided various resources to 

healthcare providers indicating how to use the UIP Portal and MEDI and receive reimbursements 

under the UIP (See Dkt. #14, Exhibits 2–3, 5–14).

D. Submitting a Claim Under the Uninsured Program

Although the parties dispute exactly how many steps are required to receive a 

reimbursement under the UIP, a healthcare provider must clearly complete certain actions to 

receive a reimbursement (Dkt. #14, Exhibit 1 ¶ 21; Dkt. 16 at p. 8; Dkt. #17 at p. 4 n.2). The most 

important actions for the purposes of this casewere that a healthcare provider must have submitted

a patient roster in the UIP Portal and received corresponding temporary patient identification 

numbers (“temporary IDs”) (the healthcare provider would then use the temporary IDs to submit 

claims for reimbursement using MEDI) (Dkt. #14, Exhibit 1 ¶ 19; Dkt. #14, Exhibit 3 at pp. 18–20, 

26; Dkt. #14, Exhibits 4–8; Dkt. #14, Exhibit 9 at p. 16).

To submit a patient roster, a healthcare provider first accessed the UIP Portal (Dkt. 14, 

Exhibit 1 ¶ 24). The healthcare provider may have submitted the patient information either for 

individual patients or for multiple patients simultaneously (Dkt. #14, Exhibit 1 ¶ 26). The patient 

1 The UIP received funds through the Provider Relief Fund (Dkt. #14 at p. 2).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 3 of 19 PageID #: 372
4

roster must have occurred in the form of a .csv file and complied with certain technical 

specifications (Dkt. #14, Exhibit 1 ¶ 26; Dkt. #14, Exhibits 5–7). If the healthcare provider 

attempted to submit a non-conforming patient roster, an error screen would appear indicating that 

an error occurred in the submission process (Dkt. #14, Exhibit 6). If the healthcare provider 

successfully uploaded a patient roster, the UIP Portal immediately provided a reference number 

indicating that the submission was successful (Dkt. #14, Exhibit 7).

On the day following a healthcare provider’s successful upload of a patient roster, the 

provider would receive an automatically generated email (Dkt. #14, Exhibit 1 ¶ 29). The email 

confirmed the receipt of the patient roster and identified any patients who already had temporary

IDs that had not expired (Dkt. #14, Exhibit 8).

After a healthcare provider successfully uploaded a patient roster into the UIP Portal, 

UnitedHealth analyzed the patient information to verify eligibility (Dkt. #14, Exhibit 1 ¶ 30). Once 

UnitedHealth verified each patient’s eligibility, it assigned a temporary ID to each of the verified 

patients (Dkt. #14, Exhibit 1 ¶ 30). The process of receiving temporary IDs typically took one to 

five days after the successful submission of the patient roster (Dkt. #14, Exhibit 1 ¶ 30). The 

provider could only submit their claims to MEDI after UnitedHealth generated and assigned the 

temporary IDs (Dkt. #14, Exhibit 1 ¶ 31).

E. Impending Shutdown of the Uninsured Program

However, on March 15, 2022, the White House announced the impending shutdown of the 

UIP due to a lack of sufficient funding (Dkt. #14, Exhibit 1 ¶ 40). HRSA reiterated the White 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 4 of 19 PageID #: 373
5

House’s announcement and announced that it would stop accepting testing and treatment claims 

from providers at 11:59 PM on March 22, 2022 (Dkt. #14, Exhibit 12).2

Following the announcement of the UIP’s impending shutdown, a “significant increase 

UIP Portal activity” occurred as healthcare providers sought to submit claims prior to the deadline 

(Dkt. #17, Exhibit 1 ¶ 10). At that time, UnitedHealth experienced delays in generating temporary 

IDs for successfully uploaded patient rosters (Dkt. #14, Exhibit 1 ¶ 65). The program manager for 

the subsidiary of UnitedHealth that managed the UIP claims that the patient roster upload process 

was separate and distinct from the temporary ID assignment process (Dkt. #17, Exhibit 1 ¶ 10). 

She further claims that no such delays or technical issues extended to the patient roster upload 

process (Dkt. #17, Exhibit 1 ¶ 10). UnitedHealth has no record of a technical issue with the UIP 

Portal that prevented participant providers from uploading patient rosters on March 17, 2023

(Dkt. #17, Exhibit 1 ¶¶ 12–13). On that day, 6,291 providers successfully uploaded 5,503,928 

patient records (within 116,627 batches) (Dkt. #17, Exhibit 1 ¶ 9). The UIP Portal assigned each of 

these March 17 upload batches a reference number (Dkt. #17, Exhibit 1 ¶ 9).

Despite the alleged differences between the two processes, United sent an email addressed 

to “Provider” on April 5, 2022, to address concerns regarding technical delays (Dkt. #6, Exhibit 3 

at p. 3). The email stated in relevant part: 

We are working with HRSA on multiple scenarios that impacted a provider’s ability 

to submit claims by the urgent program shutdown deadlines. As of right now, the 

program is not accepting new claim submissions for testing and treatment claims, 

and currently HRSA is not allowing for any exceptions around the current 

deadlines. If HRSA allows an exception directly related to the provider’s scenarios, 

we will attempt to contact.

2 The Hospital describes the March 22, 2022 deadline as arbitrary (Dkt. #6 at p. 3). However, the Court does not 

address whether the March 22, 2022 deadline was arbitrary and capricious because the issue before the Court is 

whether the agency arbitrarily and capriciously refused to reimburse the Hospital for claims that it allegedly submitted 

on March 17, 2022 (Dkt. #6 at p. 12).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 5 of 19 PageID #: 374
6

(Dkt. #6, Exhibit 3 at p. 3). The Government claims that UnitedHealth sent this email to all 

providers who had contacted UnitedHealth with questions related to patient rosters (Dkt. #14, 

Exhibit 1 ¶ 65). Further, the Government claims that the email was relevant only to providers who 

had successfully uploaded patient rosters and for whom there was a delay in generating temporary 

IDs (Dkt. #14, Exhibit 1 ¶ 65).

F. The Hospital’s Attempted Patient Roster Upload

On March 17, 2022, the Hospital claims that it (specifically the Chief Legal Officer) 

uploaded a conforming patient roster (consisting of 285 patients) to the UIL portal (Dkt. #6, 

Exhibit 2 ¶ 4). However, the Hospital claims that it never received temporary IDs before the claim 

submission deadline passed (Dkt. #6, Exhibit 2 ¶ 6). The Hospital characterizes the April 5, 2022 

UnitedHealth email as confirming that the Hospital had uploaded the patient roster on March 17, 

2022 (Dkt. #6 at p. 8). The Hospital claims that the “[UIP] portal malfunctioned and resulted in 

the failure to generate” temporary IDs (Dkt. #6 at p. 12).

The Chief Legal Officer of the Hospital claims that she called UnitedHealth’s support line

on March 22, 2022, to complain that it had not assigned temporary IDs (Dkt. #6, Exhibit 2 ¶ 7). 

She claims that “United stated that the system was ‘overwhelmed’ by the number of claims being 

submitted, but indicated that that they did see [the Hospital’s] March 17, 2022 submission on their 

end in the system” (Dkt. #6, Exhibit 2 ¶ 7). The Hospital claims that it made daily calls and 

outreach in the days after its submission (Dkt. #16 at p. 9). However, the Government disputes 

this claim and states that the first time the Hospital reached out regarding its issue was on March 

23, 2022 (Dkt. #14 at p. 12 n.5) (citing Dkt. #14, Exhibit 21). The Government claims that no 

record exists of the help center agent confirming that the alleged patient roster submission was 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 6 of 19 PageID #: 375
7

visible (Dkt. #14 at p. 12). Instead, the Government claims that the help center agent could not find 

the patient roster and a sample name that the Hospital had provided (Dkt. #14 at p. 12; Dkt. #14, 

Exhibit 21). UnitedHealth created a claim ticket #D1237 following one of these two alleged calls 

(Dkt. #6, Exhibit 2 ¶ 7; Dkt. #14, Exhibit 1 ¶ 68).

In contrast, the Government claims that the Hospital never submitted a patient roster on 

March 17, 2022 (Dkt. #14 at p. 20). Before this instance, the Hospital had successfully uploaded 

24 separate batches of patient information over an approximately two-year timespan (Dkt. #14, 

Exhibit 1 ¶¶ 45, 59). However, the Government does not have any record indicating that the 

Hospital submitted a patient roster on March 17, 2022 (Dkt. #17, Exhibit 1 ¶ 13). The Hospital’s 

last patient roster upload into the UIP Portal, according to UnitedHealth’s records, occurred on 

February 22, 2022 (Dkt. #17, Exhibit 1 ¶ 7). A record exists that a Hospital representative logged 

into the UIP Portal on March 17, 2022 (Dkt. #17, Exhibit 1 ¶ 5). No record of a reference number 

corresponding to a patient roster upload for the Hospital exists after February 22, 2022 (Dkt. #17, 

Exhibit 1 ¶¶ 6–7).

The Hospital and HRSA exchanged subsequent correspondence after March 2022 

(Dkt. #6, Exhibits 4–5; Dkt. #14, Exhibits 15–20). However, the parties were not able to resolve 

this dispute in those communications (Dkt. #6, Exhibits 4–5; Dkt. #14, Exhibits 15–20).

II. Procedural History

The Hospital brought suit against the Government for declaratory and injunctive relief, 

claiming that the Government’s actions were arbitrary, capricious, and exceeded statutory 

authority (Dkt. #1 ¶¶ 63–81). The Hospital seeks preliminary and permanent injunctions, where 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 7 of 19 PageID #: 376
8

the preliminary injunction would require the Government to preserve at least $6.5 million in the 

UIP to prevent the funds from being exhausted (Dkt. #1 ¶¶ 82–90).

On August 16, 2023, the Hospital filed the present motion requesting that the Court issue 

a preliminary injunction requiring the Government to “set aside, obligate, or deposit into the 

Court’s Registry sufficient funds to reimburse $6,419,414 in gross charges from remaining 

[Provider Relief Fund] funds, or funds recouped from [Provider Relief Fund] overpayments to 

providers” (Dkt. #6 at p. 16). The Government timely filed its response (Dkt. #14). The Hospital 

timely filed its reply (Dkt. #16). The Government timely filed its sur-reply (Dkt. #17).

LEGAL STANDARD

A party seeking a preliminary injunction must establish the following elements: (1) a 

substantial likelihood of success on the merits; (2) a substantial threat that plaintiffs will suffer 

irreparable harm if the injunction is not granted; (3) that the threatened injury outweighs any 

damage that the injunction might cause the defendant; and (4) that the injunction will not disserve 

the public interest. Nichols v. Alcatel USA, Inc., 532 F.3d 364, 372 (5th Cir. 2008). “A preliminary 

injunction is an extraordinary remedy and should only be granted if the plaintiffs have clearly 

carried the burden of persuasion on all four requirements.” Id. Nevertheless, a movant “is not 

required to prove its case in full at a preliminary injunction hearing.” Fed. Sav. & Loan Ins. Corp. 

v. Dixon, 835 F.2d 554, 558 (5th Cir. 1985) (quoting Univ. of Tex. v. Comenisch, 451 U.S. 390, 395 

(1981)). The decision whether to grant a preliminary injunction lies within the sound discretion of 

the district court. Weinberger v. Romero-Barcelo, 456 U.S. 305, 320 (1982).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 8 of 19 PageID #: 377
9

ANALYSIS

First, the Court addresses whether HRSA’s decision not to reimburse the Hospital for 

providing services to uninsured persons is reviewable under the Administrative Procedure Act. 

Then, the Court only considers the factor of whether a substantial likelihood of success on the 

merits exists because that factor is dispositive. Further, no findings in this order will bind either 

party in a motion for summary judgment or at trial. Univ. of Tex., 451 U.S. at 395.

I. Reviewability under the Administrative Procedure Act

The Court has the power to review the Government’s decision not to reimburse the 

Hospital under the Administrative Procedure Act (the “APA”). A “strong presumption [exists] 

favoring judicial review of administrative action.” Salinas v. U.S.R.R. Ret. Bd., 592 U.S. 188. 197 

(2021) (quoting Mach Mining, LLC v. EEOC, 575 U.S. 480, 486 (2015). Judicial review under the 

APA does not extend to “agency action [that] is committed to agency discretion by law.” 5 U.S.C. 

§ 701(a)(2). However, this narrow discretion exception “‘may be invoked only upon a clear and 

convincing showing that to do so would further the intent of Congress.’” MCorp v. Clarke, 755 F. 

Supp. 1402, 1410 (N.D. Tex. 1991) (quoting Ashton v. Pierce, 541 F. Supp. 635, 643 (D.D.C.1982)). 

This exception only applies “where the substantive statute left the courts with ‘no law to apply.’”

Heckler v. Chaney, 470 U.S. 821, 826 (1985).

The Government argues that the Court cannot review its decision not to reimburse the 

Hospital under the APA because it was an agency action committed to agency discretion by law

(Dkt. #14 at pp. 17–18). The Government claims that the D.C. District Court’s recent decision in 

Hospital for Special Surgery v. Becerra is instructive (Dkt. #14 at pp. 17–18). No. 22-2928 (JDB), 

2023 WL 5448017 (D.D.C. Aug. 24, 2023). In Hospital for Special Surgery, the plaintiff challenged 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 9 of 19 PageID #: 378
10

HRSA’s methodology to distribute funds to healthcare providers under Phase 3 of the Provider 

Relief Fund. Id. at *3. However, the court determined that HRSA’s decided methodology did not 

relate to the statutory standards in the Coronavirus, Aid, Relief, and Economic Security Act 

governing provision of the funds. Id. at *7. Therefore, the court determined “there is no law to 

apply” in evaluating how HRSA decided its methodology to distribute funds from the Provider 

Relief Fund. Id. Thus, the court found that HRSA’s decided methodology was an agency decision 

committed to agency discretion by law and not reviewable. Id.

Based on Hospital for Special Surgery, the Government claims that the Court cannot review 

its decision to not reimburse the Hospital (Dkt. #14 at p. 18). “The appropriations to HRSA to 

provide reimbursement to healthcare providers . . . were lump-sum appropriations” (Dkt. #14 at 

p. 18). “Congress placed minimal guardrails on HHS’ discretion: the funds are to be distributed to 

defined health care providers for testing, treatment, and/or vaccination of uninsured individuals”

(Dkt. #14 at p. 18). Therefore, according to the Government, its decision to not reimburse the 

Hospital is not reviewable by the Court because it was an agency action committed to agency 

discretion by law (Dkt. #14 at pp. 17–18).

In response, the Hospital argues that the Government has not met its burden to show that 

the agency action to not reimburse the Hospital is not reviewable (Dkt. #16 at pp. 5–7). Unlike 

Hospital for Special Surgery, the Hospital is not challenging the Government’s reimbursement 

methodology (Dkt. #16 at p. 7). Instead, the Hospital seeks judicial review of the Government’s 

decision not to reimburse the Hospital “for claims related to patient claims data that it timely 

submitted before the abrupt program shutdown deadline . . . ” (Dkt. #16 at p. 7).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 10 of 19 PageID #: 379
11

Contrary to the Government’s argument, its decision to not reimburse the Hospital is 

reviewable by the Court because its decision allegedly violates the Government’s own policies. 

“‘[E]ven if the substance of an agency’s decision is beyond review as discretionary, an agency’s 

failure to follow its own regulations may be challenged under the APA.’” Patterson v. Def 

POW/MIA Acct. Agency, 343 F. Supp. 3d 637, 650 (W.D. Tex. 2018) (quoting Ellison v. Connor, 153 

F.3d 247, 252 (5th Cir. 1998)).3 The Government (particularly HRSA) has released detailed 

policies and information related to the submission of claims for reimbursement through the UIP 

Portal and MEDI pursuant to the UIP (See Dkt. #14, Exhibits 2–3, 5–14). Even assuming the 

underlying legislation commits the Government’s decision whether to reimburse healthcare 

providers to its own discretion, these policies provide the Court with sufficient standards to 

evaluate the Government’s action (See Dkt. #14, Exhibits 2–3, 5–14). Therefore, the Cort finds 

that APA review is available for the Hospital’s claims.

II. Substantial Likelihood of Success on the Merits

The Hospital has not demonstrated a substantial likelihood of success on the merits. To 

satisfy this element, the Hospital is “not required to prove [their] entitlement to summary 

judgment.” Byrum v. Landreth, 566 F.3d 442, 446 (5th Cir. 2009). Certainty of success is not the 

standard—substantial likelihood is, which means that success on the merits must be “considerably 

more likely” than not. United States v. Thorn, 317 F.3d 107, 117 (2d Cir. 2003). To make this 

determination, the Court looks to the standards for the causes of action pleaded as provided by 

substantive law. Sepulvado v. Jindal, 729 F.3d 413, 418 (5th Cir. 2013).

3 Judicial review of an agency’s failure to follow its own regulations extends beyond violations of regulations within the 

Code of Federal Regulations. See id. at 651. Rather, judicial review may still occur where an agency violates its own 

detailed policies that provide sufficient standards by which to evaluate the agency’s actions. See id.

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 11 of 19 PageID #: 380
12

A reviewing court must “hold unlawful and set aside [an] agency action” that is “arbitrary, 

capricious, an abuse of discretion, or otherwise not in accordance with the law.” 5 U.S.C. 

§ 706(2)(A). A court’s “role is to determine whether the agency’s decision ‘was based on a 

consideration of the relevant factors and whether there has been a clear error of judgment.’”

Huawei Tech. USA, Inc. v. Fed. Commc’n Comm’n, 2 F.4th 421, 434 (5th Cir. 2021) (quoting Sierra 

Club v. U.S. Env’t Prot. Agency, 939 F.3d 649, 664 (5th Cir. 2019)). “Agencies ‘are required to 

engage in reasoned decision making.’” Id. at 433 (quoting Michigan v. E.P.A., 576 U.S. 743, 750 

(2015)). “‘Not only must an agency’s decreed result be within the scope of its lawful authority, 

but the process by which it reaches that result must be logical and rational. Id. at 433–34 (quoting 

Michigan, 576 U.S. at 750). “The agency must ‘articulate a satisfactory explanation for its action 

including a rational connection between the facts found and the choice made.’” Id. at 434 (quoting 

Sierra Club, 939 F.3d at 664). “However, [a court] cannot substitute [its] judgment for that of the 

agency.’” Id. (quoting Sierra Club, 939 F.3d at 664).

The Hospital makes two arguments regarding its likelihood of success on the merits. First, 

the Hospital claims that the Government did not provide a reimbursement for $6,419,414 in gross 

charges for pandemic-related services the Hospital provided because of the UIP Portal’s error and 

UnitedHealth’s failure to generate temporary IDs (Dkt. #6 at p. 12). Second, the Hospital claims 

that even if its error caused its inability to submit claims, it was an abuse of discretion for the 

Government to not allow the Hospital to correct that error (Dkt. #16 at pp. 11–13).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 12 of 19 PageID #: 381
13

A. Whether the Hospital Properly Submitted Its Patient Roster

The Hospital claims that the Government “failed to reasonably consider the relevant issues 

and to reasonably explain its unwarranted denial of promised reimbursement for $6,419,414 in 

gross charges for pandemic-related services rendered by the Hospital” (Dkt. #6 at p. 12). “The 

[Government] failed to account for the crucial fact that its own website portal malfunctioned and 

resulted in the failure to generate [temporary IDs]” (Dkt. #6 at p. 12). “‘[The April 5, 2022] email 

shows that the agency acknowledged that its malfunctioning portal created ‘multiple scenarios that 

impacted a provider’s ability to submit claims by the urgent program shutdown deadlines’”

(Dkt. #6 at p. 12). However, according to the Hospital, the Government has erroneously claimed 

that it has no evidence of any technical error that would have impeded Sana from uploading a 

patient roster on March 17, 2022 (Dkt. #6 at p. 12).

In support of its argument, the Hospital directs the Court to Tyler Regional Hospital, LLC 

v. Department of Health and Human Services. No. 6:23-CV-134, 2023 WL 3506471 (E.D. Tex. May 

17, 2023). In Tyler Regional Hospital, the plaintiffs challenged DHHS’s policy on accepting 

revisions to a provider’s tax-identification number (“TIN”) after the application deadline Id. at 

*2. The plaintiffs sought to receive lost revenue attributable to COVID-19 under the American 

Rescue Plan Rural program. Id. The plaintiffs had mistyped the TIN for a subsidiary hospital in its 

application, and the subsidiary hospital then did not receive any allocated funds. Id. at 4. A few 

days after this erroneous submission, the electronic portal displayed a green check mark next to 

the “Validate TIN” field of the plaintiffs’ application. Id. Later, the plaintiffs asked to correct the 

error so that HRSA could process the payment. Id. at 5. HRSA refused to allow the correction as 

part of its blanket policy to refuse revisions to applications after their submission. Id. However, the 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 13 of 19 PageID #: 382
14

plaintiffs (and applicants in general) received ambiguous information as to whether the agency 

would screen TINs before an application on the portal was complete (i.e., before the green check 

mark would appear). Id. at 3. The court held that the plaintiffs did not have fair notice that an error 

might be held against them after understanding the green check mark gave them the “green light 

to proceed with the TIN data entered.” Id. at *7. Further, the agency could have corrected this 

clerical error with minimal effort because it had various dealings with the subsidiary hospital using 

its correct TIN and had a system to verify providers’ TINs. Id. Therefore, the agency’s actions 

were arbitrary and capricious. Id. at *8.

In response, the Government claims that it did not provide reimbursement to the Hospital 

because the Hospital did not upload its patient roster on March 17, 2022 (Dkt. #14 at pp. 18–22). 

The Government points out that it has no record of the Hospital submitting its patient roster, the 

system did not automatically provide a reference number, and the Hospital has not produced the 

automated email that it should have received (Dkt. #14 at pp. 19–20; Dkt. #17 at pp. 2–3). 

Additionally, the government claims that no technical issues impacted any providers’ ability to 

submit patient rosters via the UIP Portal (Dkt. #17 at pp. 2–3). Further, the Government argues 

that it has consistently told the Hospital that no record exists of its alleged March 17, 2022 patient 

roster upload (Dkt. #14 at pp. 21–22). Finally, the Government claims that Tyler Regional Hospital 

is not analogous to this case because no comparable ambiguity exists, and clerical errors do not lay 

at the heart of the dispute in this case (Dkt. #14 at p. 22).

Tyler Regional Hospital is not factually and legally analogous to this case because the primary 

two rationales underlying the court’s decision do not apply to this case. First, a key aspect of Tyler 

Regional Hospital was that the plaintiffs submitted their TINs online and that portion of their 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 14 of 19 PageID #: 383
15

application appeared complete and verified based on the presence of a green check mark. 2023 WL 

3506471, at *4, 7. However, the fair notice rationale is not applicable in this case because multiple 

pieces of undisputed evidence demonstrate the Hospital did not receive any indication that it 

successfully uploaded its patient roster on March 17, 2022. Specifically, the Hospital has not 

produced the corresponding temporary IDs, automatically generated email, or automatically 

generated reference number (Dkt. #6, Exhibit 2 ¶ 6; Dkt. #17, Exhibit 1 ¶¶ 6–7).4

Second, the Government (more specifically HRSA or UnitedHealth) could not have 

located or determined the Hospital’s patient roster with minimal effort. In Tyler Regional Hospital, 

HRSA could have easily determined the subsidiary hospital’s correct TIN from either its past 

records relating to the hospital or through its system to verify TINs. 2023 WL 3506471, at *7. No 

evidence in the record suggests that the Government could have obtained this information with 

minimal effort.

The Hospital has not demonstrated that it either likely successfully uploaded its patient 

roster on March 17, 2022, or that technical issues with the UIP Portal (or any related system) likely 

prevented the upload. The evidence that the patient roster was not successfully uploaded includes: 

(1) the Hospital’s lack of production of an automatically generated email, (2) the lack of an 

automatically generated reference number, (3) the Hospital never received corresponding 

temporary IDs, and (4) the lack of a record of a patient roster by the Hospital on March 17, 2022 

even though records exist indicating a Hospital representative logged into the UIP Portal on that 

4 Although the alleged March 22, 2022 call where the help center agent claimed to have been able to see the patient 

roster upload could be viewed as supporting evidence, the veracity of this evidence is disputed (Dkt. #6, Exhibit 2 ¶ 7; 

Dkt. #14 at p. 12; Dkt. #14, Exhibit 21). Similarly, the April 5, 2022 email can be interpreted as supporting the 

Hospital’s claim that technical issues occurred but does not necessarily demonstrate that the Hospital successfully 

uploaded its patient roster on March 17, 2022 (Dkt. #6, Exhibit 3 at p. 3; Dkt. #14, Exhibit 1 ¶ 65).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 15 of 19 PageID #: 384
16

date (Dkt. #6, Exhibit 2 ¶ 6; Dkt. #17, Exhibit 1 ¶¶ 6–7). Although the Hospital has produced 

evidence that the technical issues occurred relating to the UIP program, it has not produced 

evidence specifically showing that these technical issues impacted a providers’ ability to upload a 

patient roster (Dkt. #6, Exhibit 2 ¶ 7; Dkt. #6, Exhibit 3). Rather, the Government has produced 

evidence that these technical issues did not extend to a providers’ ability to upload a patient roster 

(Dkt. #17, Exhibit 1 ¶¶ 12–13).

The Court does not find that the Government acted arbitrarily and capriciously by not 

providing a reimbursement to the Hospital because the Hospital likely did not submit its patient 

roster on March 17, 2022.

B. Whether the Hospital is Entitled to Correct Any Mistake It Made

The Hospital argues that “it was an abuse of discretion for [the Government] to not allow 

the Hospital to resubmit its patient roster,” regardless of whether the Hospital’s error caused its 

inability to submit claims (Dkt. #16 at pp. 11–13). Akin to Tyler Regional Hospital, according to the 

Hospital, “the guidance materials submitted by [the Government] do not state who is responsible 

in the event of a portal malfunction or error in the patient roster submission process” (Dkt. #16 at 

pp. 12–13). Therefore, “[i]t was arbitrary and capricious for [the Government] not to allow the 

Hospital to correct the error” (Dkt. #16 at p. 12).

In response, the Government claims that the Hospital is not entitled to correct the error 

regardless of which party was at fault (Dkt. #17 at pp. 4–5). According to the Government, “[a] 

necessary step was submitting a patient roster through the UIP Portal and having [temporary IDs] 

assigned to eligible patients” (Dkt. #17 at p. 4). Because of “its own failure” to complete this step, 

the Government claims the Hospital “cannot succeed on the merits of its claim” (Dkt. #17 at p. 4). 

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 16 of 19 PageID #: 385
17

Further, the Government claims “it was not arbitrary nor capricious for HRSA to set, and stick to, 

a deadline for submitting claims and to reject claims submitted after that deadline” (Dkt. #17 at 

p. 4).

Additionally, the Government argues that Tyler Regional Hospital does not support the 

Hospital’s argument for two reasons (Dkt. #17 at pp. 4–5). First, no similar ambiguity occurs in 

this case because the providers were simply required to submit patient information (Dkt. #17 at 

p. 5). Second, Tyler Regional Hospital involved an actually submitted application for the Provider 

Relief Fund, while this case has never involved a completed application (Dkt. #17 at p. 5).

Tyler Regional Hospital does not support the Hospital’s argument. That case involved a 

completed application that contained an error where the court considered whether HRSA may 

strictly construe the error against the provider. Tyler Regional Hospital, 2023 WL 3506471, at *6–

8. The question before the court was whether, considering HRSA’s ambiguous policies, the agency 

must provide fair notice before it strictly holds that error against the party despite the appearance 

that the relevant step has been successfully completed. See id. Fair notice was an issue only because 

the provider seemed to have successfully completed the relevant part of the application, but HRSA 

later rejected the application due to a typographical error. See id. at *7.

However, in this case, the Hospital likely did not submit its patient roster. In the absence 

of the appearance of a successfully submitted patient roster, the Hospital would have no reason to 

believe that it had successfully completed its application for reimbursement (See Dkt. #14, Exhibit 

1 ¶ 26; Dkt. #14, Exhibits 5–8).5 Assuming the patient roster upload process was working properly, 

no issue of fair notice exists because the Hospital did not receive indications that it had successfully 

5 If the Hospital shows that its successfully submitted its patient roster and the Government did not produce the 

corresponding temporary IDs, the Court’s analysis would likely reach a different result.

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 17 of 19 PageID #: 386
18

uploaded its patient roster on March 17, 2022 (Dkt. #6, Exhibit 2 ¶ 6; Dkt. #17, Exhibit 1 ¶¶ 6–7). 

Tyler Regional Hospital, 2023 WL 3506471, at *7.6.

Other than Tyler Regional Hospital, the Hospital has provided no authority in support of its 

argument (Dkt. #16 at pp. 12–13). The Court cannot find such a source supporting the Hospital’s 

argument based on fair notice where a party had never submitted an application. If the Hospital 

never submitted its patient roster through its own fault, the Government did not have an obligation 

to allow the Hospital to correct its error after the March 22, 2022 deadline. Further, the parties 

have not presented any facts suggesting that the Hospital could not have reattempted to upload its 

patient roster before the passage of the deadline. The Court does not find that the Government 

acted arbitrarily and capriciously by not allowing the Hospital to reattempt to submit its patient 

roster from March 22, 2022.

The Hospital has not shown that it is considerably more likely than not that it will succeed 

on the merits of its claims. Therefore, the Hospital has not demonstrated a substantial likelihood 

of success on the merits. The Court will not grant the Hospital’s application for a preliminary 

injunction.

6 The Court’s analysis may vary if the Hospital can demonstrate that the patient roster upload process did not work 

successfully on March 17, 2022. The Hospital has not produced specific evidence indicating that the patient roster 

upload did not work properly on that date (See Dkt. #6, Exhibit 2 ¶ 7; Dkt. #6, Exhibit 3). However, the Government 

has produced evidence indicating that the patient roster upload process worked properly on that date (Dkt. #17, 

Exhibit 1 ¶¶ 12–13).

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 18 of 19 PageID #: 387
19

CONCLUSION 

It is therefore ORDERED that Plaintiff’s Application for Preliminary Injunction (Dkt. #6)

is hereby DENIED.

IT IS SO ORDERED.

Case 4:23-cv-00738-ALM Document 20 Filed 12/19/23 Page 19 of 19 PageID #: 388