Source: http://openjurist.org/145/f3d/1000
Timestamp: 2015-07-03 23:51:31
Document Index: 338943281

Matched Legal Cases: ['§ 405', '§ 1395', '§ 1395', '§ 1395', '§ 1395', '§ 405', '§ 1395', '§ 1395', '§ 405']

145 F3d 1000 Midland Psychiatric Associates Inc v. United States | OpenJurist
145 F. 3d 1000 - Midland Psychiatric Associates Inc v. United States	Home145 f3d 1000 midland psychiatric associates inc v. united states
145 F3d 1000 Midland Psychiatric Associates Inc v. United States 145 F.3d 1000
Medicare & Medicaid Guide P 46,366MIDLAND PSYCHIATRIC ASSOCIATES, INC., Appellant,v.UNITED STATES of America; Mutual of Omaha InsuranceCompany, Appellees.
No. 97-3401.
Submitted April 15, 1998.Decided June 4, 1998.
Sally B. Surridge, Kansas City, MO, argued (Stephen L. Hill, Jr., United States Attorney, Alleen S. VanBebber, Kansas City, MO, on the brief), for Appellees.
Before FAGG and HANSEN, Circuit Judges, and STROM,* District Judge.
Midland Psychiatric Associates, Inc. (Midland) appeals the district court's two-pronged order dismissing Midland's lawsuit against the United States and Mutual of Omaha Insurance Company (Mutual) for lack of subject matter jurisdiction. See Fed.R.Civ.P. 12(b)(1). The district court held Midland's tortious interference with contract claim against Mutual, and Midland's Federal Tort Claims Act (FTCA) negligent supervision claim against the United States, were jurisdictionally barred by 42 U.S.C. §§ 405(h) and 1395ii. The district court also dismissed Midland's claim against Mutual based on common-law official immunity. We affirm.
Like the district court, we take our statement of the facts from Midland's complaint, but we supplement the complaint with the district court's findings where the complaint is silent on jurisdictionally significant facts. Under contracts with two Kansas City area hospitals, Midland provided partial hospitalization services to nursing-home residents. Partial hospitalization is an intensive outpatient service covered under PartB of the Medicare Act. See 42 U.S.C. §§ 1395k(a)(2)(J), 1395x(ff) (1994). Part B claims are processed by Medicare carriers--chiefly insurance companies, see id. § 1395u(f)--under contract with and on behalf of the Department of Health and Human Services. See id. § 1395u(a). Midland billed the hospitals, and the hospitals in turn submitted Medicare claims for Midland's services to Mutual, a Medicare carrier.
Mutual denied thousands of the hospitals' Midland-related claims on the grounds that Midland's services were unsupervised by a physician and medically unnecessary. See id. §§ 1395x(ff)(1), (2). Midland contends Mutual denied the claims to put Midland out of business. According to the district court, the hospitals sought administrative review of Mutual's claims denials, see Midland Psychiatric Assocs., Inc. v. United States, 969 F.Supp. 543, 547-48 (W.D.Mo.1997), but Midland was not a party to the hospitals' administrative appeal, see id. at 548. Midland maintained it was not eligible to join the appeal, and the district court did not find otherwise. See id. Unable to obtain payment through Medicare, the hospitals eventually dropped Midland's services, and several hospitals thinking of contracting with Midland decided against it. Midland then filed this lawsuit against Mutual and the United States, claiming Mutual had tortiously interfered with Midland's past and prospective hospital contracts and the Government had supervised Mutual negligently. The district court dismissed both claims for lack of subject matter jurisdiction. See id. at 554. We review de novo whether the district court properly did so. See Clarinda Home Health v. Shalala, 100 F.3d 526, 528 (8th Cir.1996).
Like the district court, we begin our analysis with the Missouri law governing Midland's diversity-based tortious interference with contract claim. Under that law, Midland would have to prove, among other elements, that Mutual interfered with Midland's hospital contracts without justification. See Rice v. Hodapp, 919 S.W.2d 240, 245 (Mo.1996). Contrary to Midland's assertion, Midland would not be able to prove absence of justification solely with evidence Mutual wanted to put Midland out of business. Regardless of its intent, Mutual cannot be held liable for tortious interference if it had a right to deny the hospitals' claims. See id. The district court thus correctly concluded that hearing Midland's tortious interference claim against Mutual would mean reviewing the merits of Mutual's Medicare claims decisions. See Midland, 969 F.Supp. at 547.
The district court also concluded 42 U.S.C. § 405(h) deprived it of the power to conduct such a review. See id. at 547-50. Section 405(h) is a provision of the Social Security Act made applicable to the Medicare Act by 42 U.S.C. § 1395ii. As modified by § 1395ii for Medicare Act purposes, § 405(h) reads:
The findings and decision of the [Secretary of Health and Human Services] after a hearing shall be binding upon all individuals who were parties to such hearing. No findings of fact or decision of the [Secretary] shall be reviewed by any person, tribunal, or governmental agency except as herein provided. No action against the United States, the [Secretary], or any officer or employee thereof shall be brought under section 1331 or 1346 of