Opinion ID: 2648174
Heading Depth: 5
Heading Rank: 2

Heading: Balentine

Text: Balentine is not part of the beneficiary class; he asserted an individual claim unique to his status as counsel for a Medicare beneficiary. Therefore, he must separately demonstrate Article III standing. DaimlerChrysler, 547 US. at 352. Because Balentine was the object of the Secretary’s demand that he withhold disbursement of Haro’s settlement funds, we begin with the presumption that he has standing to challenge the Secretary’s action. Los Angeles Haven Hospice, 638 F.3d at 655 (citing Lujan, 504 US. at 561–62). 18 HARO V. SEBELIUS The demand Balentine received bears significant similarity to the demand at issue in Los Angeles Haven Hospice. Haven Hospice challenged a Department of Health and Human Services regulation implementing a cap on reimbursement for hospice care provided to Medicare beneficiaries. See id. at 649; see also 42 US.C. § 1395f(i)(2). Haven Hospice received a demand for repayment of the amount it had been reimbursed in excess of the statutory cap. Los Angeles Haven Hospice, 638 F.3d at 652. The Secretary maintained that the hospice did not have Article III standing to challenge the regulation or seek to enjoin its enforcement. Id. at 654. But this court, applying the Lujan presumption, concluded: “[T]he fact that the allegedly unlawful regulation was directly applied to Haven Hospice and exposed it to individual liability for the claimed overpayments, is sufficient to support its claim of Article III standing to pursue the declaratory and injunctive relief sought in the complaint.” Id. at 655. The demand letter the Secretary sent to Balentine represents direct application of the Secretary’s interpretation of her authority under 42 C.F.R. § 411.24(g).4 The letter states that “Medicare’s claim must be paid up front out of settlement proceeds before any distribution occurs,” and that “Medicare must be paid within 60 days of receipt of the proceeds from the third party.” Because 42 C.F.R. § 411.24(g) provides that Medicare “has a right of action to 4 Whether we analyze 42 C.F.R. § 411.24(g) individually, or in conjunction with 42 C.F.R. § 411.24(h) is largely academic: § 411.24(h) interprets the reimbursement provision and provides that “[i]f the beneficiary or other party receives a primary payment, the beneficiary or other party must reimburse Medicare within 60 days.” The Secretary’s interpretation of the reimbursement provision is thus similarly broad—it encompasses attorneys who have received a primary payment. HARO V. SEBELIUS 19 recover its payments from any entity, including a[n] . . . attorney . . . that has received a primary payment,” the regulation subjects Balentine to individual liability. Consistent with Los Angeles Haven Hospice, Balentine has demonstrated Article III standing. 638 F.3d at 655.