Legal Document

525 U.S. 449119 S.Ct. 930142 L.Ed.2d 919 SUPREME COURT OF THE UNITED STATESYOUR HOME VISITING NURSE SERVICES, INC., PETITIONER v. DONNA E. SHALALA, SECRETARY HEALTH AND HUMAN SERVICES No. 97 1489 February 23, 1999 ON WRIT CERTIORARI TO STATES APPEALS FOR SIXTH CIRCUIT Justice Scalia delivered the opinion of Court. 1 Under Medicare Act, Title XVIII Social Security 79 Stat. 290, as amended, 42 U.S.C. § 1395 (1994 ed. and Sup. II), et seq., Secretary Health Human Services reimburses providers covered health services to beneficiaries, see §§1395f(b)(1), 1395h, 1395x(v)(1)(A). A provider seeking such reimbursement submits a yearly cost report fiscal intermediary (generally private insurance company) that acts Secretary's agent. See CFR 405.1801(b) (1997). The analyzes issues Notice Program Reimbursement (NPR) determining amount which is entitled for year. §405.1803. 2 As relevant here, dissatisfied has two ways get this determination revised. First, provision 1395oo, allows appeal, within 180 days, Provider Review Board (Board) an administrative review panel power conduct evidentiary hearing affirm, modify, or reverse intermediary's NPR determination. Board's decision subject judicial infederal district court. §1395oo(f). Second, one regulations, 405.1885 (1997), permits request intermediary, three years, reopen 3 Petitioner Your Home Visiting Nurse Services, Inc., owns operates several entities provide home care beneficiaries. submitted reports year 1989 its did not seek resulting NPRs days. Within however, it ask on ground "new material" evidence demonstrated entitlement additional compensation. denied request. sought appeal denial Board, but dismissed §405.1885 divested jurisdiction refusal 4 then brought instant action in Federal District Court, dismissal reopen. In unpublished opinion, Court agreed lacked reopen, rejected petitioner's alternative contention federal-question statute, 28 1331 mandamus §1361, gave directly. It accordingly complaint. Appeals affirmed. 132 F.3d 1135 (CA6 1997). We granted certiorari. 524 ___ (1998). 5 * primary issue case whether regulation authorizes reopening provides "[j]urisdiction rests exclusively with body rendered last decision." 405.1885(c) litigation, defends position set forth Manual §2926, App. A, ¶B.4 (Sept. 1993): "A by grant requested appealable pursuant . ."1 construes mean where, respect at issue, would divest "exclusiv[e]" "jurisdiction determination." Petitioner, other hand, contends "jurisdiction" §405.1885(c) refers only original over question, appellate refusal. Even if should win point, petitioner establish otherwise extant been excluded; still have somewhere conferred. Another regulation, §405.1889, says affirmative revise "shall be considered separate distinct determination" regulations authorizing are applicable; nothing about must thus basis unelaborated text Act itself. 6 relies upon 1395oo(a)(1)(A)(i), may obtain before "is final total program due period ." maintains constitutes "final provider." Secretary, phrase does include amount," rather make new reading §1395oo(a)(1)(A)(i) frankly seems us more natural any event well bounds reasonable interpretation, hence deference under Chevron Natural Resources Defense Council, 467 837,842 (1984). 7 reasonableness construction statute further confirmed Califano Sanders, 430 99 (1977), we held §205(g) authorize previously adjudicated claim benefits.2 reaching conclusion relied, part, considerations: opportunity benefit adjudication was afforded itself; frustrate statutory purpose imposing 60-day limit initial benefits. Id., 108. Similar considerations apply here. right exists grace 180-day NPRs, 1395oo(a)(3), frustrated permitting requests reviewed indefinitely. 8 Finally, do think inconsistent 1395x(v)(1)(A)(ii), cost-reimbursement shall "provide making suitable retroactive corrective adjustments period, aggregate produced methods costs proves either inadequate excessive." asserts construed create "suitable" procedure "retroactive adjustments" because review. support assertion, decries "double standard" inherent (during 3-year period) recouping overpayments, deny when alleged underpayments issue. 9 This argument fails reasons. most importantly, §1395x(v)(1)(A)(ii) our Good Samaritan Hospital Shalala, 508 402 (1993), reasonably clause (ii) refer year-end reconciliation monthly payments providers, 1395g determined intermediary. Although specifically consider determinations after year's books closed, there book balancing forecloses requires particular determinations. And second, procedures obtaining "unsuitable" simply administratively reviewable. already §1395oo(a) (3) Board. (1997) generously gives them second chance changed time hands itself, without That procedure, especially light traditional rule law agency's closed generally " 'committed agency discretion law' therefore exempt from ICC Locomotive Engineers, 482 270, 282 (1987). standard," given realities shocked system could never reopening. few dozen intermediaries often need years discover overpayments tens thousands they while each sophisticated Medicare-provider recipients these capable identifying underpayment own specified 1395oo(a)(3). Petitioner's invocation gross unfairness also refuted representation between 30 40 percent providers' Brief Respondent 27, n. 11. II 10 reject fallback precluded 405(h), applicable operation §1395ii, "[n]o against [Secretary] officer employee thereof section title recover arising subchapter." "arises under" meaning 'both standing substantive presentation' Act. Heckler Ringer, 466 602, 615 11 lower courts properly declined order were available claims Acts,3 relief shown existence "clear nondiscretionary duty," supra, 617, require reopening, merely permit it: reopened motion affected determination," 405.1885(a) (emphasis added). To sure, §2931.2 (Feb. 1985) "[w]hether will determination, final, depend (1) material submitted, (2) clear obvious error made, found law, rulings, general instructions." But hardly disjunctive listing factors meant convert discretionary function into mandatory one. factor (1), example, inconceivable alone no matter how unpersuasive might be. present case, note, involves decision. holding least where "committed law" Administrative Procedure unreviewable, id., 282, squarely applicable. 12 point suffice defeat suggestion judicial-review 706. addition, long independent subject-matter jurisdiction. (1977). 13 14 For foregoing reasons, judgment 15 so ordered. Notes 16 1. immediately following quoted portion reads "except located Ninth Circuit Appeals, appealable." ¶B.4. exception obviously reflects, inconsistency position, acknowledgement Circuit's rejection position. Oregon Bowen, 854 F.2d 346 (1988). 17 2. §205(g), 405(g) (1970 ed.), provided "[a]ny individual, made he party, irrespective controversy, civil commenced sixty days U.S., 18 3. urges hold altogether unavailable sentence findings fact person, tribunal, governmental except as" avoided deciding past, see, e.g., 616 (1984), again find unnecessary reach today.

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