Court Opinion

ID: 9477296
Source: CourtListenerOpinion
Date Created: 2023-08-05 06:19:33.133326+00
Date Added: 2024-06-11T17:45:48.078687
License: Public Domain

WILLIAMS, Circuit Judge,
concurring:
So that users of Lexis and other indices can find this case while researching similar issues, I wish to mention the word exhaustion. It is the standard tag for the doctrine that I believe we are applying.
As we note, plaintiffs acknowledge the need to resort to administrative adjudication of claims under the Medicare Act where they present “specific reimbursement claims.” Parts of their complaint quite clearly and literally trigger that doctrine; the provider-plaintiffs ask for an accounting for amounts due them on their legal theory. Joint Appendix at 7-8.
The only question that remains is whether those portions of the complaint asking for a pure legal opinion somehow avoid the need for exhaustion. It is hard to imagine why they would. It has never been suggested that parties may elect to by-pass administrative remedies simply by announcing their (momentary) lack of interest in specific facts. The grant of such an election would obviously undermine the doctrine’s capacity to protect agency autonomy, which it accomplishes by enabling an agency to apply its discretion and expertise before a court appears on the scene. See McKart v. United States, 395 U.S. 185, 194, 89 S.Ct. 1657, 1663, 23 L.Ed.2d 194 *935(1969). The same value of course animates the doctrine of ripeness, as our opinion recognizes in the mention of Toilet Goods Ass’n v. Gardner, 387 U.S. 158, 164-65, 87 S.Ct. 1520, 1524-25, 18 L.Ed.2d 697 (1967) (preference for testing legal issue in concrete setting). Plaintiffs’ ability to identify a legal issue that theoretically could be resolved in the absence of a specific factual context is not, standing alone, enough to dispense with the exhaustion requirement. See McKart, supra (relying on fact that the sole issue was purely one of law and on three other factors militating against requirement of exhaustion). Here, plaintiffs do not even claim that resolution of the core legal issue — application of the Prompt Payment Act to the Department’s repayment obligations — will not be illuminated by a factual setting in which the operation of the Act can be contrasted with the payment rules of the Medicare program. They have shown no reason why we should dispense with the exhaustion requirement.