Dynasty Healthcare, LLC v. Nat'l Gov't Services, Inc., No. 21-1622 (2d Cir. 2023)
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Third-Party Plaintiff Dynasty Healthcare, LLC, a medical billing firm, claimed that a Medicare Administrative Contractor (“MAC”) negligently processed and misclassified the enrollment and payment application of one of Dynasty’s clients, a medical services supplier, and that. As a result, the client was underpaid for providing Medicare services. When the client sued Dynasty for the error, Dynasty sued the MAC, blaming it for the error. The district court dismissed Dynasty’s claims for lack of subject matter jurisdiction because Dynasty failed to pursue administrative channels through the United States Department of Health and Human Services before seeking judicial review. At issue on appeal is whether Dynasty’s claims “arise under” the Medicare Act, such that the administrative channeling requirement set forth in 42 U.S.C. 14 Section 405(h) applies; and second, if so, whether the district court nonetheless had jurisdiction based on a narrow exception to the Medicare Act’s jurisdiction stripping provision recognized in Shalala v. Illinois Council on Long Term Care, Inc.
The Second Circuit affirmed. The court concluded that the claims arise under the Medicare Act and that the Illinois Council exception does not apply to these claims. The court explained that Dynasty is not entitled to the exception because Retina’s financial interests in the claims alleged in this case were aligned with Dynasty’s interests at all relevant times, and Retina had both the incentive and the ability to seek administrative review. That Retina pursued a different course is irrelevant to the court's analysis under Illinois Council’s “objective inquiry.”
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