Five Points Healthcare of NC, LLC v. Becerra et al DO NOT DOCKET IN THIS CASE. See 7:22-cv-81-D.

n May 23, 2022, Five Points Healthcare of NC, LLC d/b/a Native Angels Home Health Agency, Inc. (“Native Angels” or “Plaintiff”), represented by Knicole C. Emanuel of Practus LLP, filed a civil action against Xavier Becerra, the Secretary of the Department of Health and Human Services (“HHS”),  and Chiquita Brooks-LaSure, Administrator for the Centers for Medicare and Medicaid Services (“CMS”) (collectively “Defendants''), seeking damages for alleged improper recoupment of Medicare payments, in violation of the plaintiff’s due process rights. This case was filed in the U.S. District Court for the Eastern District of North Carolina, with Judge James C. Dever, III presiding. 

In the complaint, the plaintiff alleged, “Defendants’ recoupment of the amounts at issue without providing Native Angels the opportunity to be heard by an ALJ, as required by applicable law and the United States Constitution violates Plaintiff’s due process rights.”

The plaintiff further alleged, “Health care providers, including home health agencies such as Native Angels, furnish services to Medicare beneficiaries, following which they submit claims to HHS, which processes them through the Centers for Medicare and Medicaid Services (‘CMS’) and its contractors. The Medicare Modernization Act of 2003 (‘MMA’) authorized CMS to conduct post-payment reviews of those claims through the use of contractors.” 

The plaintiff then claimed, “Under the MMA, providers such as Native Angels have the right to contest the post-payment denials through an appeals process within HHS, with the last level consisting of judicial review. [...] As a result of increasing audit activity by HHS contractors, providers have experienced extraordinary delays in the appeals process, particularly at the ALJ level, which has effectively barred providers from challenging payment denials in a timely and efficient manner.” 

The plaintiff then alleged, “Not only has the extraordinary delay stymied timely appeals, it also violates the statute, which requires the ALJ to hold a hearing within 90 days of an appeal being filed. Instead, providers such as Native Angels often wait up to 5 years to have their claims heard by an ALJ. In many instances, the ALJ will deny the provider a hearing based on a technicality or uphold the prior ruling without a hearing, which further deprives the provider of its due process rights.” 

The plaintiff claimed, “Native Angels should be afforded a substantive hearing on its claims, whether it be directly by this Court or, alternatively, by the ALJ upon direct order of this Court.”

The plaintiff listed three claims for relief, including claims for the deprivation of procedural due process, ultra vires actions, and preservation of status of rights under section 704 of the APA.  In the prayer for relief, the plaintiff requested $3,691.30 in damages or that the court remand this matter to the Medicare Review Council for review on the merits. The plaintiff also requested costs and attorneys’ fees. 

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