American Dental Ass'n v. Shalala, No. 92-5038

CourtUnited States Courts of Appeals. United States Court of Appeals (District of Columbia)
Writing for the CourtMIKVA
Citation3 F.3d 445
Parties, 62 USLW 2142 AMERICAN DENTAL ASSOCIATION, et al., Appellants, v. Donna E. SHALALA, Secretary, United States Department of Health and Human Services, Appellee.
Docket NumberNo. 92-5038
Decision Date27 August 1993

Page 445

3 F.3d 445
303 U.S.App.D.C. 231, 62 USLW 2142
AMERICAN DENTAL ASSOCIATION, et al., Appellants,
v.
Donna E. SHALALA, Secretary, United States Department of
Health and Human Services, Appellee.
No. 92-5038.
United States Court of Appeals,
District of Columbia Circuit.
Argued April 2, 1993.
Decided Aug. 27, 1993.

Appeal from the United States District Court for the District of Columbia (D.C.Civ. No. 90-2673).

Melvin C. Garbow, Washington, DC, argued the cause for appellants. With him on the briefs were Andrew T. Karron and Patricia H. Anderson, Washington, DC.

Sylvia T. Kaser, Atty., Dept. of Justice, Washington, DC, argued the cause for appellee. With her on the briefs were Stuart M. Gerson, Acting Atty. Gen., Jay B. Stephens, U.S. Atty., Washington, DC, at the time the briefs were filed, and Barbara C. Biddle, Atty., Dept. of Justice, Washington, DC.

Bennett Boskey, Ellis Lyons, and Edward A. Groobert, Washington, DC, filed a brief for amicus curiae, American Optometric Assn.

Before: MIKVA, Chief Judge, D.H. GINSBURG and SENTELLE, Circuit Judges.

Opinion for the Court filed by Chief Judge MIKVA.

MIKVA, Chief Judge:

The American Dental Association and others (referred to collectively as "ADA") appeal a district court decision granting summary judgment in favor of the Department of Health and Human Services ("HHS" or "the Department") in an action challenging HHS regulations implementing the Health Care Quality Improvement Act of 1986.

The Health Care Act requires any "entity" which makes payments in settlement of (or in satisfaction of a judgment in) a medical malpractice claim to report the payments to a central data bank established by the Department. The district court held that regulations requiring any "person or entity" to report, and including fee refunds in the class

Page 446

[303 U.S.App.D.C. 232] of payments that must be reported, represent reasonable interpretations of the reporting provisions of the Act. ADA claims error, arguing that the regulations impermissibly enlarge the class of payors that must report and the type of payments that must be reported.

Although the Act does not define the term "entity," its language and structure indicate clearly that Congress did not intend the statutory term "entity" to include individual practitioners. We therefore reverse and remand to the district court with instructions to remand to HHS for further proceedings consistent with this opinion.

I. BACKGROUND

Congress enacted the Health Care Quality Improvement Act of 1986 ("the Health Care Act" or "the Act"), 42 U.S.C. Secs. 11101-11152, to improve the quality of medical care and to restrict the ability of incompetent doctors and dentists to move from state to state and thereby evade discovery or disclosure of their damaging or incompetent performance. 42 U.S.C. Sec. 11101(1), (2). The Act directs HHS to establish a national data bank for the collection and dissemination of malpractice information. The Act further requires that

[e]ach entity (including an insurance company) which makes payments under a policy of insurance, self-insurance, or otherwise in settlement (or partial settlement) of, or in satisfaction of a judgment in, a medical malpractice action or claim shall report ... information respecting the payment and circumstances thereof.

Id. Sec. 11131(a). The Act also provides that failure to report as required is subject to a civil penalty of up to $10,000. Id. Sec. 11131(c).

The HHS regulation implementing the reporting requirements of the Health Care Act requires that "[e]ach person or entity ... which makes a payment under an insurance policy, self-insurance, or otherwise" must report. 45 C.F.R. Sec. 60.7 (emphasis added). ADA argued below that this regulation violates the statute in two respects. First, it expands the class of "payors" required to report from any "entity" to any "person or entity"--thus sweeping in individual doctors and dentists who are not required to report under the Act. Second, it enlarges the class of payments that must be reported to include "non-insurance" types of payments such as fee refunds.

The district court upheld the HHS regulation on cross-motions for summary judgment, holding that "[t]he interpretation of the statute that plaintiffs endorse would undermine the purpose of the Act...." American Dental Association v. Sullivan, No. 90-2673, 1991 WL 277332 (D.D.C. December 12, 1991). This appeal followed.

II. ANALYSIS

We evaluate an agency's interpretation of a statute that it administers under the familiar two-step test of Chevron v. Natural Resources Defense Council, 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984). "First, always, is the question of whether Congress has directly spoken to the precise question at issue. If the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress." Id. at 842-43, 104 S.Ct. at 2781. We proceed to Chevron 's second step, and approve any reasonable agency construction of the statute, only if the statute is silent or ambiguous on the disputed point. Id. at 843, 104 S.Ct. at 2782; accord Public Employees Retirement System v. Betts, 492 U.S. 158, 171, 109 S.Ct. 2854, 2863, 106 L.Ed.2d 134 (1989); Atlanta College of Medical and Dental Careers v. Riley, 987 F.2d 821, 827 (D.C.Cir.1993); Wolverine Power Co. v. FERC, 963 F.2d 446, 449-50 (D.C.Cir.1992).

We resolve this dispute at the first step of the Chevron analysis....

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5 practice notes
  • Simpkins v. Shalala, No. Civ.A.95-1095 (RCL).
    • United States
    • United States District Courts. United States District Court (Columbia)
    • 31 Marzo 1998
    ...as an organization, triggers Section 11133(1)(A)'s reporting provisions, not individual action. In American Dental Ass'n v. Shalala, 3 F.3d 445 (D.C.Cir.1993), the D.C. Circuit determined the proper meaning of the term "entity" as used in Section 11131 of the HCQI Act. In American Dental As......
  • Fed. Energy Regulatory Comm'n v. City Power Mktg., LLC, Civil Action No. 15-1428 (JDB)
    • United States
    • U.S. District Court — District of Columbia
    • 10 Agosto 2016
    ...And in some statutes the term is used in a way that clearly does not include individuals. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 446–48 (D.C.Cir.1993).But "entity" sometimes has a broader meaning. Some dictionaries indicate that an individual person is an "entity." See, e.g., W......
  • Transmission Agency of Northern Calif. v. F.E.R.C., No. 05-1402.
    • United States
    • United States Courts of Appeals. United States Court of Appeals (District of Columbia)
    • 20 Julio 2007
    ...we need not address this argument because we grant the petition for review on statutory grounds. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 448 (D.C.Cir.1993) (declining to reach appellant's alternative arguments once the issue was decided in its...
  • Fed. Energy Regulatory Comm'n v. City Power Mktg., LLC, Civil Action No. 15-1428 (JDB)
    • United States
    • United States District Courts. United States District Court (Columbia)
    • 10 Agosto 2016
    ...And in some statutes the term is used in a way that clearly does not include individuals. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 446-48 (D.C. Cir. 1993). But "entity" sometimes has a broader meaning. Some dictionaries indicate that an individual person is an "entity." See, e.g.......
  • Request a trial to view additional results
5 cases
  • Simpkins v. Shalala, No. Civ.A.95-1095 (RCL).
    • United States
    • United States District Courts. United States District Court (Columbia)
    • 31 Marzo 1998
    ...as an organization, triggers Section 11133(1)(A)'s reporting provisions, not individual action. In American Dental Ass'n v. Shalala, 3 F.3d 445 (D.C.Cir.1993), the D.C. Circuit determined the proper meaning of the term "entity" as used in Section 11131 of the HCQI Act. In American Dental As......
  • Fed. Energy Regulatory Comm'n v. City Power Mktg., LLC, Civil Action No. 15-1428 (JDB)
    • United States
    • U.S. District Court — District of Columbia
    • 10 Agosto 2016
    ...And in some statutes the term is used in a way that clearly does not include individuals. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 446–48 (D.C.Cir.1993).But "entity" sometimes has a broader meaning. Some dictionaries indicate that an individual person is an "entity." See, e.g., W......
  • Transmission Agency of Northern Calif. v. F.E.R.C., No. 05-1402.
    • United States
    • United States Courts of Appeals. United States Court of Appeals (District of Columbia)
    • 20 Julio 2007
    ...we need not address this argument because we grant the petition for review on statutory grounds. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 448 (D.C.Cir.1993) (declining to reach appellant's alternative arguments once the issue was decided in its...
  • Fed. Energy Regulatory Comm'n v. City Power Mktg., LLC, Civil Action No. 15-1428 (JDB)
    • United States
    • United States District Courts. United States District Court (Columbia)
    • 10 Agosto 2016
    ...And in some statutes the term is used in a way that clearly does not include individuals. See, e.g., Am. Dental Ass'n v. Shalala, 3 F.3d 445, 446-48 (D.C. Cir. 1993). But "entity" sometimes has a broader meaning. Some dictionaries indicate that an individual person is an "entity." See, e.g.......
  • Request a trial to view additional results

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