U.S. v. Bushman
| Decision Date | 18 January 1989 |
| Docket Number | No. 87-1759,87-1759 |
| Citation | 862 F.2d 1327 |
| Parties | , Medicare&Medicaid Gu 37,591 UNITED STATES of America, Appellee, v. Richard D. BUSHMAN, D.P.M., Appellant. UNITED STATES of America, Appellee, v. Robert L. BUSHMAN, D.P.M., Appellant. |
| Court | U.S. Court of Appeals — Eighth Circuit |
Gerald Warren, St. Louis, Mo., for appellant.
Joseph B. Moore, St. Louis, Mo., for appellee.
Before McMILLIAN Circuit Judge, BRIGHT, Senior Circuit Judge, and Fagg, Circuit Judge.
These appeals follow actions brought by the United States to recover from appellants Richard D. Bushman and Robert L. Bushman overpayments made pursuant to Part B of the Medicare Act. The Bushmans defend their refusal to refund the overpayments by alleging that the manner in which their claims were considered violated their procedural due process rights. The district court 1 found in favor of the United States, holding that to the extent the Bushmans sought review of Medicare Part B determinations, the court lacked jurisdiction. The court further held that, although it did have jurisdiction over the Bushmans' federal constitutional claim, the Bushmans failed to prove any constitutional deprivation. The court thereupon ordered the Bushmans to refund the overpayments to the United States. This appeal followed and, for the reasons set forth below, we affirm.
Richard and Robert Bushman are podiatrists who, between October 1979 and October 1981, provided medical treatment to Medicare beneficiaries under Part B of Title XVIII of the Social Security Act, 42 U.S.C. Secs. 1395 et seq., commonly known as the Medicare program. The patients assigned their claims for benefits to the Bushmans pursuant to 42 U.S.C. Sec. 1395u(b)(3)(B)(ii) and the Bushmans, in turn, filed requests for payment with General American Life Insurance Company (General American), a carrier authorized by the Secretary of Health and Human Services to make such payments.
By letters dated December 22, 1981, and December 27, 1981, Phyllis Seka, Director of Medicare Program Control at General American, advised the Bushmans in writing that a full scale review of a statistically valid sample of their claims revealed that Richard Bushman had received $11,784.00 in overpayments and that Robert Bushman had received $9,139.20 in overpayments. Seka requested refunds of the overpayments.
The Bushmans requested a hearing on General American's determination pursuant to 42 U.S.C. Sec. 1395u(b)(3)(C) and 42 C.F.R. Secs. 405.801 et seq. Hearing Officer Linda Benso conducted the hearing at which she considered the 251 claims submitted by the Bushmans between October 1979 and October 1981, and concluded that General American had properly paid forty-two of those claims but had improperly paid the remaining 209 claims. Benso thus adjusted Richard Bushman's overpayment determination to $9,047.04 and Robert Bushman's overpayment determination to $7,484.00. 2
The Bushmans requested review by the Health Care Finance Administration (HCFA). The Associate Regional Administrator of HCFA, William Blake, after reviewing the documents submitted, requested that General American either reopen the case or reaffirm its decision. Benso reaffirmed her decision on August 27, 1984, and Blake so advised the Bushmans.
The Bushmans, nevertheless, refused to refund the overpayments, and on August 1, 1985, the United States instituted these recovery actions. The Bushmans answered, defending their refusal to pay by contending that Hearing Officer Benso conducted an unfair hearing on determination of their benefits and, thus, denied the Bushmans their due process rights.
After a trial to the district court, Judge Limbaugh, citing United States v. Erika, Inc., 456 U.S. 201, 203, 102 S.Ct. 1650, 1651-52, 72 L.Ed.2d 12 (1981), held that to the extent the Bushmans sought review of General American's Medicare Part B determinations, it was without jurisdiction to hear their complaint. The district court proceeded, however, relying on St. Louis Univ. v. Blue Cross Hosp. Serv., 537 F.2d 283, 292 (8th Cir.1976), and Hatcher v. Heckler, 772 F.2d 427, 429-31 (8th Cir.1985), to consider the Bushmans' claims to the extent that they challenged, as violative of their federal due process rights, the manner in which General American made its determinations. The court, nevertheless, held that the Bushmans failed to prove any due process violation and ordered Richard Bushman to refund overpayments totaling $9,047.04 and ordered Robert Bushman to refund overpayments totaling $7,398.40.
This appeal followed.
Our review of this case must necessarily begin with an inquiry into the court's subject matter jurisdiction. The district court concluded that it had jurisdiction over the constitutional claims. We disagree.
Part B of the Medicare Act is a voluntary supplemental insurance program covering, generally, eighty percent of the reasonable charges for physician's services, as well as certain other medical and health benefits. Benefits determinations under Part B are made by the carrier with whom the Secretary of Health and Human Services contracts to administer the program, in this case, General American. Claimants are entitled to de novo review of any benefits determination with which they are dissatisfied. 42 C.F.R. Secs. 405.807-405.812. If the amount in controversy is $100.00 or more, the dissatisfied claimant is entitled to an oral evidentiary hearing. 42 U.S.C. Sec. 1395u(b)(3)(C); 42 C.F.R. Secs. 405.820-405.835. Unless the carrier or hearing officer decides to reopen the proceeding, this decision is final and binding upon the parties. 42 C.F.R. Sec. 405.835. No further review of the carrier's determination of the amount of benefits payable under Part B is contemplated by the Act. Erika, 456 U.S. at 206-08, 102 S.Ct. at 1653-55.
The Bushmans, however, claim that they are not seeking review of the amount of General American's benefits determinations, but are seeking their constitutionally guaranteed right to a fair hearing before an unbiased hearing officer and that, thus, this court has jurisdiction to hear their claims. The Bushmans cite our opinion in St. Louis Univ., 537 F.2d at 292, where we held "that Congress did not intend...
To continue reading
Request your trial
-
Nursing Home Consultants v. Quantum Health Services
...well as certain other medical benefits" which are not covered by Medicare Part A, 42 U.S.C. §§ 1395c to 1395i-4. United States v. Bushman, 862 F.2d 1327, 1329 (8th Cir.1988), cert. denied, 493 U.S. 810, 110 S.Ct. 53, 107 L.Ed.2d 21 9 Since NHC did not itself supply medical supplies to nursi......
-
AMERICAN AMBULANCE SERVICE OF PA. v. Sullivan
...regulations, failure to follow valid procedures and policies, or the conducting of an unfair hearing. See, e.g., United States v. Bushman, 862 F.2d 1327, 1329 (8th Cir.1988) (court without jurisdiction to review claim that hearing officer based her decision on inadmissible evidence and cond......
-
American Ambulance Service of Pennsylvania, Inc. v. Sullivan
...103 L.Ed.2d 833 (1989); nor is the question one pertaining to the bias or incompetency of the Hearing Officer, cf. United States v. Bushman, 862 F.2d 1327, 1329 (8th Cir.1988) cert. denied, --- U.S. ----, 110 S.Ct. 53, 107 L.Ed.2d 21 (1989). AASI does not question the Hearing Officer's auth......
-
Midland Psychiatric Associates, Inc. v. U.S.
...(1983). Heckler v. Ringer, 466 U.S. 602, 609 n. 4, 104 S.Ct. 2013, 2018 n. 4, 80 L.Ed.2d 622 (1984); see also United States v. Bushman, 862 F.2d 1327, 1329 (8th Cir.1988), cert. denied, 493 U.S. 810, 110 S.Ct. 53, 107 L.Ed.2d 21 (1989). In this case, the intermediate insurance company was M......