Supreme Court rules Medicare challenge was too late to gain repayment

[JURIST] The US Supreme Court [official website] ruled unanimously [opinion, PDF] Tuesday in Sebelius v. Auburn Regional Medical Center [JURIST report] that 10-year-old final rulings for Medicare [official website; JURIST news archive] reimbursement cannot be appealed to the Department of Health and Human Services (HHS) [official website] beyond the deadlines previously set by the Secretary of HHS, despite evidence of intentional concealment that prevented the appeals. Justice Ruth Bader Ginsburg delivered the opinion for the court. The court held that the 180-day statutory deadline to appeal to the Provider Reimbursement Review Board (PRRB) from a final Medicare payment determination, under 42 USC § 1395oo(a)(3) [text] is not "jurisdictional," and thus it was up to HHS, an agency, to set the statute of limitations. The court also held that the principle of equitable tolling [backgrounder] "does not similarly apply to administrative appeals of the kind here considered." The holding reversed [opinion] the US Court of Appeals for the DC Circuit.

Justice Sonia Sotomayor concurred to suggest that the question of whether any agency decision is immune from equitable tolling has not been answered. "I write separately to note that the Court's decision in this case does not establish that equitable tolling principles are irrelevant to internal administrative deadlines in all, or even most, contexts. The Court is correct that our equitable tolling cases have typically involved deadlines to bring suit in federal court. But we have never suggested that the presumption in favor of equitable tolling is generally inapplicable to administrative deadlines."

 

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