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PALOMAR MEDICAL CENTER v. SEBELIUS

No. 10-56529.

693 F.3d 1151 (2012)

PALOMAR MEDICAL CENTER, Plaintiff-Appellant, v. Kathleen SEBELIUS, Secretary of Health and Human Services, Defendant-Appellee.

United States Court of Appeals, Ninth Circuit.

Filed September 11, 2012.

Attorney(s) appearing for the Case

Ronald S. Connelly (argued) and Mary Susan Philp , Powers, Pyles, Sutter & Verville, PC, Washington, DC; and Dick A. Semerdjian , Schwartz Semerdjian Haile Ballard & Cauley LLP, San Diego, CA, for the plaintiff-appellant.

Christine N. Kohl (argued) and Anthony J. Steinmeyer , U.S. Department of Justice, Civil Division, Washington, DC, for the defendant-appellee.

Douglas Hallward-Driemeier , Ropes & Gray, LLP, Washington, DC; Long X. Do , California Medical Association, Sacramento, CA; and Jon N. Ekdahl and Leonard A. Nelson , American Medical Association, Chicago, IL, Amicus Curiae for American Medical Association.

Mark Steven Hardiman , John R. Hellow , and Mark Emerson Reagan , Hooper, Lundy & Bookman, Inc., Los Angeles, CA, Amicus Curiae for Federation of American Hospitals.

Long X. Do and Francisco J. Silva , California Medical Association, Sacramento, CA, Amicus Curiae for California Medical Association.

Mark Steven Hardiman , John R. Hellow , and Mark Emerson Reagan , Hooper, Lundy & Bookman, Inc., Los Angeles, CA, Amicus Curiae for American Hospital Care Association.

Jodi P. Berlin , Lloyd A. Bookman , and Abigail W. Grigsby , Hooper, Lundy & Bookman, Inc., Los Angeles, CA, Amicus Curiae for California Hospital Association.

Before: HARRY PREGERSON, RONALD M. GOULD, and RICHARD C. TALLMAN, Circuit Judges.

OPINION

GOULD, Circuit Judge:

This case involves a Medicare provider at first paid in full for certain medical services but later determined, through operation of the congressionally mandated Recovery Audit Contractor ("RAC") program, to be liable to repay the government for these services found not to be medically reasonable and necessary. We must decide whether such a Medicare provider may in its appeal of the revised determination of overpayment challenge...

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