January 22, 2013 United States Supreme Court opinion

Sebelius v Auburn Regional Medical Center

Auburn and several other hospitals sought to increase their reimbursement for Medicare beneficiaries under a court decision holding that the Department of Health and Human Services had failed to consider all relevant data in calculating the rates. Auburn admitted it missed the statutory deadline to file a claim for review of reimbursement by ten years. It argued that equitable tolling should allow its claim. The DC Circuit agreed and ordered a hearing. The court, resolving a circuit split, unanimously reversed. It held that 42 USC 1395oo(a)(3) was a filing deadline and not jurisdictional based on the lack of express jurisdictional language such as “shall file” or “notice of appeal”. It rejected arguments that other portions in 1395oo are jurisdictional and that other section in the Medicare statute are explicitly nonjurisdictional stating that  proximity to jurisdictional provisions is not determinative and that the default rule requires explicit statement of jurisdictional effect so lack of nonjursidictional statement will not make a provision jurisdictional. As to tolling, the Court held that tolling is unavailable in administrative hearing setting where, like here, the claimants are sophisticated repeat players and Congress did not appear to intend tolling or allow the agency to permit tolling. The Court noted that the deadline can be extended 3 years under the governing regulation which the Court upheld under Chevron deference analysis. Justice Sotomayor added a concurrence observing that tolling is a background principle of law that the court has never limited to litigation settings. While the circumstances of this case support the conclusion that tolling is inappropriate, there could be other facts which would justify tolling.

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