PAMC, LTD. v. Sebelius, No. 12-56652 (9th Cir. 2014)
Annotate this CasePAMC appealed the district court's affirmance of the Secretary's decision denying PAMC its full Medicare Annual Payment Updated for the fiscal year 2009. PAMC claimed that the Department acted arbitrarily and capriciously when it refused to excuse PAMC's late filing of the required Reporting Hospital Quality Data for Annual Payment Updated (RHQDAPU) program data by the admittedly applicable deadline. The court concluded that PAMC neither pointed to any contrary or antithetical decisions by the Department under similar circumstances, nor otherwise demonstrated that the Board acted arbitrary or capriciously when it denied equitable relief. The court rejected PAMC's argument that the Board should have used the contract doctrine of substantial performance to excuse PAMC's failure to submit data at the proper time. The court did not view the Board's adherence to the policy of strict compliance with a deadline as arbitrary and capricious. Accordingly, the court affirmed the judgment of the district court.
Court Description: Expert Testimony. The panel affirmed the district court’s order affirming the Secretary of the Department of Health and Human Services’s decision denying PAMC, Ltd., its full Medicare Annual Payment Update for the fiscal year 2009. PAMC, a certified Medicare provider, failed to make a timely submission of specified data under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program, and the Centers for Medicare & Medicaid Services reduced PAMC’s annual percentage increase by two percent as a result. The panel held the Department did not act arbitrarily and capriciously when it refused to excuse PAMC’s late filing of the required RHQDAPU data by the admittedly applicable deadline. The panel rejected PAMC’s claims to a right to equitable relief, or the benefit of the contract doctrine of substantial performance, to excuse its failure to submit timely data.
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