Dominion Ambulance, LLC v. Azar, No. 17-50855 (5th Cir. 2020)Annotate this Case
The Fifth Circuit affirmed the district court's grant of HHS's motion for summary judgment in an action where HHS concluded that Dominion must return approximately $1.3 million in Medicare payments. The Secretary argues that a physician certification statement is necessary but not sufficient to establish that nonemergency, scheduled, repetitive ambulance transportation is covered by Medicare, as the contrary
interpretation would render the phrase "medically necessary" in 42 C.F.R. 410.40(d)(2) superfluous.
The court held that the Secretary's interpretation is neither plainly erroneous nor inconsistent with the regulation, and Dominion's arguments to the contrary are unavailing. Furthermore, HHS's statement in 2012 when it amended the regulation supports its position that HHS did not consider a physician certification statement conclusive. Therefore, the district court properly deferred to the agency's reasonable interpretation. Finally, the court assumed, without deciding, that the district court had jurisdiction to review the timeliness of the decision to reopen the initial determination, and held that the decision to reopen was timely.