ANDREW AVERETT, M.D., ET AL. v. UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, ET AL. - Articles

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ANDREW AVERETT, M.D., ET AL. v. UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, ET AL.

Posted by: Karen Belcher on Nov 25, 2019

Court: 6th Circuit Court (Published Opinions)

Attorneys 1:

ARGUED: Laura E. Myron, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellants. Michael A. Cottone, BASS, BERRY & SIMS, PLC, Nashville, Tennessee, for Appellees.

Attorneys 2:

ON BRIEF: Laura E. Myron, Mark B. Stern, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellants. Michael A. Cottone, David A. King, David R. Esquivel, BASS, BERRY & SIMS, PLC, Nashville, Tennessee, for Appellees.

Judge(s): GRIFFIN, KETHLEDGE, and THAPAR, Circuit Judges

Court Appealed: United States District Court for the Middle District of Tennessee at Nashville

KETHLEDGE, Circuit Judge. A statute’s terms are not ambiguous simply because the statute itself does not define them. Here, the Centers for Medicare and Medicaid Services interpreted the same phrase—“a physician with a primary specialty designation”—to have very different meanings in parallel provisions of the Affordable Care Act. The agency did so not because of any difference in context between the two provisions—instead their context is identical—but rather because the agency thought the different meanings made good policy sense. One of those meanings closely tracked the statute’s terms; the other, set forth in the agency’s “Final Medicaid Payment Rule,” assuredly did not. The plaintiffs here—all physicians— challenged that rule after the Tennessee Medicaid agency invoked it in an effort to “recoup” some $2.3 million in payments to them. In a carefully reasoned opinion, the district court granted summary judgment to the plaintiffs and declared the rule invalid. We affirm.

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