No. 20-742

Steven Bruce v. Alex M. Azar, II, Secretary of Health and Human Services, et al.

Lower Court: Ninth Circuit
Docketed: 2020-11-30
Status: Denied
Type: Paid
Response Waived
Tags: administrative-law due-process false-and-misleading fifth-amendment medically-acceptable-indications medicare-part-d ninth-circuit rehabilitation-act rehabilitation-act-section-504
Key Terms:
SocialSecurity DueProcess Securities JusticiabilityDoctri
Latest Conference: 2021-01-22
Question Presented (from Petition)

This is Compendia case, a case of first impression under Shalala v. Illinois Council, 529 U.S. 1 (2000).

1. Can the U.S. Court of Appeals for the Ninth Circuit ("9th Circuit") sidestep all issues under Medicare, Part D by not looking behind a compendium's Medically Acceptable Indications ("MAI") also known as 'on or off label' when the evidence leads to an underlying false and misleading premise for a prescription, i.e., no rational basis also under Fifth Amendment, Due Process and Section 504 of the Rehabilitation Act of 1973 ("Sec. 504")? The medication, Serostim, as listed in a compendium requires that the patient also have HIV an unrelated condition that does not treat HIV, only lipodystrophy, a life threatening condition which prevents Petitioner from retaining lipids.

2.a Does Shalala v. Illinois Council, 529 U.S. 1 (2000), an exhaustion case, preclude Due Process and/or Sec. 504? Was it an abuse of discretion not to allow Petitioner to amend the Complaint as to a Sec. 504 claim or constitutional due process?

b. Does 42 U.S.C. § 405(h) - if it arises under the Social Security Act, mean that a beneficiary cannot pursue his Due Process and Sec. 504 rights when there is a false and fraudulent premise in HHS policy? Or does § 405(h) only bar actions under 28 U.S.C. §§ 1331 and 1346?

3. Can insurance carriers which are Medicare contractors, be sued for not making statutory exceptions under Medicare, Part D? Can HHS not permit statutory peer reviewed articles from the National Institutes of Health (NIH) into account and can the 9th Circuit prevent this evidence favorable to Petitioner to be considered in cross motions for summary judgment?

Question Presented (AI Summary)

Can the U.S. Court of Appeals for the Ninth Circuit sidestep issues under Medicare Part D by not looking behind a compendium's Medically Acceptable Indications when the evidence leads to an underlying false and misleading premise for a prescription?

Docket Entries

2021-01-25
Petition DENIED.
2021-01-06
DISTRIBUTED for Conference of 1/22/2021.
2020-12-18
Waiver of right of respondent Envision Insurance Company to respond filed.
2020-12-03
Waiver of right of respondent California Physicians' Service dba Blue Shield of California to respond filed.
2020-12-02
Waiver of right of respondent Azar II, Alex, et al. to respond filed.
2020-11-24
Petition for a writ of certiorari filed. (Response due December 30, 2020)

Attorneys

Azar II, Alex, et al.
Jeffrey B. WallActing Solicitor General, Respondent
Bruce
Steven BrucePeople With Disabilities Foundation, Petitioner
California Physicians' Service dba Blue Shield of California
Joanna Sobol McCallumManatt, Phelps & Phillips, LLP, Respondent
Envision Insurance Company
Elizabeth Marie TrecklerBaker & Hostetler LLP, Respondent