United States District Court, E.D. California
L. Nunley United States District Judge.
matter is before the Court pursuant to Defendant Tom
Price's (“Defendant” or the
“Secretary”) Motion for Stay of Proceedings. (ECF
No. 7.) Plaintiff Prime Healthcare Services - Shasta LLC
(“Plaintiff”) opposes the motion. (ECF No. 10.)
Defendant filed a reply. (ECF No. 11.) The Court has
carefully considered the arguments raised by the parties. For
the reasons set forth below, Defendant's motion is
Introduction and Background
moves this Court to stay the instant action because there are
“two previously filed federal actions that likely will
have direct and substantial (if not dispositive) effects on
these proceedings.” (ECF No. 7-1 at 2.) The first
action is United States ex. rel. Bernsten v. Prime
Healthcare Services, C.D. Cal. Case No. 11-8214 (the
“FCA Action”). The second action is Alvarado
Hospital, LLC v. Price, C.D. Cal. Case No. 15-6312 (the
proponent of a stay bears the burden of establishing its
need.” Clinton v. Jones, 520 U.S. 681, 708
(1997) (citing Landis v. N. Am. Co., 299 U.S. 248,
255 (1936)). Defendant has not done so here. This is in part
due to the quality of briefing. Nowhere in Defendant's
opening brief does he address what Plaintiff will need to
demonstrate to show it is entitled to relief in the instant
action or the standard of review that applies to a final
agency decision of the sort at issue in this case. The brief
discussion of these topics in his reply brief was not
particularly illuminating. These deficiencies were compounded
by his sparse and, frankly, imprecise discussion of the FCA
Action. While Defendant has submitted a copy of the
Government's complaint in that action, this misses the
point. The Court is not a litigant in the instant action. It
is not the role of the Court to develop arguments for
litigants or parse pleadings for actions not before this
Court - with which it cannot be presumed to have any
familiarity - to see whether they support a litigant's
underdeveloped arguments. See Williams v. Eastside
Lumberyard & Supply Co., 190 F.Supp.2d 1104, 1114
(S.D. Ill. 2001).
event, the Court will analyze this motion on the merits
because stays of the sort sought here are discretionary and,
where appropriately granted, serve to promote judicial
economy and preserve judicial resources. See Landis,
299 U.S. at 254-55. To do this in an orderly way, the Court
will first set out the legal standard for granting a motion
to stay. This will be followed by a brief discussion of the
nature of the instant action and the related standard of
review. Finally, the Court will summarize the status and
nature of the FCA Action and the Settlement Action before
analyzing the instant motion.
Standard of Law
power to stay proceedings is “incidental to the power
inherent in every court to control the disposition of the
causes on its docket with economy of time and effort for
itself, for counsel, and for litigants.”
Landis, 299 U.S. at 254. “The proponent of a
stay bears the burden of establishing its need.”
Clinton, 520 U.S. at 708. A district court's
decision to grant or deny a stay is a matter of discretion.
Dependable Highway Express, Inc. v. Navigators Ins.
Co., 498 F.3d 1059, 1066 (9th Cir. 2007). Indeed,
“[a] trial court may, with propriety, find it is
efficient for its own docket and the fairest course for the
parties to enter a stay of an action before it, pending
resolution of independent proceedings which bear upon the
case.” Leyva v. Certified Grocers of Cal.,
Ltd., 593 F.2d 857, 863 (9th Cir. 1979). This rule
“does not require that the issues in such proceedings
are necessarily controlling of the action before the
court.” Id. at 863-64. Nonetheless,
“[w]here it is proposed that a pending proceeding be
stayed, the competing interests which will be affected by the
granting or refusal to grant a stay must be weighed.”
CMAX, Inc. v. Hall, 300 F.2d 265, 268 (9th Cir.
1962). “Among these competing interests are the
possible damage which may result from the granting of a stay,
the hardship or inequity which a party may suffer in being
required to go forward, and the orderly course of justice
measured in terms of the simplifying or complicating of
issues, proof, and questions of law which could be expected
to result from a stay.” Id. (citing
Landis, 299 U.S. at 254-55).
in determining whether a stay is appropriate, a district
court should be mindful that the length of the proposed stay
is reasonable in relation to the justification given for it.
See Landis, 299 U.S. at 256-57; see also Yong v.
I.N.S., 208 F.3d 1116, 1119 (9th Cir. 2000) (“If a
stay is especially long or its term is indefinite, we require
a greater showing to justify it.”). There is a general
policy “favoring stays of short, or at least
reasonable, duration.” Dependable Highway Exp.,
Inc., 498 F.3d at 1067. “Generally, stays should
not be indefinite in nature.” Id. at 1066.
“[A] stay should not be granted unless it appears
likely the other proceedings will be concluded within a
reasonable time.” Id. (quoting Leyva,
593 F.2d at 864).
Nature of Instant Action
explanation of Medicare's system of payments and
administrative appeals is necessary to understanding the
nature of this action and putting the instant motion in
proper context. The Ninth Circuit has provided precisely
The Secretary of Health and Human Services . . . administers
the Medicare program through the Centers for Medicare and
Medicaid Services (“CMS”). . . . Medicare is a
federally funded health insurance program for aged and
disabled persons. 42 U.S.C. § 1395 et seq. . .
. Through CMS, the Secretary contracts with fiscal
intermediaries, generally private insurance companies, to
perform coverage determination and payment functions.
Id. §§ 1395h, 1395kk-1; Erringer v.
Thompson, 371 F.3d 625, 627 (9th Cir. 2004).
Medicare coverage is limited to services that are medically
“reasonable and necessary.” 42 U.S.C. §
1395y(a)(1)(A). . . . [F]iscal intermediaries make
“initial determinations” of coverage and amount.
Id. § 1395ff(a)[.]
Palomar Med. Ctr. v. Sebelius, 693 F.3d 1151,
1153-55 (9th Cir. 2012). A determination of overpayment may
be appealed through a four-tier administrative appeals
process. See id. at 1155. The third-tier is a
determination by an administrative law judge
(“ALJ”). See id. This decision can be
appealed to the Medicare Appeals Council (“MAC”)
- the fourth ...