American Journal of Law & Medicine

D.C. Circuit: federal courts have jurisdiction over APA challenges to denial of coverage - El Rio Santa Cruz Neighborhood Health Center, Inc. v. HHS.(Administrative Procedure Act)

D.C. Circuit: Federal Courts Have Jurisdiction Over APA Challenges to Denial of Coverage--El Rio Santa Cruz Neighborhood Health Center, Inc. v. HHS (1)--The United States Court of Appeals for the D.C. Circuit held that a federal court has jurisdiction over a physician's claim under the Administrative Procedure Act ("APA") (2) challenging the denial of coverage under the Federal Tort Claims Act (3) ("FTCA"). (4) Moreover, the court concluded that the determination by the United States Department of Health and Human Services ("HHS") that certain physicians were ineligible for medical malpractice coverage was arbitrary and capricious. (5)

In January 2002, a group of physicians under contract with El Rio Santa Cruz Neighborhood Health Center, Inc. ("El Rio") were sued in Arizona state court for medical malpractice. (6) In response to the malpractice suit, El Rio, a federally funded non-profit clinic that qualifies for professional liability coverage under the Federally Supported Health Centers Assistance Act of 1995 ("FSHCAA"), (7) submitted an application to HHS to determine the physicians' coverage status under the FTCA. (8) HHS denied E Rio's application for coverage (i.e., a negative coverage determination). (9) Specifically, HHS stated that the individual physicians could not "be deemed employees of the Public Health Service because their contracts were between the health center and a professional corporation, and, therefore, did not meet the criteria under the FSHCAA for coverage under the FTCA." (10) The physicians contracted with El Rio both through their corporate entity and with a separately signed guarantee. …

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