Ramaswamy v. Kathleen Sebelius

Filing 20

MEMORANDUM AND ORDER - IT IS HEREBY ORDERED that Plaintiff Karthik Ramaswamys Motion for Summary Judgment, (ECF No. 13 ), is DENIED. IT IS FURTHER ORDERED that Defendant Sylvia Matthews Burwells Motion for Summary Judgment, (ECF No. 14 ), is GRANTED, and Ramaswamys Complaint, (ECF No. 1 ), is DISMISSED WITH PREJUDICE. A separate judgment will accompany this Memorandum and Order. Signed by District Judge Jean C. Hamilton on 1/6/15. (KJS)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MISSOURI
EASTERN DIVISION
KARTHIK RAMASWAMY, M.D.,
Plaintiff,
v.
SYLVIA MATTEWS BURWELL,
Secretary of the United States Department
of Health and Human Services,
Defendant.

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Case No. 4:14CV971(JCH)

MEMORANDUM AND ORDER
This matter is before the Court on cross-motions for summary judgment filed by Plaintiff
Karthik Ramaswamy, (ECF No. 13), and Defendant Sylvia Matthews Burwell, Secretary of the
United States Department of Health and Human Services (“HHS”). 1 (ECF No. 14). The motions
have been fully briefed and are ready for disposition.
BACKGROUND
A. Factual Background
On May 4, 2011, Plaintiff Ramaswamy submitted to Wisconsin Physician Services
(“WPS”) materials for enrollment in the Medicare program.2 (Defendant Statement of Material
Facts, “DSMF,” ECF No. 16, ¶ 1). Because Ramaswamy’s initial application was incomplete,3
WPS contacted Ramaswamy’s representative on May 24, 2011 to request a correction of the

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Secretary Burwell has automatically been substituted in place of former secretary Kathleen Sebelius
pursuant to Fed. R. Civ. P. 25(d).
2
Wisconsin Physician Services is an HHS contractor. (DSMF ¶ 67).
3
HHS claims that Ramaswamy’s May 4 application was missing information such as Ramaswamy’s
medical license number, the name of the state where his medical license was issued, his DEA number,
and the date of expiration of his medical license. (DSMF ¶¶ 69-72). Ramaswamy denies that this
information was missing. (Ramaswamy Response to DSMF, ECF No. 18, ¶¶ 69-72).

1

initial application. Id. ¶ 3. According to HHS, WPS’ records showed no response from
Ramaswamy to the May 24 request as of June 29, 2011. Id. ¶¶ 8, 79. Based on that alleged lack
of response, WPS sent Ramaswamy a letter on June 29, 2011 denying Ramaswamy’s
application. Id. ¶ 79. On May 1, 2012, Ramaswamy requested that WPS reconsider its initial
determination to deny his May 4, 2011 enrollment application. Id. ¶¶ 28. HHS does not make
clear what the result of that request was, but the Administrative Law Judge (“ALJ”) and
Departmental Appeals Board (“DAB”) found it was dismissed as untimely. (ALJ Decision,
Record, at 5; DAB Decision, Record at 13; see also Record at 792).
Ramaswamy presents a different series of events after his representative received the
request for additional materials on May 24, 2011. According to Ramaswamy, his representative
responded on May 24 to WPS’ request “by submitting via facsimile materials responding to
WPS’s comments and a Certification Statement (Form CMS-855I Section 15) originally signed
by [Ramaswamy] . . . .” (DMSF ¶ 8). Ramaswamy claims to have had no contact with WPS,
including the June 29 letter HHS alleges was sent to him, until October 17, 2011. Id. ¶¶ 11, 12,
14. On that day, Ramaswamy’s representative allegedly made a phone call to “WPS to inquire
regarding the status of [his] application and spoke to a WPS customer service representative who
. . . informed [Ramaswamy’s representative] that all necessary materials had been received and
that [Ramaswamy’s] enrollment application was in process.” Id. ¶¶ 12, 13 (internal citations
omitted). Ramawamy’s representative made another call on December 14, 2011 and was again
told Ramaswamy’s application was in process. Id. ¶ 15. Ramaswamy’s representative again
called WPS on January 17, 2012 and March 19, 2012. Id. ¶ 16. She received no response. Id.
Ramaswamy then claims his representative called WPS once more on March 28, 2012
“and was verbally informed by WPS that [Ramaswamy’s] application was denied, with a stated

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effective date of June 29, 2011.” Id. ¶ 17. Ramaswamy’s representative received a letter
confirming the denial on April 3, 2012. Id. ¶ 20. Then, as HHS admits, Ramaswamy filed a
request for reconsideration of the denial on May 1, 2012. Id. ¶¶ 26, 28. According to
Ramaswamy, this request was not evaluated in any way. Id. ¶ 35.
The remaining facts are undisputed. “On May 15, 2012, Ramaswamy submitted a second
signed Medicare supplier enrollment application to HHS.” Id. ¶ 84. “HHS approved the second
enrollment application on July 9, 2012, using an effective billing date of April 21, 2012 . . . .” Id.
¶ 87. Ramaswamy then filed with WPS “a request for reconsideration of the enrollment date
indicated in WPS’s July 9, 2012 letter.” Id. ¶ 37. WPS returned an unfavorable reconsideration
decision, finding that Ramaswamy had not provided reason for a change to the effective billing
date. Id. ¶ 43. Ramaswamy appealed this decision to an ALJ on November 14, 2012. Id. ¶ 45.
The ALJ affirmed WPS’ decision. Id. ¶¶ 51-53, 56. The ALJ’s decision was in turn affirmed by
the DAB. Id. ¶ 58. Ramaswamy filed this case on May 23, 2014 seeking review of the DAB’s
decision. (Complaint, ECF No. 1).
B. The ALJ’s Decision
The ALJ found both that WPS correctly determined the effective date of Ramaswamy’s
enrollment based on the May 15, 2012 application and that it had no authority to review WPS’
dismissal of the request for reconsideration Ramaswamy filed in relation to his May 4, 2011
application. (ALJ Decision, Record at 1-6).
In relation to WPS’ determination of Ramaswamy’s effective date, the ALJ found:
WPS determined that the effective billing date or retrospective billing
period of Petitioner’s benefits was April 21, 2012. WPS indicated that
‘[t]his effective billing date is based on 30 days prior to the filing date.’
The Secretary’s regulations provide that the effective date of
enrollment of physicians is ‘the later of the date of filing of a Medicare
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enrollment application that was subsequently approved by a Medicare
contractor or the date an enrolled physician . . . first began furnishing
services at a new practice location.’ 42 C.F.R. § 424.520(d) (emphasis
added). The ‘date of filing’ is the date that the Medicare contractor
‘receives’ a signed provider/supplier enrollment application that the
Medicare contractor is able to process to approval. 73 Fed. Reg. 69,726,
69,769 (Nov. 19, 2008); see also Caroline Lott Douglas, PA, DAB CR2406,
at 5-7 (2011); Rizwan Sadiq, M.D., DAB CR2401, at 5 (2011). Because
WPS received a complete, approvable application from [Ramaswamy] on
May 21, 2012, WPS properly determined this date as [Ramaswamy’s]
effective date.
The regulations applicable to this case permit limited retrospective
billing for physician services provided to Medicare beneficiaries for up to
30 days before the effective date of enrollment. 42 C.F.R. § 424.521(a).
Thus, WPS correctly determined, based on a May 21, 2012 date of filing,
that the enrollment effective date is May 21, 2012, and [Ramaswamy] could
retrospectively bill for services provided to beneficiaries beginning on April
21, 2012.
(ALJ Decision, Record at 3-4 (ALJ’s record citations omitted)). In sum, the ALJ held that WPS
had properly applied the correct regulations in determining the start date of Ramaswamy’s
billing privileges.
The ALJ then found it had no authority to review WPS’ decision regarding the
reconsideration request Ramaswamy filed in relation to his May 4, 2011 application. It explained
the facts and applicable regulations as follows:
[Ramaswamy] submitted a corrective action plan and an initial request
for reconsideration of the June 29, 2011 denial determination on May 1,
2012. [Ramaswamy] asserted that he had furnished the requested
information in a timely manner and that he had not received a copy of the
June 29, 2011 denial letter until April 3, 2012. WPS dismissed
[Ramaswamy’s] request for reconsideration on May 18, 2012 because it had
not been timely submitted and [Ramaswamy] had not shown good cause for
the late filing.
A provider or supplier may request reconsideration by filing a request
for reconsideration within 60 days from receipt of the notice of initial
determination, unless CMS or its agent determines there is ‘good cause’ for
extending the deadline. 42 C.F.R. §§ 498.5(l)(1), 498.22. A supplier
‘dissatisfied with a reconsidered determination . . . is entitled to a hearing
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before an ALJ.’ 42 C.F.R. § 498.5(l)(2). If a supplier does not request and
receive reconsideration of an initial determination, then the initial
determination is ‘binding.’ 42 C.F.R. § 498.20(b). Only reconsidered
determinations related to the denial or revocation of billing privileges are
eligible for ALJ review and I do not have authority to inquire into a
Medicare contractor’s determination whether there is good cause for the late
filing of a request for reconsideration. Better Health Ambulance, DAB No.
2475, at 4 (2012); Denise A. Hardy, D.P.M., DAB No. 2464, at 4 (2012);
Hiva Vakil, MD., DAB No. 2460, at 5 (2012) (noting that ‘the regulations
plainly require that CMS or one of its contractors issue a ‘reconsidered
determination’ before the affected party is entitled to request a hearing
before an ALJ’). Here, WPS never issued a reconsidered determination
concerning the May 4, 2011 applications. Instead, it dismissed
[Ramaswamy’s] request for reconsideration as untimely. In the absence of a
reconsidered determination from WPS, the initial determination became
binding and, therefore, administratively final. See 42 C.F.R. § 498.20(b). As
a result, my review is limited to the applications filed in May 2012, and
[Ramaswamy’s] earlier applications are not relevant to the decision in this
case.
(ALJ decision, Record at 5 (ALJ’s record citations omitted)).
C. The DAB’s Decision
The DAB upheld both of the ALJ’s determinations. In affirming the ALJ’s determination
of Ramaswamy’s effective date of enrollment, the DAB found:
The regulations provide that the effective date of enrollment is the date
on which a contractor received an application which it was subsequently
able to process to approval. Thus, while the contractor may require and
request additional information to complete the application, the effective date
will relate back to the date of filing so long as that application continues to
be processed to a decision on whether to approve it. The process ends,
however, once the application is rejected or denied. 71 Fed. Reg. at 20,759
(enrollment process culminates in ‘the granting of billing privileges or
denial or rejection of the application’). A later submitted application,
therefore, even if then processed to completion, will be approved with the
effective date of its filing date, not that of any earlier application which the
contractor was not able to process to approval.
[Ramaswamy’s] position essentially is that the ALJ should have looked
to the date of filing of his 2011 application because [Ramaswamy] was not
aware that the processing of that application had culminated in a denial for
which he could, within the regulatory time frame, seek reconsideration, and
that he provided information that should have made it possible for the
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contractor to continue processing that application to approval.
[Ramaswamy] provided testimony to establish that he did respond to the
May 24, 2011 notice from WPS that his application was incomplete and
might be denied. He offered a fax transmission notice of the same date to
show that he sent the missing information to WPS.
...
We agree with the ALJ that [Ramaswamy’s] factual allegations are not
material. As noted, 42 C.F.R. § 424.520(d) provides that the effective date
of a physician’s enrollment in Medicare is ‘the later of the date of filing of a
Medicare enrollment application that was subsequently approved by a
Medicare contractor or the date an enrolled physician . . . first began
furnishing services at a new practice location.’ (Emphasis added). Thus,
under the plain language of the regulation, neither an ALJ nor the Board
may change an effective date to the date of receipt of an earlier application
that was denied, because such an application was not processed to approval.
To the extent that [Ramaswamy] contends that the denial of the earlier
application was wrong because he did provide the missing information, the
regulations provide a separate channel for review through a timely
reconsideration on the denial of that application.
(DAB Decision, Record at 11-12 (DAB’s record citations omitted) (emphasis added)).
The DAB also agreed with the ALJ’s reasoning regarding the scope of review available
when a reconsideration request has been dismissed as untimely. It explained:
[Ramaswamy] argues that, in this case, he could not avail himself of
reconsideration because he was not informed of the denial of his original
application until almost a year later, despite inquiries, and that his request
for reconsideration was not acted on even though it was filed within 60 days
of when he actually received the denial. He presented this argument in
requesting reconsideration of the denial of his May 2011 application, as
noted above, but WPS nevertheless concluded that his request was untimely
and that good cause was not shown. [Ramaswamy] contends that WPS
improperly dismissed his reconsideration request merely because the
contractor ‘arbitrarily and capriciously decided not to evaluate’ the request
rather than because it actually determined that the request was untimely. . .
.
Even if we accept as true for purposes of this decision that events
occurred as [Ramaswamy] alleges and even if we were to agree with
[Ramaswamy] that the decision to dismiss his reconsideration request was
ill-founded or improper, we would not conclude that the ALJ erred in
applying the effective date regulation.
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The regulations set out which contractor actions and determinations are
reviewable. They do not provide for further review from a contractor
dismissal of a reconsideration request as untimely. For us to entertain
arguments that WPS applied erroneous standards, made erroneous findings,
or reached erroneous conclusions in dismissing this reconsideration request
would amount to reviewing the dismissal, which we, like the ALJ, have no
authority to do. If we could credit such arguments in order to grant the same
effective date that would have been available had [Ramaswamy] been
determined to have timely sought reconsideration and prevailed on the
merits in showing that his first application was complete and approvable,
we would effectively have made a nullity of the regulations making final
and binding an initial determination that has not been the subject of a
reconsidered determination. 42 C.F.R. § 498.20(b).
This conclusion is consistent with the settled case law. In Better Health
Ambulance, DAB No. 2475 (2012), the supplier (BHA) argued that the
contractor should not have dismissed his reconsideration request as
untimely because it was addressed to a different company and, hence, had
not been received on time. The ALJ found that BHA failed to prove good
cause for its late filing. The Board concluded that the ALJ erred in reaching
the question of whether there was good cause because a dismissal for
untimeliness does not result in a reconsidered determination and is not
subject to further review. The Board explained that, if ‘a supplier does not
request and receive reconsideration of an initial determination, then the
initial determination is ‘binding.’’ DAB No. 2475, at 1 (emphasis added).
See also Haissam Elzaim, M.D., DAB No. 2501 (2013) (petitioner has no
right to ALJ review of a revocation where he argues that his reconsideration
request was improperly dismissed as untimely because the notice went to an
old address.); Denise A. Hardy, D.P.M., DAB No. 2464, at 4 (2012); Hiva
Vakil, M.D., DAB No. 2460, at 5 (2012) (noting that ‘the regulations plainly
require that CMS or one of its contractors issue a ‘reconsidered
determination’ before the affected party is entitled to request a hearing
before an ALJ’).
(DAB Decision, Record at 12-13 (DAB’s record citations omitted)).
In his Complaint, Ramaswamy seeks: (1) a declaration “that [HHS’] refusal to recognize
May 7, 2011 as [Ramaswamy’s] appropriate effective date of Medicare enrollment is not
authorized under CMS regulations and guidance and is null and void and of no effect[;]” (2) “an
order requiring [HHS] to process [Ramaswamy’s] application for Medicare enrollment with an

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appropriate effective date of May 7, 2011[;]”4 and (3) “an order recognizing [Ramaswamy’s]
right to submit claims for Medicare reimbursement dating back to April 7, 2011 . . . .”
(Complaint at 19). Ramaswamy contends he is entitled to summary judgment on these claims.
(Ramaswamy MSJ, ECF No. 13). HHS believes it is entitled to a summary judgment denying
Ramaswamy’s claims on the grounds that the ALJ and DAB decisions were correct. (HHS MSJ,
ECF No. 14).
SUMMARY JUDGMENT STANDARD
Under the Federal Rules of Civil Procedure, courts must “grant summary judgment if the
movant shows that there is no genuine dispute as to any material fact and the movant is entitled
to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The substantive law determines “which
facts are material.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). “Only disputes
over facts that might affect the outcome of the suit under the governing law will properly
preclude summary judgment.” Id.
DISCUSSION
Ramaswamy contends that WPS’ determination of his effective billing date, and the
affirmance of that date by the ALJ and DAB, run afoul of the Administrative Procedure Act
(“APA”). (Ramaswamy Support Memo, ECF No. 13-3, at 8). Ramaswamy asserts first that WPS
violated the APA by applying the wrong standard in dismissing as untimely his request for
reconsideration of WPS’ denial of his May 4, 2011 application. Id. at 10-12. In so acting, WPS
failed to review whether Ramaswamy had provided sufficient materials with that application,

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The effective date of May 7, 2011 would be based on the application Ramaswamy sent on May 4, 2011,
which the Court refers to as the May 4, 2011 application. Under 42 C.F.R. § 520(d), the effective date is
the “date of filing,” which has been interpreted to mean the date on which the HHS contractor receives
the application. Caroline Lott Douglas, DAB No. CR 2406, 5-7 (2011). According to Ramaswamy, May
7, 2011 was the date on which WPS received the May 4, 2011 application. (DSMF ¶ 2).

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which prevented Ramaswamy from obtaining his desired effective billing date of April 7, 2011.5
See id. at 11. He contends further that the ALJ and DAB violated the APA in determining that,
under the applicable regulations, they have no authority to review an HHS contractor’s dismissal
of a reconsideration request. Id. at 12-15.
HHS counters that the ALJ and DAB properly determined there is no basis on which to
review WPS’ dismissal of Ramaswamy’s request for reconsideration regarding the denial of his
May 4, 2011 application. (HHS Reply, ECF No. 19, at 3-6). It contends this interpretation of the
scope of their reviewing authority is entitled to deference. Id. at 6. Moreover, any broader
interpretation of the scope of the ALJ’s and DAB’s reviewing authority would be tantamount to
a rewriting of the applicable regulations. (HHS Support Memo, ECF No. 15, at 11). Further,
substantial evidence supports the ALJ’s and DAB’s factual findings. Id. at 14; (HHS Reply at 6).
The APA requires courts to “hold unlawful and set aside agency action, findings, and
conclusions found to be – (A) arbitrary, capricious, an abuse of discretion, or otherwise not in
accordance with law [or] (D) without observance of procedure required by law . . . .” 5 U.S.C.
§§ 706(2)(A), (D). District courts reviewing agency actions are required to “give substantial
deference to an agency’s interpretation of its own regulations.” Thomas Jefferson Univ. v.
Shalala, 512 U.S. 504, 512 (1994). “[T]he agency’s interpretation must be given ‘controlling
weight unless it is plainly erroneous or inconsistent with the regulation.’” Id. (quoting Martin v.
Occupational Safety and Health Review Comm’n, 499 U.S. 144, 150-51 (1991)). An agency’s
factual determinations are reviewed only for substantial evidence. Greenbrier Nursing and
Rehab. Ctr. v. United States Dep’t of Health & Human Sev’s, Ctrs. for Medicare and Medicaid
Sev’s, 686 F.3d 521, 526 (8th Cir. 2012). Thus, a reviewing court may reverse an agency’s
5

This billing date would have been established by setting May 7, 2011 as the date of filing under 42
C.F.R. § 424.520(d) and allowing 30 days of retrospective billing pursuant to 42 C.F.R. § 424.521(a).

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factual finding only if there is no evidence such “as a reasonable mind might accept as adequate
to support a conclusion.” Id (internal quotation marks omitted). These standards combine to
make a district court’s review of agency actions a narrow one.
Pursuant to 42 U.S.C. § 1395cc(j)(1)(A)-(B), HHS established a set of regulations with
which prospective suppliers must comply to enroll in Medicare. Those regulations set forth, inter
alia, the procedures for enrollment and certain circumstances under which prospective suppliers
may appeal an initial determination made by HHS or an HHS contractor. Physicians may begin
billing Medicare on “the later of—(1) The date of filing of a Medicare enrollment application
that was subsequently approved by a Medicare contractor; or (2) The date that the supplier first
began furnishing services at a new practice location.” 42 C.F.R. § 424.520(d). If any prospective
supplier is dissatisfied with a contractor’s initial determination of his effective billing date, he
may file a request for the contractor to reconsider that determination. 42 C.F.R. § 498.22(a). To
obtain a reconsideration, the prospective supplier must comply with certain procedures. Id.
Among other requirements, he must file his request for reconsideration “[w]ithin sixty days from
receipt of the notice of initial determination” unless the prospective supplier shows good cause
for an extension. § 498.22(b)(3). “The date of receipt will be presumed to be 5 days after the date
on the notice unless there is a showing that it was, in fact, received earlier or later.” Id. “For
denial or revocation of enrollment, prospective providers and suppliers . . . have a right to
reconsideration.” § 498.22(a). If the prospective supplier fails timely to request reconsideration,
the initial determination becomes binding. 42 C.F.R. § 498.20(b)(1).
The regulations also provide appeal rights related to supplier enrollment, which are
exercised through a four-step process. First, a prospective supplier who is “dissatisfied with an
initial determination . . . related to the denial or revocation of Medicare billing privileges may

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request reconsideration in accordance with § 498.22(a).” 42 C.F.R. § 498.5(l)(1). Next, if the
prospective supplier is “dissatisfied with a reconsidered determination under paragraph (l)(1) of
this section, . . . [he is] entitled to a hearing before an ALJ.” § 498.5(l)(2). Finally, a prospective
supplier who is “dissatisfied with a hearing decision may request Board review, and any . . .
prospective supplier . . . has a right to seek judicial review of the Board’s decision.”
§ 498.5(l)(3). Ramaswamy’s challenge to the determination of his effective billing date focuses
on the application and interpretation of these regulations.
Ramaswamy’s claims must fail because he has not presented a basis on which the Court
can review WPS’ actions regarding his May 4, 2011 application. In general, a litigant seeking
judicial review of a Medicare determination must first exhaust his administrative remedies.
Heckler v. Ringer, 466 U.S. 602, 605-606 (1984) (citing 42 U.S.C. § 405(g)).6 As explained in
the preceding paragraphs, the HHS regulations create a system of appellate rights and procedures
regarding enrollment determinations. These procedures, as interpreted by the ALJ and DAB,
require a reconsidered determination before any review of an HHS contractor’s initial
determination can occur. Both the ALJ and DAB found that WPS did not issue a reconsidered
determination; instead it dismissed Ramaswamy’s request as untimely.7 Ramaswamy has not
demonstrated a valid basis on which to avoid the applicable administrative review procedures.
See, e.g., Thorbus v. Bowen, 848 F.2d 901, 903 (8th Cir. 1988). Thus, Ramaswamy can prevail
on the theory that his enrollment date should be changed based on WPS’ alleged failures
regarding his May 4, 2011 application only if he demonstrates that the ALJ and DAB improperly
construed the scope of reviewing authority under the regulations. Otherwise, Ramaswamy did
not exhaust his administrative remedies, and the Court may not review WPS’ actions.
6

Ramaswamy has brought this case under § 405(g). (Complaint ¶¶ 4, 5).
The factual finding that WPS dismissed Ramaswamy’s reconsideration request as untimely is based on
substantial evidence. (See Record at 792).
7

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According to Ramaswamy, the ALJ’s and DAB’s interpretation is improper. Specifically,
Ramaswamy contends that “[a] supplier has a ‘right to reconsideration’ to the extent that he
‘files a written request . . . [w]ithin 60 days from receipt of the notice of initial determination . . .
. Because WPS failed to address the merits of [Ramaswamy’s] request for reconsideration in its
response, WPS effectively denied [Ramaswamy’s] right to reconsideration as explicitly required
by 42 C.F.R. § 498.22.” (Ramaswamy Support Memo at 11 (first alteration in original)
(emphasis in original)). Further, by interpreting the regulations as depriving them of the authority
to review WPS’ actions absent a reconsidered determination, the ALJ and DAB effectively made
a nullity of the right to reconsideration established under the regulations. Id. at 13-15.
Ramaswamy fails to show that the ALJ’s and DAB’s interpretation of the applicable
regulations is not entitled to deference. The regulations establish a detailed set of procedures for
enrollment, which includes procedures to be followed for exercising appeal rights. The ALJ and
DAB found that this detailed scheme is exclusive—that if the regulations do not explicitly
establish a right to appeal in a particular situation, no right to appeal exists in that situation.
While this may not be the only possible interpretation of the regulations and while it may in
certain situations be unfair, it is not plainly erroneous or inconsistent with the regulations.
The interpretation provided by Ramaswamy is nothing more than a reasonable
alternative. It is certainly possible to read the regulations as creating a right to reconsideration
upon compliance with the applicable procedures. It also would be possible, as the dissent to the
DAB decision suggested, to read into the regulations an implied authority of the ALJ or DAB to
review WPS’ dismissal of a reconsideration request. (DAB Dissent, Record at 16-18). A
reasonable alternative interpretation is not, however, a basis for a district court to decline to give
controlling weight to an agency’s interpretation of its own regulations. There is therefore no

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basis on which to review WPS’ initial determination regarding Ramaswamy’s May 4, 2011
enrollment application, and Ramaswamy’s attempt to establish an effective billing date of April
7, 2011 must fail.8

Accordingly,
IT IS HEREBY ORDERED that Plaintiff Karthik Ramaswamy’s Motion for Summary
Judgment, (ECF No. 13), is DENIED.
IT IS FURTHER ORDERED that Defendant Sylvia Matthews Burwell’s Motion for
Summary Judgment, (ECF No. 14), is GRANTED, and Ramaswamy’s Complaint, (ECF No. 1),
is DISMISSED WITH PREJUDICE. A separate judgment will accompany this Memorandum
and Order.

Dated this 6th day of January, 2015.

/s/ Jean C. Hamilton
UNITED STATES DISTRICT JUDGE

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Ramaswamy presents another argument for the first time in his Reply: that, under the regulations, the
review of his May 2012 application should have included a review of whether he filed sufficient materials
in May 2011 for WPS to accept that earlier application. (Ramaswamy Reply, ECF No. 17, at 7). As with
Ramaswamy’s argument related to the ALJ’s and DAB’s scope of review, this argument is based on
nothing more than an alternative reading of the enrollment regulations. (See DAB Decision, Record at 1112).

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