GOOSE CREEK PHYSICAL MEDICINE, LLC v. BECERRA

Filing 95

ORDER directing parties to file various documents under seal for the record by no later than 5 p.m. on Thursday, March 13, 2025, and substituting Robert F. Kennedy, Jr. as the defendant in this case. Signed by the Honorable David C. Norton on March 6, 2025. (estr, )

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF SOUTH CAROLINA
CHARLESTON DIVISION
GOOSE CREEK PHYSICAL MEDICINE,
LLC,

)
)
)
Plaintiff,
)
)
vs.
)
)
ROBERT F. KENNEDY, JR., in his official
)
capacity as Secretary, United States
)
Department of Health and Human Services,
)
)
Defendant.
)
_______________________________________)

No. 2:22-cv-03932-DCN
ORDER

In this matter, plaintiff Goose Creek Physical Medicine, LLC (“GCPM”) seeks
judicial review of an alleged Medicare overpayment. See generally ECF No. 24, Amend.
Compl. In short, GCPM alleges that it availed itself of the Medicare appellate process,
and that on January 18, 2021, the Administrative Law Judge (the “ALJ”) issued a
partially favorable decision and ordered that GCPM’s overpayment amount be
recalculated. Id. ¶¶ 242–243. GCPM further alleges that, on February 18, 2022,
Palmetto GBA, LLC (“Palmetto”), a Medicare Administrative Contractor, sent GCPM a
letter indicating that, in light of the ALJ’s decision, GCPM’s overpayment amount had
been reduced, and Palmetto later issued GCPM a refund check based on that reduction.
Id. ¶¶ 246, 249. However, GCPM contends that Palmetto did not provide documentation
supporting how it determined the refund amount. Id. ¶¶ 249–53. Thus, in this court,
GCPM filed both a direct appeal of the ALJ’s decision and non-direct appeal claims
pursuant to Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1 (2000), based
largely on Palmetto’s alleged failure to provide an accounting to support the refund

1

amount. See Amend. Compl. ¶¶ 257–92; see also ECF No. 80 (GCPM’s briefing
explaining the basis of its claims brought pursuant to Illinois Council).
During a hearing on August 27, 2024, the court ordered the Secretary 1 to file the
administrative record in this case under seal. ECF No. 78. The court ORDERS that
Secretary Kennedy make this filing by no later than 5 p.m. on Thursday, March 13, 2025.
Additionally, GCPM references various documents in its amended complaint in
support of its non-direct appeal claims, including the letter Palmetto sent GCPM on
February 18, 2022, and subsequent correspondences between GCPM and Palmetto in
June 2022. Amend. Compl. ¶¶ 246, 249–253. However, because these documents
apparently originated after the ALJ’s decision, GCPM does not provide a citation for
these documents in the administrative record. See id. The court has authority to develop
an evidentiary record when reviewing claims brought pursuant to Illinois Council, 529
U.S. at 24. Therefore, the court ORDERS that GCPM file under seal the documents
referenced in its amended complaint related to Palmetto’s alleged failure to support its
refund determination by no later than 5 p.m. on Thursday, March 13, 2025.

1

At the time of that hearing, the defendant in this case was Secretary Xavier
Becerra. Robert F. Kennedy, Jr. (“Secretary Kennedy”) was sown in as Secretary of
Health and Human Services on February 13, 2025. Pursuant to Federal Rule of Civil
Procedure 25(d), he is substituted as the defendant in this case.
2

AND IT IS SO ORDERED.

DAVID C. NORTON
UNITED STATES DISTRICT JUDGE
March 6, 2025
Charleston, South Carolina

3