Kaiser Foundation Hospitals v. Michael O. Leavitt ( 2011 )


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  •                     FOR PUBLICATION
    UNITED STATES COURT OF APPEALS
    FOR THE NINTH CIRCUIT
    KAISER FOUNDATION HOSPITALS, a           
    California Nonprofit Public
    Benefit Corporation, DBA Kaiser
    No. 09-56200
    Foundation Hospital-Anaheim,
    Plaintiff-Appellant,               D.C. No.
    v.                            2:08-cv-02129-
    DDP-PJW
    KATHLEEN SEBELIUS,* Secretary of
    OPINION
    the United States Department of
    Health and Human Services,
    Defendant-Appellee.
    
    Appeal from the United States District Court
    for the Central District of California
    Dean D. Pregerson, District Judge, Presiding
    Argued and Submitted
    November 1, 2010—Pasadena, California
    Filed June 15, 2011
    Before: Alfred T. Goodwin and Johnnie B. Rawlinson,
    Circuit Judges, and Jack Zouhary, District Judge.**
    Opinion by Judge Rawlinson;
    Dissent by Judge Zouhary
    *Kathleen Sebelius is substituted for her predecessor, Michael O.
    Leavitt, as Secretary of the Department of Health and Human Services,
    pursuant to Fed. R.App.P. 43(c)(2).
    **The Honorable Jack Zouhary, United States District Judge for the
    Northern District of Ohio, sitting by designation.
    8135
    KAISER FOUNDATION HOSPITALS v. SEBELIUS    8137
    COUNSEL
    Jordan B. Keville (argued), John P. Neustadter and Nina N.
    Adatia; Hooper, Lundy, & Bookman, Inc., Los Angeles, Cali-
    fornia, for appellant Kaiser Foundation Hospitals.
    8138        KAISER FOUNDATION HOSPITALS v. SEBELIUS
    Russell W. Chittenden (argued), Leon W. Weidman and
    Indira Joy Cameron-Banks; Assistant United States Attor-
    neys, Los Angeles, California for appellee Kathleen Sebelius,
    Secretary of the United States Department of Health and
    Human Services.
    OPINION
    RAWLINSON, Circuit Judge:
    Kaiser Foundation Hospital-Anaheim (Kaiser), a medicare
    provider, appealed its notice of program reimbursement for
    the fiscal year ending in 2001 to the Provider Reimbursement
    Review Board (PRRB or Board), which dismissed the appeal
    because Kaiser missed its deadline to file a preliminary posi-
    tion paper. After the Board denied Kaiser’s motion for rein-
    statement of its appeal, Kaiser filed this action. Kaiser now
    appeals the district court’s order granting Sebelius’s motion
    for summary judgment.
    We have jurisdiction pursuant to 
    28 U.S.C. § 1291
    , and we
    affirm the district court’s judgment.
    I.   BACKGROUND
    A.     Statutory and Regulatory Framework
    The Medicare Act established a system of health insurance
    for the aged and disabled. See 
    42 U.S.C. § 1395
     et seq.
    Eligible beneficiaries receive medical care from
    “providers,” which are medical care facilities that
    have entered into agreements with the Secretary to
    furnish care, and the providers are then reimbursed
    by the Medicare program. Part A of the Medicare
    program authorizes payments for institutional care
    KAISER FOUNDATION HOSPITALS v. SEBELIUS             8139
    provided primarily on an inpatient basis. See 42
    U.S.C. §§ 1395c-1395i-4.
    Medical care facilities, such as plaintiffs, receive
    reimbursement under Part A or Part B (or both) from
    a “fiscal intermediary,” . . . that functions as the Sec-
    retary’s agent in making payment on covered claims.
    At the close of each fiscal year, a provider must sub-
    mit a “cost report” to the fiscal intermediary showing
    the costs it has incurred, and the appropriate portion
    of such costs to be allocated to the Medicare pro-
    gram during the fiscal period covered by the cost
    report. 
    42 C.F.R. §§ 413.20
    , 413.24.
    Irvine Med. Ctr. v. Thompson, 
    275 F.3d 823
    , 826 (9th Cir.
    2002) (citations omitted).
    After analyzing a provider’s cost report, the fiscal interme-
    diary is to “furnish the provider . . . a written notice reflecting
    the intermediary’s determination of the total amount of reim-
    bursement due to the provider.” 
    42 C.F.R. § 405.1803
    (a). This
    notice is commonly referred to as the Notice of Provider
    Reimbursement (NPR). If a provider “is dissatisfied with the
    final determination of the . . . fiscal intermediary . . . as to the
    amount of total program reimbursement[,] . . .” it may obtain
    a hearing, before the Provider Reimbursement Review Board.
    42 U.S.C. § 1395oo(a)(1). “The Board shall have the power
    to affirm, modify, or reverse a final determination of the fiscal
    intermediary with respect to a cost report. . .” 42 U.S.C.
    § 1395oo(d).
    The statutory requirements for appealing an intermediary’s
    NPR are that the amount in controversy be at least $10,000,
    and that the provider file the request for a hearing within 180
    days after receiving the NPR. See 42 U.S.C. § 1395oo(a)(2)
    and (3). A group of providers may appeal an NPR if (i) each
    provider in the group was eligible to request a hearing, (ii) the
    aggregate amount in controversy is at least $50,000, and (iii)
    8140       KAISER FOUNDATION HOSPITALS v. SEBELIUS
    the matters in controversy involve a common question of fact
    or interpretation of law or regulations. See 42 U.S.C.
    § 1395oo(b). The Board is endowed with the power to pro-
    mulgate rules and procedures “which are necessary or appro-
    priate” to hear and decide these appeals. See 42 U.S.C.
    § 1395oo(e).
    At all times relevant to this action, the 2002 PRRB Instruc-
    tions were in effect. Pursuant to those instructions, once the
    Board received a request for a hearing, it sent an “Acknowl-
    edgment and Critical Due Dates” letter to both the provider
    and fiscal intermediary. PRRB Instructions, Part I(C)(I). This
    letter notified the provider of the due dates for the preliminary
    position paper (due to the intermediary) the final position
    paper (due to the Board) and placed the appeal on the Board’s
    long-term calendar. See id.; see also PRRB Instructions, Part
    II(B). When the provider submits its preliminary position
    paper to the intermediary, it must also submit the first page to
    the Board. See PRRB Instructions, Part II(B)(I). If the pro-
    vider fails to submit the preliminary position paper by the due
    date, “the Board will dismiss [the provider’s] appeal for fail-
    ure to follow Board procedure.” Id. The provider is subject to
    the same action if it fails to submit its final position paper by
    the specified due date. PRRB Instructions, Part II(B)(II).
    If multiple providers are eligible to bring an appeal based
    on one common issue regarding a question of fact or interpre-
    tation of law, regulation, or Centers for Medicare and Medic-
    aid Services (CMS) ruling, then they may request an
    “optional” group appeal. PRRB Instructions, Part I(B)(I)(d).
    If multiple providers “are under common ownership or con-
    trol and have an issue in common, [they] must file a group
    appeal if the amount in controversy is $50,000 or more.” Id.
    Individual providers may also join a group appeal. See PRRB
    Instructions, Part I(C)(VI) and (VII).
    Finally, the Board may consider requests to reinstate
    appeals that were dismissed due to failure to comply with
    Board procedure. See PRRB Instructions, Part I(C)(XIII)(b).
    KAISER FOUNDATION HOSPITALS v. SEBELIUS           8141
    B.   Factual Background
    On or around April 18, 2007, Kaiser received its NPR from
    fiscal intermediary Mutual of Omaha Insurance Company, for
    the fiscal year ending December, 2001 (FYE 2001). On Sep-
    tember 21, 2007, Kaiser timely filed a request for a hearing
    before the PRRB, and designated counsel for the appeal. See
    42 U.S.C. § 1395oo(a)(3) (providing 180 days to file an
    appeal).
    Kaiser received the PRRB’s “Acknowledgment and Critical
    Due Dates” letter on October 9, 2007. The letter referred Kai-
    ser to the Board Instructions and set the following deadlines:
    (1) February 1, 2008, for Kaiser to submit preliminary posi-
    tion papers to the intermediary; (2) April 1, 2008, for the
    intermediary to submit preliminary position papers to the pro-
    vider; and (3) June 1, 2008, for both parties to submit final
    position papers to the Board. The Board also set October,
    2008, as a tentative date for the hearing. Finally, the letter
    stated:
    You are responsible for pursuing your appeal in
    accordance with the Board’s procedures, which are
    outlined in the Board’s Instructions. You must file
    your position papers, regardless of any outstanding
    jurisdictional challenges, motions or subpoena
    requests. If you miss any of your due dates including
    meeting either position paper due date, the Board
    will dismiss your appeal. The Board will not send a
    due date reminder.
    Approximately a month after the due date for Kaiser’s pre-
    liminary position paper passed, the Board advised Kaiser that
    because its position paper was not submitted to the intermedi-
    ary, its appeal was being dismissed. On March 4, 2008, Kaiser
    petitioned the Board for reinstatement of its appeal, and
    enclosed its Final Position Paper. The Board replied on March
    8142       KAISER FOUNDATION HOSPITALS v. SEBELIUS
    19, 2008, noting the filing of Kaiser’s final position paper that
    included the following arguments for reinstatement:
    -no party was prejudiced and the situation was easily
    rectifiable in advance of the final position paper
    deadline and the live hearing;
    -the Board should allow a decision on the merits
    rather than punish the Provider over a procedural
    technicality;
    -Federal Statutes and Regulations do not require pro-
    viders to file preliminary position papers; and
    -the case involves a single issue that would have
    been transferred to a Common Issue Related Party
    (CIRP) group.
    Nevertheless, the Board denied Kaiser’s request, concluding
    that it was the “Group Representative’s responsibility to
    determine when a CIRP [Common Issue-Related Party] group
    is required and to structure the group accordingly.” The Board
    also noted that if the issue was previously briefed in the CIRP
    appeal, Kaiser could have easily reproduced the applicable
    arguments in a preliminary position paper for its individual
    appeal. Finally, the Board explained that Kaiser failed to
    transfer the individual appeal to the CIRP despite Kaiser’s
    counsel’s experience in handling cases before the Board.
    Kaiser subsequently filed this action against the Secretary
    of the United States Department of Health and Human Ser-
    vices. Kaiser moved for summary judgment and Sebelius
    moved for dismissal based on lack of subject matter jurisdic-
    tion, or in the alternative, for summary judgment. The district
    court denied Kaiser’s motion for summary judgment and
    Sebelius’s motion to dismiss, but granted Sebelius’s motion
    for summary judgment. Kaiser filed a timely notice of appeal.
    KAISER FOUNDATION HOSPITALS v. SEBELIUS                  8143
    We have jurisdiction pursuant to 
    28 U.S.C. § 1291
     and we
    affirm the district court’s judgment.
    II.    STANDARD OF REVIEW
    “We review de novo both the district court’s grant of sum-
    mary judgment and its holdings on questions of statutory
    interpretation.” Phoenix Mem’l. Hosp. v. Sebelius, 
    622 F.3d 1219
    , 1224 (9th Cir. 2010) (citation omitted). When no issues
    of fact are raised, and both parties move for summary judg-
    ment, we review the issues raised as matters of law. See Con-
    rad v. Ace Prop. & Cas. Ins. Co., 
    532 F.3d 1000
    , 1004 (9th
    Cir. 2008).
    Our review of the Board’s decision is governed by the
    Administrative Procedure Act, see 
    id.,
     which provides that the
    agency’s decision will be set aside only if it is “arbitrary,
    capricious, an abuse of discretion, or otherwise not in accor-
    dance with law . . . or unsupported by substantial evidence.”
    
    5 U.S.C. § 706
    (2)(A), (E). “Courts must give substantial def-
    erence to the Secretary’s interpretation of Medicare reim-
    bursement regulations. Under this standard of review, the
    agency’s interpretation must be given controlling weight
    unless it is plainly erroneous or inconsistent with the regula-
    tion. In other words, we must defer to the Secretary’s interpre-
    tation unless an alternative reading is compelled by the
    regulation’s plain language or by other indications of the Sec-
    retary’s intent at the time of the regulation’s promulgation.”
    Robert F. Kennedy Med. Ctr. v. Leavitt, 
    526 F.3d 557
    , 561-
    562 (9th Cir. 2008) (citations and internal quotation marks
    omitted).
    III.   DISCUSSION1
    1
    Sebelius contends that the Board’s decision is not subject to judicial
    review and that this court thus lacks jurisdiction to hear this appeal. How-
    ever, 42 U.S.C.§ 1395oo(f)(1) expressly “gives providers the right to
    obtain judicial review of any final decision of the Board, or of any rever-
    sal, affirmance, or modification by the Secretary.” Loma Linda Univ. Med.
    Ctr. v. Leavitt, 
    492 F.3d 1065
    , 1074 (9th Cir. 2007) (citation and internal
    quotation marks omitted).
    8144         KAISER FOUNDATION HOSPITALS v. SEBELIUS
    A.     The PRRB’s Required Submission of a Preliminary
    Position Paper Does Not Violate the Medicare Act2
    Kaiser asserts that the preliminary position paper require-
    ment is “not necessary and appropriate to carrying out the
    Board’s functions.”
    [1] The Board has “full power and authority” to establish
    rules and procedures for managing its caseload. 42 U.S.C.
    § 1395oo(e). Pursuant to that authority, the Board promul-
    gated rules requiring the provider to submit a preliminary
    position paper and a final position paper. The rules specified
    that failure to submit a preliminary position paper by the due
    date would lead to dismissal of the provider’s appeal. PRRB
    Instructions, Part II(B)(I) (emphasis added). Although the
    Ninth Circuit has yet to rule on this issue, other courts have
    held that the procedural requirement of two position papers is
    reasonable and necessary to the efficient administration of the
    provider appeals process. See High Country Home Health,
    Inc. v. Thompson, 
    359 F.3d 1307
    , 1313 (10th Cir. 2004)
    (“Because we cannot say that the requirement of a second
    position paper responding to the Intermediary’s preliminary
    position paper is arbitrary and capricious, we decline to inval-
    idate that requirement indirectly by excusing its violation.”)
    (citation omitted); see also UHI, Inc. v. Thompson, 
    250 F.3d 993
    , 996-97 (6th Cir. 2001) (“Both the procedural require-
    ment itself, as well as the Department’s application of it, are
    reasonable and necessary to the smooth functioning of the
    agency appellate process, and therefore cannot be considered
    arbitrary and capricious or an abuse of agency discretion.”);
    Rapid City Reg’l. Hosp. v. Sebelius, 
    681 F.Supp. 2d 56
    , 60
    2
    Kaiser asserts that the Board’s rules authorizing dismissals for failure
    to submit preliminary position papers conflict with the long-standing fed-
    eral policy codified in the Medicare Act of adjudicating claims on their
    merits. As Kaiser provides no supporting authority for this contention, we
    will not discuss it further. See Barapind v. Reno, 
    225 F.3d 1100
    , 1115 (9th
    Cir. 2000) (declining to find merit in an argument that was not supported
    by citation to legal precedent).
    KAISER FOUNDATION HOSPITALS v. SEBELIUS         8145
    (D. D. C. 2010) (“[T]he crafting of such procedural rules is
    well within agency authority and expertise.”) (citations omit-
    ted); Inova Alexandria Hosp. v. Shalala, 
    244 F.3d 342
    , 351
    (4th Cir. 2001) (same).
    [2] We are persuaded by the reasoning of these cases that
    have upheld the procedural rules as reasonable and necessary
    to the administration of the Board’s substantial caseload. The
    position paper requirements assist in narrowing the issues on
    appeal, see Rapid City Reg’l. Hosp., 681 F.Supp. 2d at 62;
    and efficiently managing the Board’s caseload, see UHI, Inc.,
    
    250 F.3d at 996-97
    . They also allow the Board to “ignore late
    or improperly presented claims.” High Country Home Health,
    
    359 F.3d at 1311
    .
    [3] We are not swayed by Kaiser’s citation to the provi-
    sions of 42 U.S.C. § 1395oo(a)(1), which grant providers the
    right to request a hearing before the Board. Rather, we agree
    with the Fourth Circuit that “a provider’s statutory right to a
    hearing is not unduly burdened by a rule allowing dismissal
    for failure to file a timely position paper.” Inova, 
    244 F.3d at 349
    .
    Kaiser, like the plaintiff in Rapid City Reg’l. Hosp.,
    attempts to distinguish the cases that have upheld dismissals
    for failure to comply with procedural rules by arguing that the
    cases involved the late filing of final position papers, which
    serve a different purpose than preliminary position papers.
    Kaiser asserted in its briefing and during oral argument that
    preliminary position papers are pro forma documents that
    were virtually ignored by the Board and intermediaries alike.
    However, Kaiser failed to cite to any evidence in the record
    supporting this contention. In any event, as the court in Rapid
    City Reg’l. Hosp. noted, “[t]he decisions . . . do not rely on
    the unique nature of a final position paper to affirm the
    Board’s dismissals. Rather, the cases rely solely on the more
    general proposition that legitimate procedural rules can be
    relied upon to control the Board’s docket by dismissing
    8146         KAISER FOUNDATION HOSPITALS v. SEBELIUS
    appeals that are not timely filed.” Rapid City Reg’l. Hosp.,
    681 F.Supp.2d at 61 (citations omitted). Indeed, none of the
    cases even hinted that failure to file a final position paper
    should be analyzed differently than failure to file a prelimi-
    nary position paper.
    Kaiser also urges us to hold that its failure to submit a pre-
    liminary position paper had no effect on the proceedings
    before the Board because Kaiser’s appeal issues were subject
    to inclusion in a group appeal. At least one court has rejected
    a similar argument that failure to submit a position paper did
    not cause prejudice because a position paper in another case
    effectively described the provider’s claims. See High Country
    Home Health, 
    359 F.3d at 1313
     (“The PRRB was under no
    duty to hunt around . . . in the records for other cases[ ] in an
    attempt to discern the nature of [Kaiser’s] legal claims. Even
    assuming that such a hunt would have provided the PRRB
    with the same information that would have been in the final
    position paper . . . that does not make the Board’s dismissal
    arbitrary or capricious.”). We reach the same conclusion. To
    hold otherwise would require us to interject ourselves into the
    inner workings of the Board’s hearing process to determine
    whether the group appeal indeed “effectively described [Kai-
    ser’s] claims,” as asserted by Kaiser. This we decline to do.
    See Fones4All Corp. v. Fed. Commc’n. Comm’n., 
    561 F.3d 1031
    , 1033 (9th Cir. 2009) (recognizing our obligation to
    defer to the expertise of administrative agencies).
    B.     The PRRB’s Dismissal of Kaiser’s Appeal was not Arbi-
    trary or Capricious
    “An agency violates the APA if it has relied on factors
    which Congress has not intended it to consider, entirely failed
    to consider an important aspect of the problem, offered an
    explanation for its decision that runs counter to the evidence
    before the agency, or is so implausible that it could not be
    ascribed to a difference in view or the product of agency
    expertise. “ County of Los Angeles v. Leavitt, 
    521 F.3d 1073
    ,
    KAISER FOUNDATION HOSPITALS v. SEBELIUS           8147
    1078 (9th Cir. 2008) (citation, alteration and internal quota-
    tion marks omitted). “An arbitrary and capricious challenge
    requires us to adhere to a narrow scope of review, wherein we
    are not to substitute our judgment for that of the agency. The
    agency, however, is required to examine the relevant data and
    articulate a satisfactory explanation for its action including a
    rational connection between the facts found and the choices
    made, and we in turn must review that explanation, consider-
    ing whether the decision was based on a consideration of the
    relevant factors and whether there has been a clear error of
    judgment.” Providence Yakima Med. Ctr. v. Sebelius, 
    611 F.3d 1181
    , 1190 (9th Cir. 2010) (citations, alteration and
    internal quotation marks omitted).
    [4] We review the Board’s ruling, keeping in mind the def-
    erence we owe to the Board’s interpretation of its regulations
    and the fact that the Instructions unambiguously stated that if
    a provider failed to file a preliminary position paper, “the
    Board will dismiss [the] appeal for failure to follow Board
    procedure.” PRRB Instructions, Part II(B)(I). Additionally,
    the PRRB’s October 9, 2007 “Acknowledgment and Critical
    Due Dates” letter stated: “You are responsible for pursuing
    your appeal in accordance with the Board’s procedures . . .
    [and] [i]f you miss any of your due dates including meeting
    either position paper due date, the Board will dismiss your
    appeal. The Board will not send a due date reminder.” The
    Board cited the Instructions and the letter in its decision, spe-
    cifically that portion warning of dismissal for failure to sub-
    mit timely position papers.
    [5] Although this is an issue of first impression for us, sev-
    eral other courts have held that the Board’s decision to dis-
    miss an appeal for failure to timely submit a position paper
    does not constitute arbitrary and capricious conduct. See High
    Country Home Health, 
    359 F.3d at 1311-1312
     (holding that
    the Board’s dismissal of a provider’s appeal because of failure
    to submit its final position paper, due to staff’s failure to prop-
    erly docket the due date, was not arbitrary and capricious);
    8148       KAISER FOUNDATION HOSPITALS v. SEBELIUS
    see also Inova, 
    244 F.3d at 351
     (concluding that dismissal of
    a provider’s appeal because of failure to submit a position
    paper due to “administrative oversight” was not arbitrary and
    capricious); Novacare, Inc. v. Thompson, 
    357 F.Supp.2d 268
    ,
    272-73 (D. D.C. 2005) (explaining that dismissal because of
    failure to submit a position paper due to miscommunication
    with the provider’s attorney was not arbitrary and capricious).
    We join these courts and hold as a matter of first impression
    in this Circuit, that the Board’s dismissal of Kaiser’s appeal
    for failure to file a preliminary position paper as required by
    the Board’s procedural rules was not arbitrary or capricious.
    Kaiser was forewarned that failure to file the position paper
    would result in dismissal of the appeal. The Board considered
    Kaiser’s arguments for excusing the failure and denied Kai-
    ser’s request to reinstate the appeal. Under these circum-
    stances, we cannot say that the Board abused its discretion.
    Kaiser’s argument that this panel must review the Board’s
    decision under an “excusable neglect” standard is unavailing.
    Kaiser propounds an equitable analysis of “excusable neglect”
    based on Ninth Circuit case law interpreting the Federal Rules
    of Civil Procedure. Specifically, Kaiser relies on the Fourth
    Circuit’s observation in Inova that “[t]he decision to dismiss
    an administrative appeal is similar to the kind of dismissal
    decisions that courts routinely review for error” and its cita-
    tion to several sections of the Federal Rules of Civil Proce-
    dure. Inova, 
    244 F.3d at 348
    . However, the Inova court did
    not itself apply the equitable analysis suggested by Kaiser.
    Rather, as mentioned earlier, Inova explicitly held that “a pro-
    vider’s statutory right to a hearing is not unduly burdened by
    a rule allowing dismissal for failure to file a timely position
    paper.” Inova, 
    244 F.3d at 349
    .
    Importantly, none of the other cases that have considered
    a board’s dismissal due to a provider’s failure to timely file
    a position paper mentioned, much less applied, an excusable
    neglect standard. Rather, the issue was resolved under the
    well-established arbitrary and capricious standard of review.
    KAISER FOUNDATION HOSPITALS v. SEBELIUS          8149
    We adhere to that standard in view of our precedent consis-
    tently applying the arbitrary and capricious standard of review
    when considering challenges to decisions by an administrative
    body. See County of Los Angeles, 
    521 F.3d at 1078
     (“Judicial
    review of a decision of the PRRB is pursuant to the Adminis-
    trative Procedure[ ] Act (APA). For this reason, we may not
    set aside its findings or conclusions unless they are . . . arbi-
    trary, capricious, an abuse of discretion, or otherwise not in
    accordance with law.”) (citations and internal quotation marks
    omitted).
    “[W]hile an agency should provide a reasoned basis for its
    actions, we will uphold a decision of less than ideal clarity if
    the agency’s path may be reasonably discerned.” Providence
    Yakima Med. Ctr., 
    611 F.3d at 1190
     (citations and internal
    quotation marks omitted). As discussed above, the Board’s
    decision was explicitly based on Kaiser’s failure to adhere to
    the Board’s Instructions and “Acknowledgment and Critical
    Due Dates” letter. The Board considered the evidence pre-
    sented and the administrative record prior to dismissing Kai-
    ser’s appeal. No abuse of discretion or clear error in judgment
    was exhibited.
    IV.   CONCLUSION
    [6] The district court committed no error when it granted
    Sebelius’s motion for summary judgment. The Board’s
    Instructions requiring dismissal of claims due to failure to
    timely submit preliminary position papers did not violate the
    Medicare Act and the Board’s dismissal of Kaiser’s claim was
    neither arbitrary nor capricious.
    AFFIRMED.
    ZOUHARY, District Judge, dissenting:
    I find that the Board’s decision in this case was “arbitrary,
    capricious, an abuse of discretion . . . or unsupported by sub-
    8150       KAISER FOUNDATION HOSPITALS v. SEBELIUS
    stantial evidence.” 
    5 U.S.C. § 706
    (2)(a)(e). I understand that
    substantial deference is given to a Board’s decision. However,
    the facts of this case do not support the Board’s decision.
    First, there is no other reported decision where the sole
    issue has been the late filing of a preliminary paper, as
    opposed to the late filing of a final position paper. The differ-
    ence between the two is significant. Second, the Board does
    not always dismiss motions for reinstatement where a filing
    has been untimely. Third, in light of the Board’s inconsistent
    dismissal of untimely motions combined with the general
    proposition that procedural rules can be relied on to control
    the Board’s docket, there is little logic to why the Board acted
    like it did when, in this case, a missing preliminary paper and
    an early final paper did not adversely impact the Board’s
    docket. Preliminary paper deadlines are logically not the same
    as final position paper deadlines, and the Board failed to
    recite how its decision in this case adversely impacted its
    docket. Rather, the Board seemed to rely on the curious
    notion that the experienced hospital lawyers “should have
    known better,” and failed to distinguish how this case differed
    from other cases where late filings were permitted. Fourth, the
    Board failed to account for the clear policy reasons favoring
    the hospital: the lack of prejudice, the subsequent change in
    the Rules which no longer even require the filing of a prelimi-
    nary paper (see PRRB Rules, Part II, Rule 23.1), the availabil-
    ity of the group appeal where this case would have been
    transferred (and already disposed of), and the early filing of
    the final position paper which not only did not delay hearing
    this case, but arguably advanced the case for resolution or
    transfer.
    Arbitrary and capricious does not mean unfettered discre-
    tion by the Board. Dismissal of an appeal for a technical pro-
    cedural violation, without addressing the factors outlined
    above, fails to provide guidance for litigants. For these rea-
    sons, I respectfully dissent.