Encompass Health Rehabilitation Hospital of Sarasota, LLC v. Becerra

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

ENCOMPASS HEALTH

REHABILITATION HOSPITAL

OF SARASOTA, LLC, et al.,

Plaintiffs,

v. Case No: 8:22-cv-2573-KKM-UAM

XAVIER BECERRA,

Defendant.

___________________________________

ORDER

Medicare denied coverage to Encompass Health Rehabilitation Hospital of

Sarasota, LLC, and Encompass Health Rehabilitation Hospital of Largo, LLC,

(“Encompass”) for the medical services that Encompass provided to sixty-three patients.

In each case, an administrative law judge (ALJ) determined that the patient’s medical

condition did not justify the type of care offered by Encompass. Encompass requested

review of the ALJs’ decisions, but the Medicare Appeals Council affirmed after finding

that Encompass’s requests did not adequately explain its reasons for appealing. 42

C.F.R. § 405.1112(b) (requiring appellants to explain their disagreement with an ALJ’s

decision). Encompass now asks this Court to remand the cases to the agency. Pl. MSJ

(Doc. 53) at 97. For the reasons given below, the Court instead affirms.

I. BACKGROUND

From 2012 to 2017, Encompass provided various inpatient rehabilitation facility

(IRF) services to the sixty-three patients at issue in this case. Pl. MSJ at 8; Def. MSJ (Doc.

61) at 5. “Compared to other rehabilitation settings, IRFs maintain a high level of physician

supervision in order to provide intensive rehabilitation therapy services.”

, No. 8:14-cv-778, 2021 WL 149265, at *1 (M.D. Fla. Jan. 15, 2021)

(quotation omitted), , No. 21-10421, 2021 WL 6102260 (11th Cir. Dec. 23, 2021).

erefore, the Centers for Medicare and Medicaid Services (CMS) takes care to discern

whether IRF services are “reasonable and necessary” and thus reimbursable. 42 U.S.C.

§ 1395y(a)(1)(A).

During the relevant time period, CMS regulations specified that IRF services are

only reasonable and necessary when there is a reasonable expectation that the patient’s

condition:

(i) Requires the active and ongoing therapeutic intervention of multiple

therapy disciplines (physical therapy, occupational therapy, speech-language

pathology, or prosthetics/orthotics therapy), one of which must be physical

or occupational therapy.

(ii) Generally requires and can reasonably be expected to actively participate

in, and benefit from, an intensive rehabilitation therapy program. Under

current industry standards, this intensive rehabilitation therapy program

generally consists of at least 3 hours of therapy (physical therapy,

occupational therapy, speech-language pathology, or prosthetics/orthotics

therapy) per day at least 5 days per week. . . . Benefit from this intensive

rehabilitation therapy program is demonstrated by measurable improvement

that will be of practical value to the patient in improving the patient's

functional capacity or adaptation to impairments. e required therapy

treatments must begin within 36 hours from midnight of the day of

admission to the IRF.

(iii) Is sufficiently stable at the time of admission to the IRF to be able to

actively participate in the intensive rehabilitation therapy program that is

described in [the previous] paragraph . . .

(iv) Requires physician supervision by a rehabilitation physician, defined as a

licensed physician with specialized training and experience in inpatient

rehabilitation. e requirement for medical supervision means that the

rehabilitation physician must conduct face-to-face visits with the patient at

least 3 days per week throughout the patient's stay in the IRF to assess the

patient both medically and functionally, as well as to modify the course of

treatment as needed to maximize the patient's capacity to benefit from the

rehabilitation process.

42 C.F.R. § 412.622(a)(3) (2010). Collectively, these four requirements are known as the

beneficiary eligibility criteria.

CMS regulations also imposed other limitations on IRF coverage. ese included

technical documentation criteria, which oblige the party seeking reimbursement to include

several types of medical records in the patient’s file. § 412.622(a)(4). Further, “the

patient must require an interdisciplinary team approach to care” consisting of weekly team

meetings between a rehabilitation physician, a registered nurse, a social worker or case

manager, and a therapist from each therapy discipline involved in treating the patient.

§ 412.622(a)(5). If coverage is denied, either the hospital or the patient is liable for the

expense. 42 U.S.C. § 1395pp (identifying who is liable under what circumstances).

Medicare claims are initially adjudicated by a private contractor, 42 U.S.C.

§ 1395ff(a)(1), and objections to the contractor’s decision are subject to a multi-step appeal

process. To start, parties who are denied reimbursement may ask the contractor to

reevaluate its decision. . § 1395ff(a)(3). If the contractor still denies coverage, parties

may seek review from a new, independent contractor. . § 1395ff(b)(1), (c). If the

second contractor agrees with the first, parties may ask an ALJ to adjudicate the coverage

decision. . § 1395ff(d)(1). If the ALJ also denies coverage, parties may appeal to the

Medicare Appeals Council. . § 1395ff(d)(2).

e agency denied the claims at issue here at each level of review, culminating in

the Council’s affirmation of the denial of coverage. AR Vols. 1–63 at 3–4. Encompass then

sought judicial review by suing the Secretary of the United States Department of Health

and Human Services in this Court. Compl. (Doc. 1). Both parties now move

for summary judgment.

II. LEGAL STANDARDS

In an action for judicial review of a Medicare claim denial, the district court sits as

an appellate tribunal. 42 U.S.C. § 405(g) (providing for judicial review of final

decisions of the Commissioner of Social Security); 42 U.S.C. § 1395ff(b)(1)(A)

(incorporating § 405(g) for Medicare). “[J]udicial review of the Secretary’s decision

regarding a claim for Medicare benefits is limited to whether there is substantial evidence

to support the findings of the Secretary, and whether the correct legal standards were

applied.” , 468 F.3d

1347, 1350 (11th Cir. 2006) (cleaned up). “Substantial evidence is more than a scintilla

and is such relevant evidence as a reasonable person would accept as adequate to support a

conclusion.” , 614 F.3d 1276, 1280 (11th Cir.

2010). Summary judgment motions are the correct mechanism to resolve Medicare appeals

in the district court, but the appropriate legal standard is supplied by 42 U.S.C. § 405(g),

not Federal Rule of Civil Procedure 56. , 175 F. Supp. 3d 1338, 1349

(M.D. Fla. 2016), ., 702 F. App’x

856 (11th Cir. 2017).

III. DISCUSSION

In its motion for summary judgment, Encompass offers three arguments as to why

the Court should vacate and remand the decisions of the Medicare Appeals Council. First,

Encompass argues that the Council incorrectly concluded that Encompass did not comply

with 42 C.F.R. § 405.1112(b), which requires appellants to identify what parts of the ALJ

decisions they disagree with and explain their reasons for disagreeing. Pl. MSJ at 75–87.

Second, Encompass argues that even if it failed to comply with § 405.1112(b), the Council

impermissibly treated Encompass differently than other providers by declining to offer a

detailed analysis of Encompass’s appeals. at 87–90. ird, Encompass argues that the

Council should have reversed the ALJ decisions for clear error because the ALJs applied

legal standards not found in the text of the applicable regulations and did not assemble a

complete administrative record. at 90–97. All three arguments fail. After detecting no

legal error in the agency’s handling of the appeals, the Court also concludes that the agency

decisions are supported by substantial evidence.

A. Encompass Did not Explain Its Reasons for Disagreeing with the ALJs

Encompass did not comply with § 405.1112(b). at regulation provides that when

a party requests the Council to review an adjudication:

e request for review must identify the parts of the ALJ’s or attorney

adjudicator's action with which the party requesting review disagrees and

explain why he or she disagrees with the ALJ’s or attorney adjudicator's

decision, dismissal, or other determination being appealed. For example, if

the party requesting review believes that the ALJ’s or attorney adjudicator's

action is inconsistent with a statute, regulation, CMS Ruling, or other

authority, the request for review should explain why the appellant believes

the action is inconsistent with that authority.

If a request does not conform to this requirement, the Council will “adopt the ALJ’s action

without comment, unless the ALJ’s decision or dismissal contains on its face a clear error

of law.” 67 Fed. Reg. 69312, 69336 (Nov. 15, 2002).

CMS promulgated this rule in 2002 because it was receiving numerous “requests for

review stat[ing] only general reasons for appealing, such as ‘I disagree with the ALJ’s

decision’ or ‘e decision is not supported by the evidence and is inconsistent with the law.’

” at 69335. Disposing of such appeals is “very time and labor intensive, including

examination of aspects of the decision with which the party may not actually disagree.”

Section 405.1112(b) addresses this problem by directing parties to explain what aspect of

the decision they disagree with and why.

Encompass’s requests for review took three forms. In most of the appeals,

Encompass requested review because “[t]he beneficiary met the criteria for admission to

the IRF and met medical complexity to require IRF.” AR Vols. 1–2, 5, 20, 22–27, 30, 39–

45, 47–48, 54–63 at 5; AR Vols. 21, 28–29 at 9; AR Vol. 33 at 10; AR Vols. 37–38 at 15.

In a few others, Encompass averred that “[t]he beneficiary met Medicare criteria for

admission to the IRF and we request the Appeals Board review the ALJ’s decision.” AR

Vols. 3–4, 32 at 5; AR Vol. 31 at 9. And sometimes, Encompass instead posited that “[t]he

beneficiary met Medicare criteria for admission to the IRF. e ALJ’s decision did not take

into account all of the testimony and the information provided in the medical record.” AR

Vols. 34–36, 46, 49–50, 51A, 52–53 at 5.

ese requests did not explain why Encompass disagreed with the ALJ decisions.1

An appellant must offer a reason the ALJ erred, not just a conclusion that it did. at

requirement is unambiguously outlined in § 405.1112(b), which provides that if a party

believes that an ALJ decision contradicts a regulation, “the request for review should

explain why the appellant believes the action is inconsistent with that authority.”2 Yet

Encompass did not specify the content of its disagreement with the ALJs’ decisions.

Alleging that the beneficiaries met the eligibility criteria, that the beneficiaries “met

medical complexity,” , AR Vol. 1 at 5, or that an “ALJ’s decision did not take into

account all of the testimony and the information,” , AR Vol. 34 at 5, does not

explain what specific legal or factual error the ALJ has committed. Such requests amount

to impermissibly conclusory statements that “[t]he decision[s] [were] not supported by the

evidence and [were] inconsistent with the law.” 67 Fed. Reg. at 69335.

Encompass resists this conclusion for two reasons. First, it points out that CMS

1 The parties also dispute whether Encompass identified the parts of the ALJ decisions with which it

disagreed. Pl. MSJ at 75–78, Def. MSJ at 11–15. But because § 405.1112(b) requires

appellants to “identify the parts of the ALJ's . . . action with which the party requesting review disagrees

explain why he or she disagrees with the ALJ's . . . decision,” Encompass’s failure to explain its

disagreement is dispositive.

2 Because the Court concludes that this regulation was unambiguous, the Court need not address the

alternative argument that the Council’s actions are justified by deference. , 519

U.S. 452 (1997); , 588 U.S. 558, 573 (2019) (establishing that “the possibility of

deference can arise only if a regulation is genuinely ambiguous”).

regulations do not require appellants to file a brief along with their request for review.

42 C.F.R. § 405.1120 (permitting but not mandating briefs). According to Encompass,

requiring further elaboration of its disagreements with the ALJs under § 405.1112(b)

would impose a briefing requirement by another name. Pl. MSJ at 80. Second,

Encompass argues that if its requests for review fail to satisfy § 405.1112(b), then Form

DAB-101—the standard form used to appeal ALJ decisions—is potentially inadequate for

its purpose, since it contains space for only four lines of text. . at 81.

Neither objection succeeds. Section 405.1112(b) required Encompass to explain

what factual or legal errors it believed had infected the ALJ decisions. Encompass could

have flagged the substantive issues it now raises in a few words—for example, “the ALJ

falsely assumed that beneficiaries are ineligible for IRF services if they are in a stable

condition.” A legal brief was not necessary to communicate such concerns. For the same

reasons, Encompass likely could have used the four lines of text in Form DAB-101 to raise

its objections to the ALJs’ decisions. And even if four lines did not suffice, Form DAB-

101 itself instructs appellants to “[a]ttach additional sheets if you need more space.” ,

AR Vol. 1 at 16. More fundamentally, it is not evident that the format of Form DAB-101

should influence the interpretation of § 405.1112(b), and Encompass does not cite any

authority that suggests it should.

B. The Council’s Application of § 405.1112(b) Was not Arbitrary or

Capricious

It was not arbitrary and capricious for the Council to adopt the ALJ decisions

without comment after concluding that Encompass did not comply with § 405.1112(b).

e Administrative Procedure Act (APA) prohibits agencies from acting in a manner that

is “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.”

5 U.S.C. § 706(2)(A). Encompass argues that it was treated differently from two other

appellants whose cases were adjudicated more than a decade ago.

, 2013 WL 7872031, (H.H.S. Apr. 16, 2013); ,

2012 WL 4760802, (H.H.S. Sept. 4, 2012). erefore, relying on cases holding that

agencies “acted arbitrarily and capriciously by treating similarly situated” parties differently,

, 485 F.3d 1247, 1260 (11th Cir. 2007), Encompass

concludes that the Council did not apply the correct legal standard to its appeals.

is chain of reasoning has some weak links. Encompass contends that the Council

acted arbitrarily and capriciously even if it applied the correct legal standard, so long as the

Council did not apply the correct legal standard in other, previous cases. Taken to its

natural conclusion, Encompass’s argument would forever excuse appellants from

complying with any agency procedure, so long as the parties could find a single instance

where the agency did not hew to its processes in the past.

But even if Encompass’s logic is sound, its starting premise is flawed. Neither of

Encompass’s authorities show disparate treatment. In , the

appellant requested review in three cases because “[t]he facts of the case and the written

brief were not given proper consideration in the decision making process. ese charts

concerning the same patients who have been paid different times by different judges. For

them now not to be paid makes no sense.” 2013 WL 7872031, at *1. e Council

concluded that this request did not comply with § 405.1112(b). e Council

summarized the factual and procedural background of each appeal, then adopted the ALJs’

decisions without analysis. at *2–5. at is almost exactly what happened here. In each

appeal, the Council briefly summarized the background of the case and then adopted the

ALJ’s decision. AR Vols. 1–63 at 3–4. On a per case basis, the Council spilled almost as

much ink discussing the appeals here as it did on the appeals in .

AR Vols. 1–63 at 3–4 (two pages each), , 2013 WL

7872031, at *1–6 (seven pages for three consolidated appeals). Encompass was similarly

situated to All Care Home Health and was treated similarly.

In , the appellant was treated differently than

Encompass because it was not similarly situated to Encompass. ere, the request for

review was as follows: “Worst telephone hearing that I have ever participated in. Please

listen to the tape. ALJ was confused and rambling. Please re-consider.” 2012 WL 4760802,

at *2. e Council noted that this request did not comply with § 405.1112(b). at *2 n.3.

Yet the Council found it necessary to “modif[y] the ALJ's decision to expand its reasoning,”

though it largely accepted the ALJ’s conclusions. at *1–4. at contrasts with

Encompass’s appeals, where the Council did not perceive a need to modify the ALJ’s

decision and therefore did not offer analysis of the ALJs’ decisions before adopting them.

AR Vols. 1–63 at 3–4. e Council was not obliged to devote the same level of analysis

for an ALJ decision that it adopted wholesale as it was for an ALJ decision that needed

modification. It is not arbitrary and capricious to treat dissimilar cases dissimilarly, so

Encompass’s argument fails.

C. The ALJ Decisions Did not Contain Clear Error

Next, Encompass argues that even if the Council properly limited its review to clear,

facial errors, the ALJ decisions should be overturned. It identifies three putative examples

of clear error. First, Encompass notes that in 23 cases, the ALJs mentioned that the patient

was “stable” upon admission to the IRF. Pl. MSJ at 91–93 (collecting instances). According

to Encompass, the ALJs clearly erred by relying on the patients’ stability as a reason to deny

coverage, even though the beneficiary eligibility criteria required patients to be “sufficiently

stable at the time of admission to the IRF to be able to actively participate in the intensive

rehabilitation therapy program.” 42 C.F.R. § 412.622(a)(3)(iii) (2010). Second, it faults

the ALJs in 39 cases for stating that the patients’ medical conditions were insufficiently

“complex” to warrant IRF services, even though that word does not appear in the

beneficiary eligibility criteria. Pl. MSJ at 93–94 (collecting instances). ird, Encompass

argues that the ALJs failed to assemble a complete administrative record in eight of the

cases. Pl. MSJ at 94–97. e first two arguments fail, and the third is waived.

i. The ALJ Decisions Did not Impose a ‘Stability’ Requirement

Start with the first argument. e beneficiary eligibility criteria are meant to limit

IRF services to a particular kind of patient: someone who is healthy enough to engage with

a rigorous therapy regimen, but who is unwell enough to need that regimen and require

close medical supervision. “No legal authority appears to require that beneficiaries must

have unstable vital signs and be in acute distress in order to need hospital-level

rehabilitation.” , 2009 WL 5788651, *5 (H.H.S.

2009). Patients must be “sufficiently stable at the time of admission to the IRF to be able

to actively participate in the intensive rehabilitation therapy program.” 42 C.F.R. §

412.622(a)(3)(iii) (2010). At the same time, if beneficiaries’ condition was such that their

“needs could . . . have been met” at a facility with a less intensive level of care, “that would

justify non-coverage of care in an IRF.” , 2009

WL 5788651, at *5. e medical condition must justify “the active and ongoing therapeutic

intervention of multiple therapy disciplines,” “at least 3 hours of therapy . . . per day at least

5 days per week,” and close physician supervision in the form of “face-to-face visits with

the patient at least 3 days per week.” 42 C.F.R. § 412.622(a)(3)(i)–(ii), (iv) (2010).

None of the ALJ decisions impermissibly imposed a “stability” requirement. e

wording of the ALJ decisions varies from case to case, but each concludes “that [the

patients’] rehabilitation needs and the monitoring of [their] medical conditions could have

been safely met with a lower level of care.” AR Vol. 3 at 25; , AR Vol. 4 at 23

(same); AR Vol. 34 at 19 (same); AR Vol. 36 at 25 (same). ose conclusions reflect the

regulatory desideratum that beneficiaries must need intensive therapy and close supervision

to qualify for IRF coverage. 42 C.F.R. § 412.622(a)(3)(i)–(ii), (iv) (2010). Encompass

does not identify a single instance where an ALJ used “stability” as a of

eligibility. Instead, the decisions offer fulsome accounts of the patients’ medical conditions,

which sometimes included the fact that a particular medical condition (or combination of

medical conditions) was “stable.” It appears that Encompass simply accuses the ALJs of

misapplying the law every time that a decision uses a cognate of the term “stable.” But ALJs

are not forbidden from considering the stability of a given medical condition in their overall

assessment of the need for IRF services; they simply must not “ that beneficiaries

must have unstable vital signs.” , 2009 WL

5788651, at *5 (emphasis added). Each decision reflects an awareness that a patient must

be “sufficiently stable” to participate in IRF services, 42 C.F.R. § 412.622(a)(3)(iii) (2010),

while still recognizing that a patient with no medical need for intensive therapy and close

supervision cannot be reimbursed for such services, § 412.622(a)(3)(i)–(ii), (iv).

ii. The ALJ Decisions Did not Impose a ‘Complexity’ Requirement

In much the same way, the ALJ decisions that used the word “complex” did not

impose a legal standard separate from the beneficiary eligibility criteria. As Encompass

concedes, “the term ‘complexity’ is sometimes used as a form of proverbial shorthand to

describe qualified IRF patients.” Pl. MSJ at 94. In other words, when a case presents

insufficient complexity, that means that the patient’s medical needs did not require IRF

services. CMS has used the word in this sense in the pages of the Federal Register. 74

Fed. Reg. at 39796 (observing that “the medical complexity of rehabilitation patients has

increased over time”); at 39788 (explaining that “patients for whom IRF coverage was

intended . . . require complex rehabilitation in a hospital environment”). So did Encompass

in the very requests for review at issue in this case. , AR Vol. 1 at 5 (“e beneficiary

met the criteria for admission to the IRF and met medical complexity to require IRF.”);

Pl. MSJ at 94 & n.16 (admitting this fact, but averring that Encompass’s use of

the word was “largely” reflective of the ALJs’ usage). e ALJs were not obligated to avoid

this term simply because it does not appear in the text of § 412.622, provided that their

decisions were anchored in one or more of the beneficiary eligibility criteria. at was the

case here. , AR Vol. 2 at 13–14 (“[T]he record does not support that the

beneficiary’s medical, rehabilitation, and nursing needs were of such complexity

to the IRF.” (emphasis added));

42 C.F.R. § 412.622(a)(3)(iv) (2010) (physician supervision requirement).

iii. Encompass Waived Its Argument That the Administrative

Record Is Incomplete

Finally, Encompass speculates that the administrative record in eight cases is

incomplete. Encompass argues that the medical records for these cases are relatively short

and that some of the statements made by the Medicare contractors and the ALJs assume

the existence of documents not included in the record. Pl. Reply (Doc. 62) at 15–16;

Def. Reply (Doc. 63) at 7–8 (disagreeing with Encompass’s interpretation of

these statements). ough it never provides the medical documents that it says are missing

from the record,3 Encompass concludes that the ALJs failed to compile a complete record

and contends that the ALJs’ alleged failures amount to reversible error.

is argument is waived. “Under ordinary principles of administrative law, a

reviewing court will not consider arguments that a party failed to raise in timely fashion

before an administrative agency.” , 485 F.3d 1247, 1254

(11th Cir. 2007) (quotation omitted). But Encompass did not argue that the administrative

record was incomplete before the ALJs. Nor did it raise the issue in any of its requests for

review. , 90 F.3d 421, 423 (10th Cir. 1996) (“Plaintiff did not

3 As the party responsible for submitting the allegedly missing documentation, 42 C.F.R. § 424.5(a)(6),

Encompass presumably has access to the specific records that it believes are missing for each patient.

present his remaining two arguments on appeal to either the ALJ or the Appeals Council.

Accordingly, he has waived those points and we decline to address them.”). Encompass

does not argue otherwise. Instead, it avers that it could not waive the argument because the

ALJ has “an independent obligation . . . to compile a administrative record.”

Encompass Reply at 16. It also refers to the Council’s practice of remanding decisions

if the record is incomplete. at 16–17 (compiling cases). ose arguments conflate

two different propositions. It may be the case that the ALJ and the Council had a duty to

comb through the record for missing documents. Yet that does not mean that Encompass

is released from ordinary waiver rules in proceedings before this Court.

D. The ALJ Decisions Are Supported by Substantial Evidence

Although Encompass averred that the agency’s final decisions “are not supported by

substantial evidence” in its complaint, Compl. ¶¶ 42–44 (Count I), it does not argue that

the decisions are unsupported by substantial evidence in its motion for summary judgment.

Pl. MSJ at 73–97 (offering only legal arguments for remand).4 Secretary

Becerra moves for summary judgment on this issue, Def. MSJ at 30–100, and

Encompass does not contest the Secretary’s arguments in its response, electing to focus

entirely on the legal arguments. Pl. Reply at 1–17.

4 Encompass offers short factual summaries of each case in its background section, but none of these

summaries substantively engage with the analysis offered by the ALJ. Pl. MSJ at 9–72.

Having reviewed the briefing, the ALJ decisions, and the record, the Court finds

that substantial evidence supports the final agency decisions. is is a low bar. Substantial

evidence exists so long as “a reasonable mind might accept [the agency’s] conclusions,”

“even if the evidence appears to weigh against the decision.”

., 568 F. App’x 758, 759 (11th Cir. 2014) (citing , 894 F.2d

1520, 1529 (11th Cir.1990). Here, each ALJ concluded that the beneficiary eligibility

criteria were not satisfied after providing a detailed summary of the relevant patient’s

medical history, including multiple medical factors that indicated that IRF services were

not necessary.5 Encompass does not identify any reason that this evidence is insufficient in

any case, and the Court finds none.

IV. CONCLUSION

Accordingly, the following is ORDERED:

5 AR Vol. 1 at 24–30; AR Vol. 2 at 25–32; AR Vol. 3 at 35–45; AR Vol. 4 at 35–45; AR Vol. 5 at 26–

36; AR Vol. 6 at 27–36; AR Vol. 7 at 26–34; AR Vol. 8 at 28–38; AR Vol. 9 at 26–34; AR Vol. 10 at 26–

34; AR Vol. 11 at 28–38; AR Vol. 12 at 29–40; AR Vol. 13 at 24–30; AR Vol. 14 at 25–32; AR Vol. 15 at

26–34; AR Vol. 16 at 25–32; AR Vol. 17 at 26–34; AR Vol. 18 at 27–36; AR Vol. 19 at 26–34; AR Vol.

20 at 25–32; AR Vol. 21 at 45–53; AR Vol. 22 at 27–36; AR Vol. 23 at 26–34; AR Vol. 24 at 26–34; AR

Vol. 25 at 27–36; AR Vol. 26 at 35–44; AR Vol. 27 at 42–50; AR Vol. 28 at 52–61; AR Vol. 29 at 45–55;

AR Vol. 30 at 27–36; AR Vol. 31 at 47–64; AR Vol. 32 at 41–57; AR Vol. 33 at 36–45; AR Vol. 34 at 37–

48; AR Vol. 35 at 36–47; AR Vol. 36 at 36–47; AR Vol. 37 at 42–49; AR Vol. 38 at 42–49; AR Vol. 39 at

26–34; AR Vol. 40 at 27–36; AR Vol. 41 at 15–24; AR Vol. 42 at 29–37; AR Vol. 43 at 26–34; AR Vol.

44 at 33–45; AR Vol. 45 at 35–49; AR Vol. 46 at 29–38; AR Vol. 47 at 32–42; AR Vol. 48 at 35–48; AR

Vol. 49 at 31–43; AR Vol. 50 at 31–43; AR Vol. 51 at 35–48; AR Vol. 52 at 33–44; AR Vol. 53 at 33–45;

AR Vol. 54 at 39–56; AR Vol. 55 at 34–45; AR Vol. 56 at 28–36; AR Vol. 57 at 28–40; AR Vol. 58 at 27–

35; AR Vol. 59 at 32–42; AR Vol. 60 at 30–38; AR Vol. 61 at 30–38; AR Vol. 62 at 33–44; AR Vol. 63 at

29–36.

1. Encompass Health Rehabilitation Hospital of Largo, LLC, and Encompass

Health Rehabilitation Hospital of Sarasota, LLC’s motion for summary

judgment (Doc. 53) is DENIED.

2. Secretary Becerra’s motion for summary judgment (Doc. 61) is

GRANTED.

3. The Clerk is directed to ENTER JUDGMENT in favor of Secretary

Becerra, which shall read “The final agency decisions are affirmed,”

TERMINATE any pending motions and deadlines, and to CLOSE this

case.

ORDERED in Tampa, Florida, on September 11, 2024.

WILLIAM F. JUNG

UNITED STATES DISTRICT JUDGE*

* Signed by Judge William F. Jung to expedite the resolution of this action. This case remains assigned to

Judge Kathryn Kimball Mizelle.