Fox Insurance Company, Inc. v. Centers for Medicare and Medic

These are two appeals stemming from the government’s immediate termination of a Medicare Part D services contract with a prescription drug insurance coverage provider, Plaintiff-Appellant Fox Insurance Company, Inc. The government terminated the contract in March of 2010 after it had warned Fox of delays in patients’ access to needed medication. Fox had frequently delayed and sometimes completely denied patients’ access to medically necessary drugs by subjecting its enrollees to improper hurdles, such as unnecessary tests and invasive medical procedures, as a condition to receiving their already delayed medications for serious medical con ditions. This misconduct is not now disputed.

Medicare Part D was enacted in 2003. 42 U.S.C. §. 1395w-101 et seq. The government administers the program through the Centers for Medicare and Medicaid Services, within the Department of Health and Human Services. This is the first Medicare Part D contract termination to reach a federal appeals court. The government acted pursuant to a statutory provision authorizing immediate termination, without pretermination hearing, upon a finding that delay would create an “imminent and serious risk”…