Source: http://openjurist.org/152/f3d/1132/foothill-presbyterian-hospital-v-shalala
Timestamp: 2015-08-02 22:36:48
Document Index: 720276569

Matched Legal Cases: ['§ 1395', '§ 413', '§ 1395', '§ 1395', '§ 1395', '§ 1395', '§ 1395', '§ 1395', '§ 413', '§ 413', '§ 405']

152 F3d 1132 Foothill Presbyterian Hospital v. Shalala | OpenJurist
152 F. 3d 1132 - Foothill Presbyterian Hospital v. Shalala Home
152 F3d 1132 Foothill Presbyterian Hospital v. Shalala 152 F.3d 1132
58 Soc.Sec.Rep.Ser. 21, 98 Cal. Daily Op. Serv. 6312,98 Daily Journal D.A.R. 8757FOOTHILL PRESBYTERIAN HOSPITAL, Plaintiff-Appellant,v.Donna E. SHALALA, Secretary, in her official capacity asSecretary of the United States Department ofHealth and Human Services, Defendant-Appellee.
No. 97-55335.
Argued and Submitted June 1, 1998.Decided Aug. 13, 1998.
James M. Gaynor, Jr., McDermott, Will and Emery, Chicago, Illinois, Thomas J. Weiss, Seyfarth, Shaw, Fairweather & Geraldson, Los Angeles, California, for plaintiff-appellant.
Jeffrey G. Micklos, United States Department of Health and Human Services, Baltimore, Maryland, Gerard Keating, United States Department of Health and Human Services, Washington, DC, for defendant-appellee.
Appeal from the United States District Court for the Central District of California; David V. Kenyon, District Judge, Presiding. D.C. No. CV 95-4674-KN.
At issue in this case is Foothill Presbyterian Hospital's reimbursement from Medicare for inpatient hospital services for fiscal year 1983. The Hospital argues that the district court erred in holding that its 1992 request for an exception to its 1983 target rate limit under 42 U.S.C. § 1395ww(b)(4)(A) and 42 C.F.R. § 413.40(e) was untimely. Although the Hospital's target rate limit was revised in the second revised notice of program reimbursement ("NPR") in 1991, the revision was based solely on malpractice insurance costs and wholly unrelated to the Hospital's request for an exception due to atypical services. We hold that the atypical services issue had to have been raised within 180 days of the initial NPR, in 1985. Thus, the exception request in 1992 was untimely.
Under the Medicare statute, 42 U.S.C. §§ 1395 to 1395ccc (1988), the Secretary of Health and Human Services reimburses health care providers for services provided to Medicare patients. Foothill Presbyterian Hospital is a provider of hospital services under the Medicare program. During the period of time relevant in this case, the Medicare statute authorized payment for hospitals based on the lower of the hospital's customary charges or the reasonable cost of providing services to program beneficiaries. 42 U.S.C. § 1395f(b)(1). In Section 101 of the Tax Equity and Fiscal Responsibility Act of 1982 ("TEFRA"), Pub.L. No. 97-248, 96 Stat. 339, Congress limited the rate of increase of hospital reimbursement for the operating costs of inpatient hospital services. 42 U.S.C. § 1395ww(b). The TEFRA rate of increase limit for a hospital is based on a target amount defined as the provider's reasonable costs of inpatient hospital service for the base year. 42 U.S.C. § 1395ww(b)(1)(A)(3)(A). The target amount is increased by a specific percentage in each succeeding cost reporting period. 42 U.S.C. § 1395ww(b)(3)(A), (B). The hospital absorbs some of the cost increases in excess of its target amount and receives a bonus if cost increases are less than or equal to the target amount. 42 U.S.C. § 1395ww(b)(1)(A), (B); 42 C.F.R. § 413.40(d).
Providers file cost reports annually with their fiscal intermediary to obtain reimbursement from Medicare. 42 C.F.R. § 413.20. The intermediary audits the report and makes a final determination of the total amount of reimbursement owing by Medicare. The determination is set forth in an initial NPR. 42 C.F.R. §§ 405.1803, 413.20, 413.60. If the provider is dissatisfied with a final determination and the am