Source: https://law.justia.com/cases/federal/appellate-courts/F2/804/302/435425/
Timestamp: 2020-01-18 18:01:46
Document Index: 582773306

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

15 Soc.sec.rep.ser. 312, Medicare&medicaid Gu 35,920the Riley Hospital & Benevolent Association, Andmeridan-riley Hospital Association, Plaintiffs-appellants, v. Otis R. Bowen, M.d., Secretary of Health & Human Services,and Blue Cross & Blue Shield of Mississippi, Inc.,et al., Defendants-appellees, 804 F.2d 302 (5th Cir. 1986) :: Justia
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15 Soc.sec.rep.ser. 312, Medicare&medicaid Gu 35,920the Riley Hospital & Benevolent Association, Andmeridan-riley Hospital Association, Plaintiffs-appellants, v. Otis R. Bowen, M.d., Secretary of Health & Human Services,and Blue Cross & Blue Shield of Mississippi, Inc.,et al., Defendants-appellees, 804 F.2d 302 (5th Cir. 1986)
US Court of Appeals for the Fifth Circuit - 804 F.2d 302 (5th Cir. 1986) Nov. 12, 1986
This case involves a dispute between a provider hospital and the Secretary, acting through an intermediary, concerning the disallowance of certain portions of the provider's claim for reimbursement pursuant to the Medicare Act. The plaintiffs-appellants in this action, Riley Hospital and Benevolent Association and Meridian-Riley Hospital Corporation, both are Mississippi non-profit hospital corporations located in Meridian, Mississippi. Blue Cross and Blue Shield of Mississippi,1 the intermediary, is a non-profit corporation acting on behalf of Blue Cross Association as a fiscal intermediary of the Medicare Act that makes payments to providers of hospital services pursuant to Part A of that act. 42 U.S.C. § 1395 et seq. In November, 1966, Meridian-Riley Hospital Corporation (Meridian-Riley) was organized to construct and maintain a public hospital. Although the hospital facility involved herein is owned by Meridian-Riley, the Riley Hospital and Benevolent Association (Riley Benevolent) operates the facility under a lease from Meridian-Riley pursuant to the provisions of Sec. 1861(e) of the Medicare Act. 42 U.S.C. § 1395x(e).
The United States District Court entered its judgment in favor of appellants on the 10th day of April, 1981. The Secretary's appeal of the district court's decision was voluntarily dismissed on October 5, 1981. On April 15, 1982, the Secretary filed a Rule 60 Motion to Correct the Judgment of 1981, but the district court denied the Secretary's motion for relief on August 22, 1983, insofar as it pertained to reduction of the $60,256.00 award. The court did modify the 1981 judgment to conform its award of interest to 42 U.S.C. § 1395 oo.
Jurisdiction to review Medicare reimbursement determinations is available only as prescribed in the Medicare Act. Heckler v. Ringer, 466 U.S. 602, 104 S. Ct. 2013, 80 L. Ed. 2d 622 (1984); Dr. John T. MacDonald Foundation, Inc. v. Califano, 571 F.2d 328 (5th Cir. 1978) (en banc), cert. denied, 439 U.S. 893, 99 S. Ct. 250, 58 L. Ed. 2d 238 (1979). The Medicare Act does not have its own statutory section precluding judicial review; rather, Sec. 1395ii incorporates 42 U.S.C. § 405(h), which precludes review of decisions under Title II of the Social Security Act.2 Therefore, appeals from adverse determinations on cost reimbursement under the Medicare Act may be had only as specifically set forth by Congress. See American Association of Councils of Medical Staffs of Private Hospitals, Inc. v. Califano, 575 F.2d 1367 (5th Cir. 1978), cert. denied, 439 U.S. 1114, 99 S. Ct. 1018, 59 L. Ed. 2d 72 (1979). If a provider hospital is dissatisfied with the cost reimbursement determination of the Secretary or the intermediary, then the Medicare statute requires the provider to contest this determination before the PRRB, the administrative appeals board with exclusive jurisdiction to settle Medicare reimbursement claims. 42 U.S.C. § 1395oo (a).
The district courts have jurisdiction to review cost report adjustments under 42 U.S.C. § 1395oo (f) (1), but only after a final decision by the Board. Section 1395oo (f) (1) defines the jurisdiction of district courts and states, in pertinent part, that " [P]roviders shall have the right to obtain judicial review of any final decision of the Board." (emphasis added). 42 U.S.C. § 1395oo (f) (2) permits interest only for cost reporting years for which judicial review has been sought under Sec. 1395oo (f) (1).
IT IS, THEREFORE, ORDERED AND ADJUDGED that the plaintiffs herein have judgment against the defendant in the sum of $60,256.00, together with lawful interest thereon, as computed and determined by the provisions of 42 U.S.C. § 1395oo (f) (2) (Supp. V, 1981), until paid by the defendant; that for all costs [sic] reporting years subsequent to the fiscal year ending September 30, 1974, the period of twenty-four (24) years, or the period coinciding with the final bond maturities in November, 1992, shall be used as the proper schedule or period over which to prorate and allocate depreciation of the hospital facilities of the plaintiffs.