Opinion ID: 2746816
Heading Depth: 2
Heading Rank: 2

Heading: Annual Hospital Cost Reports

Text: Mastej’s complaint also refers to the annual hospital cost reports, but there is also no reference to referred patients in those cost reports. Here is what the complaint says about those cost reports. Because the Defendants’ Medical Center has one hospital license and one provider number, the Defendants submitted one combined annual hospital cost report covering both Collier Boulevard and Pine Ridge. As alleged, the hospital cost report is the final Medicare claim that a hospital submits annually to the government. The annual hospital cost report states the total amount of reimbursement the Defendants’ Medical Center believes it is due for the year. 11 From this sum, the report subtracts the total payments made during the year to determine the amount owed back to the Medicare Program or the amount owed to the Defendants’ Medical Center. The hospital cost report merely totals the amounts billed and paid for all Medicare patients in a calendar year, without giving any specifics. 17 Case: 13-11859 Date Filed: 10/30/2014 Page: 18 of 41 Medicare relies on annual hospital cost reports to determine whether a hospital is entitled to a greater reimbursement than the hospital already received based on interim claim forms, or whether the hospital should reimburse Medicare because the hospital was over-paid during the calendar year. The Defendant HMA’s individual hospital campuses, such as Collier Boulevard, do not prepare the annual cost report. Rather, Defendant HMA’s reimbursement department prepared the hospital cost reports for each of HMA’s hospitals. Once prepared, Defendant HMA gave those cost reports to Defendant Naples HMA’s Medical Center for the ultimate execution by the hospital’s chief administrator or his responsible designee. As alleged, the Defendants submitted these annual hospital cost reports for the Medical Center to Medicare: (1) a 2007 hospital cost report submitted May 30, 2008, and signed by Pine Ridge CEO Geoff Moebius; (2) a 2008 hospital cost report submitted June 7, 2010, and signed by Medical Center CFO Todd Lupton; and (3) a 2009 hospital cost report submitted May 26, 2010, and signed by CFO ——————————– 11 It totals “Medicare liability for inpatient services . . . with any other Medicare liabilities” to “determine[] Medicare’s true liability for services rendered to Medicare beneficiaries during the . . . fiscal year.” 18 Case: 13-11859 Date Filed: 10/30/2014 Page: 19 of 41 Lupton.12 Each report contained a certification that the Medicare “services identified in th[e] report were provided in compliance with [health care] laws and regulations.” Notably, since Mastej left the Defendants’ employ in October 2007, there is no allegation that Mastej signed or helped prepare any of the hospital cost reports. Even the 2007 hospital cost report was not submitted to Medicare until May 30, 2008.