Advanced Professional Home Health Care, Inc. v. Blue Cross & Blue Shield (In Re Advanced Professional Home Health Care, Inc.)

82 B.R. 837, 18 Collier Bankr. Cas. 2d 117, 1988 Bankr. LEXIS 260
CourtUnited States Bankruptcy Court, E.D. Michigan
DecidedJanuary 24, 1988
Docket19-20304
StatusPublished
Cited by10 cases

This text of 82 B.R. 837 (Advanced Professional Home Health Care, Inc. v. Blue Cross & Blue Shield (In Re Advanced Professional Home Health Care, Inc.)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Advanced Professional Home Health Care, Inc. v. Blue Cross & Blue Shield (In Re Advanced Professional Home Health Care, Inc.), 82 B.R. 837, 18 Collier Bankr. Cas. 2d 117, 1988 Bankr. LEXIS 260 (Mich. 1988).

Opinion

AMENDED MEMORANDUM OPINION

RAY REYNOLDS GRAVES, Bankruptcy Judge.

Advanced Professional Home Health Care, Inc., (“Advanced”), brought this action, Adversary Proceeding No. 86-1052, under 11 U.S.C. § 541, to recover monies withheld from post-petition partial interim payments by Blue Cross and Blue Shield of Michigan (“Blue Cross”) and the Department of Health and Human Services. Subsequently, Blue Cross was dismissed as a defendant. The Debtor in Possession also seeks sanctions under 11 U.S.C. 362 (h) for willful violation of the automatic stay provision. In response, the defendant submits that the withholdings were recoupments and, thus, not violations of the automatic stay. Based upon official records, exhibits, briefs of the parties, and oral arguments of counsel at trial, as well as the Court’s own research, the Court enters the following findings of fact and conclusions of law.

The facts of the case are as follows. At one time Advanced was the second largest home health provider in Southeastern Michigan. It filed a Chapter 11 petition on November 12, 1986. Counsel for the debt- or hand-delivered notice of the bankruptcy filing to Blue Cross, the fiscal intermediary through which payments were made to Advanced on November 13, 1986. Despite notice of the Chapter 11 filing, Blue Cross withheld monies it would have paid to Advanced on November 18,1986 and indicated that it would continue withholding all monies due to Advanced until overpayments in an undetermined amount had been recovered. On November 19, 1986 Advanced filed a complaint to initiate this adversary proceeding, alleging that at least $213,000 in payments were owing from the Medicare program for the 1986 fiscal year. (Advanced Complaint to Compel Turnover, A.P. No. 86-1052, Docket # 1). The United States has stated, on behalf of the Secre *839 tary of the Department of Health and Human Services (“Secretary”), that it “has recouped all of the overpayments and is no longer recouping payments to the debtor.” (Trial Brief of United States at page 4). The matter came before the Court for trial on October 16, 1987.

Debtor is a provider of home health services, primarily serving individuals sixty-five years of age and older who qualify for benefits under Part A-Hospital Insurance Benefits for Aged and Disabled of the Medicare Act, Title XVIII of the Social Security Act, as amended, 42 U.S.C. §§ 1395 et seq. Prior to the commencement of this Chapter 11 proceeding Advanced had been reimbursed by Medicare for approximately 90 percent of its services under the terms of a “Provider Agreement,” receiving payments through Blue Cross, the private fiscal intermediary designated by the Secretary. Subsequent to filing for protection of the Bankruptcy Code, Advanced did not obtain court approval to assume or reject the Provider Agreement, as may have been required by 11 U.S.C. § 365. (Trial Transcript at —). However, Advanced continued to perform as a “provider,” to submit claims to the Secretary, and to receive periodic payments from the Secretary.

Congress imposes upon the Secretary of the Department of Health and Human Services the responsibility for determining the amount owed to providers such as Advanced and for paying them, prior to an audit and on at least a monthly basis, from the Federal Hospital Insurance Trust Fund. Congress also authorizes the Secretary to make “necessary adjustments” to account for prior overpayments or underpayments to providers. 42 U.S.C. 1395g. Any overpayment must be reclaimed from current and future payments to the provider. In re Yonkers Hamilton Sanitarium Inc., 22 B.R. 427, 429 (Bankr.S.D.N.Y.1982). At least one court has described similar financial arrangements under a Medicare Provider Agreement as “current financing” which provides “working capital” with which to run the provider’s business. Matter of Monsour, 8 B.R. 606, 609 (Bankr.W. D.Pa.1981), aff'd, 11 B.R. 1014 (W.D.Pa.1981).

The defendant states the policy of 42 U.S.C. § 1395g as being an expression of Congressional recognition “that providers would have difficulty operating for a year without receiving payments” and that “Congress’s (sic) solution to this problem was to authorize the Secretary to make estimated interim payments with a year-end accounting to make adjustments for overpayments or underpayments.” (Trial Brief of United States at page 2).

Counsel for the Secretary acknowledges that “[tjhere is no [factual] dispute that the United States has recouped Medicare funds that were due to the debtor [post-petition] ... The real issue is the legal issue of whether or not this is permissible.” (Trial Brief of United States at page 4). Thus, this court must decide three questions. Did the doctrine of recoupment permit the Secretary to withhold funds due the debtor for post-petition services as credit against a pre-petition debt? Further, even if the doctrine did permit the withholding, did the filing of the Chapter 11 petition operate as a stay against the Secretary’s withholding procedures under 11 U.S.C. Section 362 (a) of Title 11? Finally, if the automatic stay provision did require a motion and order lifting the stay in favor of the Secretary, does § 362 (h) mandate the imposition of sanctions against the Secretary?

The commencement of a case under the Bankruptcy Code creates an “estate” which includes “all legal or equitable interests of the debtor in property as of the commencement of the case.” 11 U.S.C. § 541 (a)(1). The Code includes executory contracts, agreements which obligate both parties to continuing performance, in the newly formed estate. 11 U.S.C. § 365(a). In order to protect the debtor’s interest in property of the estate, an injunction arises, by operation of law, at the moment of filing under § 301, 302, or 303 of Title 11. That injunction applies “to all entities”, including governmental units, and prohibits:

§ 362 (a)(1)
(1) the commencement or continuation, including the issuance or employment of *840 process, of a judicial, administrative, or other action or proceeding against the debtor that was or could have been commenced before the commencement of the case under this title, or to recover a claim against the debtor that arose before the commencement of the ease under this title;
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(3) any act to obtain possession of property of the estate or of property from the estate or to exercise control over property of the estate;
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82 B.R. 837, 18 Collier Bankr. Cas. 2d 117, 1988 Bankr. LEXIS 260, Counsel Stack Legal Research, https://law.counselstack.com/opinion/advanced-professional-home-health-care-inc-v-blue-cross-blue-shield-mieb-1988.