Albany General Hospital v. Heckler

657 F. Supp. 87, 1987 U.S. Dist. LEXIS 2676
CourtDistrict Court, D. Oregon
DecidedJanuary 22, 1987
DocketCiv. No. 83-851-FR
StatusPublished

This text of 657 F. Supp. 87 (Albany General Hospital v. Heckler) is published on Counsel Stack Legal Research, covering District Court, D. Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Albany General Hospital v. Heckler, 657 F. Supp. 87, 1987 U.S. Dist. LEXIS 2676 (D. Or. 1987).

Opinion

FRYE, Judge:

Plaintiffs, various community hospitals throughout the State of Oregon, filed this case to recover Medicare reimbursement amounts due to them for cost reporting periods ending in 1980 and 1981. Plaintiffs challenged defendant, Secretary of Health and Human Services’ (the Secretary), Malpractice Rule, 42 C.F.R. § 405.452(b)(l)(ii) (1980), adopted in 1979 (the 1979 Rule) on the grounds that it violated the Medicare Act, P.L. 89-97, Codified at 42 U.S.C. §§ 1395, et seq. On cross-motions for summary judgment, this court held that the 1979 Rule was inconsistent with the Medicare Act, Albany General Hospital v. Heckler, 584 F.Supp. 614 (D.Or.1984), and ordered defendant to reimburse plaintiffs in a manner consistent with its Opinion and Order of March 2, 1984.

The Secretary appealed the court’s ruling. During the time of the appeal, the Secretary developed and promulgated a “new” Malpractice Rule, 51 Fed.Reg. 11142 (1986) (the 1986 Rule), which was published in final form on April 1, 1986, with an effective date of May 1, 1986. The 1986 Rule states that it replaces the 1979 Rule and applies retroactively “to cost reporting periods beginning on or after July 1,1979.” Id.

By order dated July 29, 1986, 796 F.2d 478, the Ninth Circuit remanded this case to the district court to consider the consequences of the Secretary’s adoption of the 1986 Rule. Thus, the issue presently before the court is whether promulgation of the 1986 Rule has any effect on the judgment previously entered by this court.

HISTORY OF THE VARIOUS RULES

Prior to the issuance of the 1979 Rule, Medicare reimbursed hospitals for the cost of malpractice insurance based upon the ratio of Medicare patient utilization of hospital services to total patient utilization of hospital services.

Under this “utilization” method of apportionment, which is the basic standard for most Medicare reimbursement, all of a hospital’s “allowable” costs are assigned to particular cost centers, of which there are two types: (a) revenue-producing, and (b) non-revenue-producing. Non-revenue-producing cost centers supply services for which patients are not billed. These costs are frequently referred to as overhead costs. Housekeeping and dietary services are examples of non-revenue-producing cost centers. By contrast, a patient is specifically billed for services furnished by a revenue-producing cost center. The radiology department, operating room, and laboratory are examples of revenue-producing cost centers. The costs in non-revenue-producing cost centers, including those accumulated in the General and Administrative (G & A) cost center, are then allocated to the revenue-producing cost centers. Once allocated to a revenue-producing cost center, the total costs in each center are then apportioned to determine the proportion of costs that Medicare beneficiaries must pay, based upon the percentage of total services in that cost center utilized by Medicare patients. As the court noted above, this is the method used to determine the cost of malpractice insurance attributable to Medicare patients and for which the hos[89]*89pitáis were reimbursed by the Secretary prior to the adoption of the “Malpractice Rule.” [The 1979 Rule].

Albany General Hospital v. Heckler, 584 F.Supp. 614, 616 (D.Or.1984).

Alarmed by increases in the cost of hospital malpractice insurance premiums, the Medicare Bureau within the Department of Health and Human Services began a study of malpractice insurance costs in 1975. The Bureau concluded that Medicare’s share of a hospital’s yearly malpractice insurance premium was extremely high in comparison with the amount of money actually paid on malpractice claims filed by Medicare patients. These studies led to the promulgation of the 1979 Rule, which resulted in the following system of reimbursement:

If 99% of a hospital’s patients are Medicare patients and if the hospital has paid one malpractice claim over the past five years, and that claim was paid to a Medicare beneficiary, 100% of that hospital’s malpractice costs will be reimbursed by Medicare. On the other hand, if that one claim was paid to a non-Medicare patient, Medicare will not reimburse any of the hospital’s malpractice costs, despite the fact that 99 percent of the patients at that hospital are Medicare patients. If no malpractice claims have been paid during the five-year period, the hospital will be reimbursed for 5.1% of its cost of providing hospital malpractice insurance, regardless of the percent of its patients which are Medicare patients and regardless of the fact that these Medicare patients have been covered by hospital malpractice insurance during all of their stay in the hospital.

Albany General, 584 F.Supp. at 618.

The 1979 Rule has been challenged numerous times. No appellate court has upheld the 1979 Rule. Every district court upholding the Rule has been reversed. The relevant court of appeals decisions are Bethesda Community Hospital v. Bowen, 795 F.2d 1004 (2nd Cir.1986); Cumberland Medical Center v. Secretary of H.H.S., 781 F.2d 536 (6th Cir.1986); Bedford County Memorial Hospital v. Heckler, 769 F.2d 1017 (4th Cir.1985); Menorah Medical Center v. Heckler, 768 F.2d 292 (8th Cir.1985); DeSoto General Hospital v. Heckler, 766 F.2d 182, as amended, 776 F.2d 115 (5th Cir.1985); Lloyd Noland Hospital and Clinic v. Heckler 762 F.2d 1561 (11th Cir. 1985); St. James Hospital v. Heckler, 760 F.2d 1460 (7th Cir.), cert. denied, — U.S. -, 106 S.Ct. 229, 88 L.Ed.2d 228 (1985); Humana of Aurora, Inc. v. Heckler, 753 F.2d 1579 (10th Cir.), cert. denied, — U.S. -, 106 S.Ct. 180, 88 L.Ed.2d 149 (1985); Abington Memorial Hospital v. Heckler, 750 F.2d 242 (3d Cir.1984), cert. denied, — U.S. -, 106 S.Ct. 180, 88 L.Ed.2d 149 (1985); and Walter O. Boswell Memorial Hospital v. Heckler, 242 U.S.App.D.C. 110, 749 F.2d 788 (1984) (remanding with suggestion that 1979 Rule is invalid).

The Secretary seeks to avoid the application of the pre-1979 Rule by adopting the 1986 Rule, which declares itself retroactive “to cost reporting periods beginning on or after July 1, 1979.”

CONTENTIONS OF THE PARTIES

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Bluebook (online)
657 F. Supp. 87, 1987 U.S. Dist. LEXIS 2676, Counsel Stack Legal Research, https://law.counselstack.com/opinion/albany-general-hospital-v-heckler-ord-1987.