Alexandria Hospital v. Bowen

631 F. Supp. 1237, 1986 U.S. Dist. LEXIS 27464
CourtDistrict Court, W.D. Virginia
DecidedMarch 31, 1986
DocketCiv. A. 85-C-676-R
StatusPublished
Cited by5 cases

This text of 631 F. Supp. 1237 (Alexandria Hospital v. Bowen) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Alexandria Hospital v. Bowen, 631 F. Supp. 1237, 1986 U.S. Dist. LEXIS 27464 (W.D. Va. 1986).

Opinion

MEMORANDUM OPINION

TURK, Chief Judge.

This action arises under Title XVIII of the Social Security Act, 42 U.S.C. § 1395-1395xx, commonly known as the Medicare statute. The plaintiff hospitals continue their challenge to the validity of a regulation promulgated by the Department of Health & Human Services (“HHS”) in 1979 governing reimbursement to hospitals for costs of malpractice insurance incurred rendering services to Medicare patients. On December 30, 1985 this court entered partial summary judgment on behalf of the plaintiff hospitals. The case is now before the court on defendant’s motions to reconsider the grant of partial summary judgment and to dismiss the complaint for lack of subject matter jurisdiction. For the reasons set forth below, defendant’s motion to reconsider is granted and the court’s order of December 30, 1985 is vacated. In addition, defendant’s motion to dismiss will be granted.

BACKGROUND

This is another chapter in the by now familiar saga of hospitals seeking to recover the costs of malpractice insurance incurred in rendering services to Medicare patients. The controversy stems from the HHS regulation governing reimbursement of malpractice costs attributable to Medicare patients, 42 C.F.R. 405.452(a)(1)(ii) (1985). At last count, more than twenty-six district courts, including this one, see Bedford County Memorial Hospital v. Heckler, 583 F.Supp. 367 (W.D.Va.1984), aff'd 769 F.2d 1017 (4th Cir.1985), had invalidated the 1979 malpractice regulation. 1 *1239 The case is brought as part of the Virginia Hospital Association group appeal program. In 1983, Virginia hospitals participating in the Medicare program joined together in a group sponsored by the Virginia Hospital Association and filed a group appeal for reimbursement of malpractice-related costs before the Provider Reimbursement Review Board (the “PRRB” or “Board”), as contemplated by 42 U.S.C. § 1395oo(b). This suit is the result of a “follow-up” group appeal in which the hospitals have attempted to recover costs incurred in subsequent cost years. The complaint states that the hospitals are appealing intermediary settlements for cost years ending in 1980, 1981, 1982 and 1983.

The hospitals allege that at the close of each fiscal year, they submitted required cost reports to their fiscal intermediaries as required by law. See 42 C.F.R. § 405.-406(b) (1985). They then sought administrative review of the intermediaries’ settlement of their reimbursement for malpractice costs before the PRRB. The record does not indicate, however, when the appeals were first lodged with the PRRB.

After their appeals had been pending with the PRRB for some time, the hospitals on March 26, 1985 requested expedited judicial review (“EJR”) from the PRRB, pursuant to 42 U.S.C. § 1395oo(f), with respect to malpractice insurance cpsts disallowed in Notices of Program Reimbursement for the cost years in issue. On April 26, 1985, the PRRB sent notice to the hospitals that it required further documentation regarding their appeal. On May 9, 1985, the hospitals allege that they provided the PRRB with all the documentation it had requested, and renewed their EJR request. PRRB records, however, do not contain the hospitals’ May 9 correspondence. When the PRRB failed to respond to the hospitals’ EJR request within 30 days of the May 9 letter, and the PRRB failed to respond to hospital phone calls concerning the status of the EJR request, the hospitals filed this action on August 5, 1985 to protect their rights under 42 U.S.C. § 1395oo (f), which requires such actions to be brought within 60 days of the lapse of the 30-day EJR evaluation period.

Near the end of the 60-day period for filing its answer to the complaint, the defendant requested an additional 60 days to file its answer. On December 4, 1985, defendant filed an answer, admitting that jurisdiction exists in this court under 42 U.S.C. § 1395oo (f) for the claims of almost all the hospitals. Only with respect to the claims of Arlington Hospital, Culpepper Memorial Hospital and Mary Immaculate Hospital did the defendant contest jurisdiction, alleging their failure to exhaust administrative remedies. It is now clear, however, that defendant’s answer was formulated without seeing the PRRB records of the hospitals’ claims, because those records were lost until sometime in January, 1986.

On December 27,1985, the hospitals filed a motion for partial summary judgment based upon the binding precedent of Bedford County Memorial Hospital v. Heckler, 769 F.2d 1017 (4th Cir.1985). On December 30, 1985, before the defendant had an opportunity to respond to the hospitals’ motion, the court entered partial summary judgment for plaintiffs and directed the parties to confer and report within 20 days concerning the only jurisdictional issues joined by the pleadings: whether the three hospitals named above were properly before the court because they had “self-disallowed” the costs at issue in their cost reports. 2

Counsel had several telephone conferences on the subject set forth in the court’s order of December 30. During these conferences, counsel for the defendant informed plaintiffs’ counsel that the PRRB’s Legal Advisor had been and was still unable to find the files in this case. The hospitals then supplied defendant with nar *1240 rative descriptions of the jurisdictional facts on January 13, 1986 and offered to make available any other documents he might need. Finally, at some point after receiving the hospitals’ description of the jurisdictional facts in this case, defendant’s counsel received the PRRB records relating to the hospitals’ claims.

On February 4,1986, the hospitals filed a motion for entry of a final order, along with a proposed stipulation of facts. On February 14, 1986, defendant filed the motions currently before the court. Defendant urges this court to reconsider the grant of partial summary judgment and to dismiss the complaint for lack of jurisdiction.

ANALYSIS

I. The Motion to Reconsider

The court will first consider defendant’s motion to reconsider its grant of partial summary judgment. For the reasons set forth below, defendant’s motion to reconsider is granted, and this court’s order of December 30, 1985 granting partial summary judgment to the hospitals is vacated.

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Cite This Page — Counsel Stack

Bluebook (online)
631 F. Supp. 1237, 1986 U.S. Dist. LEXIS 27464, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alexandria-hospital-v-bowen-vawd-1986.