Charlotte Memorial Hospital v. Bowen

665 F. Supp. 455, 1987 U.S. Dist. LEXIS 6669, 18 Soc. Serv. Rev. 876
CourtDistrict Court, W.D. North Carolina
DecidedJuly 21, 1987
DocketNo. C-C-85-310-P
StatusPublished
Cited by1 cases

This text of 665 F. Supp. 455 (Charlotte Memorial Hospital v. Bowen) is published on Counsel Stack Legal Research, covering District Court, W.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Charlotte Memorial Hospital v. Bowen, 665 F. Supp. 455, 1987 U.S. Dist. LEXIS 6669, 18 Soc. Serv. Rev. 876 (W.D.N.C. 1987).

Opinion

MEMORANDUM OF DECISION

ROBERT D. POTTER, Chief Judge.

Plaintiff in this matter has filed a Motion for summary judgment, and Defendant has filed a cross Motion for summary judgment.

A hearing was held at Charlotte, North Carolina on July 17, 1987 at which Gary A. Ratner, Assistant Regional Counsel, Region IV, appeared for Defendant and Robert E. Mazer, Attorney at Law, appeared for Plaintiff.

Under the Medicare Act (“Act”) Part A, health insurance is provided for the aged and disabled for hospital and post-hospital services. 42 U.S.C. § 1395 et seq. Under that law hospitals under agreement with the Secretary of Health and Human Services (“Secretary”) provide a wide range of services to Medicare beneficiaries and are paid from the Medicare Trust Fund, 42 U.S.C. § 1395ec(a), through fiscal intermediaries acting as the Secretary’s agent to review claims and make payments.

In the period 1979-81 fiscal years, which is the time period we are concerned with in this case, the Act provides that the hospitals will be reimbursed for their actual “reasonable cost,” 42 U.S.C. § 1395f(b)(l), which is determined in accordance with regulations promulgated by the Secretary. 42 U.S.C. § 1395x(v)(l)(A).

The regulations provide for reimbursement to the hospital of all necessary and proper (“allowable”) costs for patient care. 42 C.F.R. § 405.451 (now 413.9). Under the regulations the cost data must provide adequate financial data, and the cost data must be based on the accrual method of accounting. The regulations further provide that under the, accrual basis of accounting, expenses are reported in the period when they are incurred, regardless of when they are paid.

In this case, Plaintiff applied to the intermediary, Blue Cross and Blue Shield of North Carolina (“Blue Cross”) which, in accordance with the regulations, reviewed the cost report of Plaintiff and issued its “Notice of Program Reimbursement” on September 30, 1981 for the fiscal year ending September 30, 1979, and on September 30,1982 for the fiscal years ending September 30, 1980, and 1981.

Blue Cross disallowed compensation earned by executive employees which was held by Plaintiff and invested on their behalf pursuant to a contractual compensation arrangement, on the grounds that it [457]*457did not meet all the requirements for reimbursement.

Plaintiff made a timely request for an appeal before the Provider Reimbursement Review Board (“PRRB”) pursuant to 42 C.F.R. § 405.1835.

A hearing was held before the PRRB on May 19,1983 and it affirmed the intermediary’s adjustment. The decision of the PRRB was received by Plaintiff on March 15, 1985. By letter dated April 29, 1985, the Administrator of the Health Care Financing Administration declined to reverse, affirm, or modify the decision, entered by the PRRB. Plaintiff, having exhausted its administrative remedies, filed this complaint on May 14, 1985, pursuant to 42 U.S.C. § 1395oo (b) and 42 C.F.R. § 405.-1877.

The decision of the PRRB is REVERSED.

DISCUSSION

This matter is properly before the Court for determination on cross Motions for summary judgment by Plaintiff and by Defendant.

The issues in this case, as contended by Plaintiff, are four in number:

(1) Whether the Secretary may refuse to reimburse Charlotte Memorial for certain executive compensation costs in the year in which they were incurred, contrary to the Secretary’s regulations requiring reimbursement in accordance with accrual accounting principles, 42 C.F.R. § 405.453(a).
(2) Whether the Secretary may require Charlotte Memorial to place employee contributions to an executive compensation plan with a trustee or similar funding agency, which funding would eliminate the tax deferral for which the plan was created.
(3) Whether the Secretary may impose certain funding requirements set forth in its Provider Reimbursement Manual as an executive compensation plan funded entirely by employee contributions, contrary to the Manual’s express provisions.
(4) Whether the Secretary may hold that federal certificates of deposit are not an “acceptable type fund” in which employee contributions may be held, when he has explicitly approved other funding mechanisms which are identical in all relevant respects.

As stated by Plaintiff on p. 17 of its brief:

Judicial Review of a final decision by the Secretary is conducted under the Administrative Procedure Act, 5 U.S.C. § 706, 42 U.S.C. § 1395oo(f). The Administrative Procedure Act directs that an agency decision be reversed if it is unsupported by “substantial evidence” in the record or is arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law. 5 U.S.C. § 706(2)(A) and (E).

The Court will consider each of parties’ arguments as to the finding of the PRRB.

Plaintiff contends that the Secretary’s decision disallowing executive compensation costs is inconsistent with Medicare regulations mandating that all participant's in the medicare program maintain financial records and be reimbursed pursuant to the accrual method of accounting.

The Deferred Compensation Agreement in this case was established in 1972 and provided that a sum will be withheld from the regular pay of the employee and placed in a deferred compensation account which shall be separately maintained by the hospital for employees and invested by the Hospital. The Agreement further provides in Paragraph 3(D) that the breach by the employee of any of the covenants in subparagraphs (A), (B), and (C) of Paragraph 3 would result in a forfeiture of all rights of the Employee to receive any payments from the amounts set up as a credit to the employee.

The employee’s interest under Plaintiff’s deferred compensation plan being subject to a substantial risk of forfeiture avoids the pitfall of the economic benefit doctrine under the IRS Regulations which dictates that the promise to pay deferred compensa[458]*458tion constitutes the equivalent of cash to be taxed in the current year at present value.

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665 F. Supp. 455, 1987 U.S. Dist. LEXIS 6669, 18 Soc. Serv. Rev. 876, Counsel Stack Legal Research, https://law.counselstack.com/opinion/charlotte-memorial-hospital-v-bowen-ncwd-1987.