Duke University

578 F.2d 1389, 216 Ct. Cl. 412, 1978 U.S. Ct. Cl. LEXIS 78
CourtUnited States Court of Claims
DecidedMarch 17, 1978
DocketNo. 177-76
StatusPublished
Cited by1 cases

This text of 578 F.2d 1389 (Duke University) is published on Counsel Stack Legal Research, covering United States Court of Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Duke University, 578 F.2d 1389, 216 Ct. Cl. 412, 1978 U.S. Ct. Cl. LEXIS 78 (cc 1978).

Opinion

"This is a Medicare provider case, before the court on defendant’s motion for summary judgment and plaintiffs opposition thereto. The question in this case is which of two accounting methods should have been used to allocate employee fringe benefit costs to plaintiffs fiscal year 1967 Medicare program. For reasons which follow, we agree with defendant that the 'composite’ fringe benefit rate originally applied by plaintiff attributed á disproportionate amount of fringe benefit costs to the Medicare program and that retroactive adjustment to a 'differentiated’ fringe benefit rate (an adjustment made by the intermediary and affirmed by a provider appeal panel) must be sustained.

"Plaintiff, Duke University (the University), is a private educational institution which operates the Duke University Medical Center (the Medical Center). During the period at issue, June 1966 through June 30, 1967 (plaintiffs fiscal year 1967), the Medical Center was a voluntary general short-term care facility and a participating 'provider’ of Medicare program services under 42 U.S.C. § 1395x(u) (1970). One of the Medical Center’s claimed reimbursable costs was that portion of employee fringe benefits attributable to the Medicare program. In allocating these costs’, the Medical Center used a 'composite’ rate which had been established for the University as a whole and which was computed by figuring in the total payroll costs and fringe benefit package of all other University departments as well as the Medical Center.

"The Medical Center filed its cost report in April 1968. On May 20, 1968, Blue Cross and Blue Shield of North Carolina (the local delegee of the Blue Cross Association, the fiscal intermediary) made a preliminary settlement following a desk audit of the report. Final settlement was delayed, and, in 1971, the intermediary notified the Medical Center that the University-wide composite fringe benefit rate was not an acceptable method of establishing the Medicare portion of employee fringe benefits. Since plaintiff had apparently not retained records to establish [414]*414the actual fringe benefits paid to Medical Center employees, the intermediary allowed plaintiff to use another approximation. The fringe benefit rate acceptable to the intermediary required a four-part, 'differentiated,’ rate allocation which took into account the University’s four major fringe benefit packages applicable to four different classes of University employees (faculty and staff, biweekly employees, student employees, and hospital staff). The differentiated rate resulted in a disallowance of $26,592 of plaintiffs claimed reimbursable costs for fiscal year 1967.

"Plaintiff next appealed to the Blue Cross Association Provider Appeal Panel which, after a hearing, unanimously affirmed the intermediary’s adjustment. In May 1976, plaintiff filed the instant suit in this court. Though plaintiff has been using the four-part differentiated fringe benefit rate since November 1972, its position is that it should not be required to use the differentiated rate for the earlier years. Plaintiff seeks $26,5921 in Medicare benefits for its fisal year 1967 which it had claimed under its 'composite’ rate and which were disallowed by subsequent adjustment to the 'differentiated’ rate.

"Defendant moves for summary judgment, relying on the pleadings, its brief and exhibits, and the administrative record. Defendant argues it is undisputed that the 'composite’ rate used by plaintiff did not produce accurate results for any one segment of the University and that it, in fact, allocated a disproportionate share of University employee fringe benefit costs to the Medical Center and passed them on to the Medicare program. Defendant asserts that, because it charged non-Medicare costs to the Medicare program in violation of the statutory provisions and Medicare regulations,2 the composite rate is a clearly unacceptable method of allocation. Defendant argues that this court must sustain the retroactive adjustment applied by the provider appeal panel.

[415]*415"Plaintiff asserts that (1) there is no administrative record for the court to rely on in this case, but merely a series of informal discussions between the University and the Provider Appeal Panel, (2) the 'composite’ rate which plaintiff had originally used is a reasonable and proper method of allocation, and in any event, (3) in this case, it would be so unfair to apply the change in allocation method retroactively that defendant should be barred from making such an adjustment. Plaintiff also asserts that there are material facts in dispute. Plaintiff seeks a trial de novo in this court and maintains that this case is not appropriate for summary resolution.

"This court has had sufficient experience with Medicare provider cases that it is able to dispose of plaintiffs points with some brevity. The legal questions pertinent to the instant case have already been resolved and, as applied to the undisputed material facts here, lead us to hold for defendant.

"Plaintiffs first contention, that there is no administrative record for this court to consider (despite the fact that there has been an appeal to the Blue Cross Association Provider Appeal Panel) overlooks our prior cases which have outlined the nature of such administrative proceedings. We have held that an administrative appeal to the Provider Appeal Panel is compulsory;3 that proceedings before the Panel comport with due process;4 and that our scope of review of those proceedings is very narrow.5 It is, thus, well established that the hearing before the Provider Appeal Panel is an administrative proceeding and does produce an administrative record which this court may consider.

"Plaintiffs second point, that its 'composite’ I fringe benefit rate is a reasonable and proper method of allocation, was fully considered by the Provider Appeal Panel. Plaintiffs contention is that, given the inexactness [416]*416of any accounting system which uses approximations rather than actual cost, the choice of how far to carry the refinements so as to approach actual cost is a matter of judgment and no single method is proper. The Provider Appeal Panel (with knowledge that, of some nine other hospital-university complexes which receive Medicare grants, not one of them used an accounting system such as plaintiffs) was not persuaded. It was the Panel’s finding that, notwithstanding the disparate degrees of sophistication in cost accounting techniques possessed by providers in the early days of the Medicare program:

The composite rate used by [plaintiff] is subject to the rather serious criticism that the relative mix of salary levels between the hospital and university is not the same in that the hospital employs proportionately more unskilled and semiskilled workers, and, thus, the salary and the fringe benefit levels of hospital employees are below the levels of the rest of the university. As a result, the use of a composite rate produces an over allocation of fringe benefits to the hospital. If the Provider were permitted to use a composite rate the result would be that the Medicare Program would be paying a portion of the compensation of university employees not engaged in patient care activities.

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Related

Sumner v. United States
678 F.2d 202 (Court of Claims, 1982)

Cite This Page — Counsel Stack

Bluebook (online)
578 F.2d 1389, 216 Ct. Cl. 412, 1978 U.S. Ct. Cl. LEXIS 78, Counsel Stack Legal Research, https://law.counselstack.com/opinion/duke-university-cc-1978.