Gingold v. United States Ex Rel. Department of Health & Human Services (In Re Shelby County Healthcare Services)

80 B.R. 555, 17 Collier Bankr. Cas. 2d 1192, 1987 Bankr. LEXIS 1840, 16 Bankr. Ct. Dec. (CRR) 1050, 1987 WL 4451
CourtUnited States Bankruptcy Court, N.D. Georgia
DecidedSeptember 8, 1987
Docket19-51644
StatusPublished
Cited by29 cases

This text of 80 B.R. 555 (Gingold v. United States Ex Rel. Department of Health & Human Services (In Re Shelby County Healthcare Services)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, N.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gingold v. United States Ex Rel. Department of Health & Human Services (In Re Shelby County Healthcare Services), 80 B.R. 555, 17 Collier Bankr. Cas. 2d 1192, 1987 Bankr. LEXIS 1840, 16 Bankr. Ct. Dec. (CRR) 1050, 1987 WL 4451 (Ga. 1987).

Opinion

ORDER

STACEY W. COTTON, Bankruptcy Judge.

Presently before the court is the motion of the United States of America, on behalf of its agency the. Department of Health and Human Services, (“HHS”), to dismiss the complaint in the above-styled adversary proceeding for lack of subject matter jurisdiction. In the underlying complaint the trustee of the estates of the debtors objects to the allowance of certain claims filed by HHS. These claims are based on home healthcare provider cost reimbursement adjustments under the Medicare program. The trustee also seeks judgment against HHS for funds allegedly held and owed by HHS that are property of debtors’ estates. The trustee argues that this court has jurisdiction of the entirety of this proceeding notwithstanding the involvement of Medicare reimbursement issues.

Based on an examination of the record, there does not appear to be any factual dispute. Accordingly the court makes findings of fact and conclusions as set forth hereinafter.

Each of the debtors was in the business of rendering home healthcare services. Each debtor is a wholly-owned subsidiary of Healthcare Services, Inc. (“HSI”) whose sole shareholder is Joseph H. Hale. A substantial portion of debtors’ revenues was derived from the Medicare program as administered by HHS through its Health Care Financing Administration (“HCFA”). See 42 U.S.C. Sections 1395c through i — 2, 1395x(u). After entering a provider agreement with the Secretary of HHS (42 U.S.C. Sections 1395x(u), 1395cc), the provider becomes entitled to payment for the lesser of “reasonable cost” or “customary charge” for allowable services provided to Medicare beneficiaries. 42 U.S.C. Sections 1395f(b), 1395x(v). HCFA contracts with various health insurance carriers as fiscal in *557 termediaries in processing and paying claims submitted by providers. 42 U.S.C. Section 1395h. Reimbursement payments are made on an interim basis throughout the fiscal year. These payments, however, are subject to adjustment by HHS for any overpayments or underpayments. 42 U.S. C. Section 1395g; 42 C.F.R. Section 405.-405, 405.454; Neuman v. Blue Cross/Blue Shield of Greater New York (In re Neuman), 55 B.R. 702, 706 (S.D.N.Y.1985).

The providers submit an annual cost report which the intermediary audits and reviews. 42 U.S.C. Section 1395h(a). The intermediary then issues a “Notice of Amount of Medicare Program Reimbursement” (“NPR”), stating final adjustments and Medicare reimbursement allowed and any amounts due by either the provider or HHS, with respect to the interim payments made. 42 C.F.R. Sections 405.1803, 405.-454(f)(3). Pursuant to the procedural requirements of 42 U.S.C. Section 1395oo (a), a provider may request a hearing before the Provider Reimbursement Review Board (“PRRB”) for review of a determination of the amount of total program reimbursement due made by a fiscal intermediary. The decision is final unless the Secretary of HHS reviews the ruling and a provider may thereafter seek judicial review. 42 U.S.C. Section 1395oo (f)(1).

In his complaint, the trustee alleges that as a result of tax assessments and levies against Joseph Hale, Health Care International, Inc., and non-debtor corporations owned by Hale, by the United States, through its agency the Internal Revenue Service, debtors were forced to terminate their business and commence the above-styled bankruptcy cases. The previous trustee filed cost reports for the debtors asserting Medicare receivables of $1,300,-000.00 and acknowledging payables to their intermediaries of $860,000.00. The intermediaries thereafter issued NPR’s disallowing debtors’ costs by the sum of over $3,500,000.00. Various reasons are alleged for the disallowance and among them in particular, debtors’ failure to pay certain costs within one year following the cost reporting period. The trustee asserts that such costs could not be paid as prepetition claims except in accordance with a Chapter 7 distribution. Before and during debtors’ filings of their bankruptcy petitions, interim Medicare payments were reduced to recoup overpayments as determined by debtors’ intermediaries over several of the previous fiscal years.

CONCLUSIONS OF LAW

HHS argues that this court lacks subject matter jurisdiction over the claims raised in the trustee’s complaint. It contends judicial review of disputed final determinations of Medicare program reimbursement is appropriate only after the administrative appeals process established in 42 U.S.C. Section 1395oo (f) is exhausted. HHS further maintains that all of the claims set forth in the trustee’s complaint are governed by jurisdictional preclusion even though they allege theories of relief other than a frontal challenge to the Medicare reimbursement determinations. Weinberger v. Salfi, 422 U.S. 749, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975). See also Marin v. HEW, Health Care Financing Agency, 769 F.2d 590, 592 (9th Cir.1985). HHS contends that this jurisdictional limitation applies with equal force in the bankruptcy court as in the district court. Finally, HHS maintains that sovereign immunity prevents this court from exercising jurisdiction in this adversary proceeding until the debtors exhaust their administrative remedies. See generally 11 U.S.C. Section 106.

The trustee counters arguing that the underlying claims and objections both arise in and are related to debtors’ cases and property of their estates under Title 11. See 28 U.S.C. Section 1334(a), (b), (d). The estates could gain over $1,300,000.00 for the benefit of creditors as well as the disal-lowance of over $2,300,000.00 in claims as a result of this proceeding. In accordance with 28 U.S.C. Section 157(b)(2)(B), the trustee argues, objections to allowance of HHS’ claims constitute core proceedings which were referred to this court by the district court. Additionally, the trustee argues the affirmative claims are counterclaims by the estates against persons filing claims against the estate or seek orders to *558 turn over property of the estate. 28 U.S.C. Section 157(b)(2)(C) and (E).

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Bluebook (online)
80 B.R. 555, 17 Collier Bankr. Cas. 2d 1192, 1987 Bankr. LEXIS 1840, 16 Bankr. Ct. Dec. (CRR) 1050, 1987 WL 4451, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gingold-v-united-states-ex-rel-department-of-health-human-services-in-ganb-1987.