Homan & Crimen, Inc. v. Patricia Roberts Harris, Secretary of Health and Human Services, Defendant

626 F.2d 1201, 1980 U.S. App. LEXIS 13523
CourtCourt of Appeals for the Fifth Circuit
DecidedOctober 1, 1980
Docket78-3364
StatusPublished
Cited by57 cases

This text of 626 F.2d 1201 (Homan & Crimen, Inc. v. Patricia Roberts Harris, Secretary of Health and Human Services, Defendant) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Homan & Crimen, Inc. v. Patricia Roberts Harris, Secretary of Health and Human Services, Defendant, 626 F.2d 1201, 1980 U.S. App. LEXIS 13523 (5th Cir. 1980).

Opinion

RONEY, Circuit Judge:

The Secretary of Health and Human Services appeals from a judgment of the district court reversing her determination that increased Medicare reimbursement for *1204 indirect costs such as depreciation, interest and return on equity cannot be based on a step-up in basis resulting when all the stock of a Medicare provider is purchased but the corporate provider continues to own the assets. Finding that the Secretary’s interpretation of the Medicare Act and the regulations issued pursuant thereto are reasonable and entitled to judicial deference, we reverse.

A. BACKGROUND

The Medicare Act, Title XVIII of the Social Security Act, 42 U.S.C.A. §§ 1395-1395rr, was enacted in 1965 and created a broad program of health insurance for the aged and disabled. Part A of the Medicare Act provides hospital insurance and covers expenses of hospital and certain post-hospital services. Under Part A, hospitals which participate in the program are designated “providers of services” and are paid the reasonable costs of services provided to Medicare patients. 42 U.S.C.A. §§ 1395x(u) and 1395f(b). 1

The “reasonable costs” of care rendered to Medicare beneficiaries, for which “providers” are entitled to receive reimbursement, are defined by statute and regulations. 42 U.S.C.A. § 1395x(v)(l)(A) and (B); 2 42 C.F.R. §§ 405.401-.544 (1979). In *1205 addition to defining reimbursable reasonable costs as those directly related to patient care services such as nursing care and drugs, the regulations, as required by statute, allow reimbursement of indirect costs required for patient care, such as depreciation on buildings and equipment, interest incurred on loans and a return on equity capital. It is reimbursement for these indirect costs which is at issue in this case.

B. FACTS

The material facts are not in dispute. On January 1, 1972, Medenco, Inc., through its wholly owned subsidiary Southwestern General Hospital, Inc., purchased 100% of the stock of Homan & Crimen, Inc., an unrelated corporation doing business as Southwestern General Hospital. The purchase price was $1 million in cash and notes. The transaction was negotiated at arms length and the price reflected the fair market value of the hospital and its assets.

Immediately following the purchase, Medenco assumed complete management and control over the operation of the hospital. Although operating through the corporate form, Medenco in effect installed its own management team, negotiated new contracts for ancillary services, terminated the previously existing pension plan and removed bank accounts to new banks. A $1.5 million capital expenditure program resulted in a complete renovation of the facility. Homan & Crimen, however, was never liquidated and it continued to own the assets and participate in the Medicare program under the same provider agreement.

The purchase price plus other costs associated with the acquisition exceeded the net book value of the hospital by almost $830,-000. When Homan & Crimen, d/b/a Southwestern General Hospital, submitted its Medicare cost reports for the 1972 and 1973 fiscal years, it claimed the $830,000 as a step-up in the cost basis of its assets, which resulted in higher claimed reimbursement for depreciation, interest, and return on equity capital. The additional reimbursement on the $830,000 step-up was disallowed by the Secretary’s intermediary. Plaintiff appealed those disallowances to the Provider Reimbursement Review Board (PRRB), a five-member panel of experts authorized by Congress to resolve such disputes. 42 U.S. C.A. § 1395oo. The PRRB reversed the decision of the intermediary and allowed the additional reimbursement, ruling that the purchase of 100% of the Homan & Crimen stock and actual assumption of management by Medenco constituted a purchase of an ongoing hospital operation.

Under 42 U.S.C.A. § 1395oo(f) and 42 C.F.R. § 405.1875 (1979), the Secretary, on her own motion and at her discretion, may review a decision of the PRRB and on review has all the powers she would have if making the initial determination. 5 U.S.C.A. § 557(b). Thus the decision of the PRRB carries no more weight on review by the Secretary than any other interim decision made along the way in an agency where the ultimate decision of the agency is controlling. The argument that the court should recognize the expertise of the members of the PRRB must be met with the assumption that those persons within the agency who assisted the Secretary in a contrary decision must be regarded as being equally expert. Pursuant to her authority, the Secretary (through the Social Security Commissioner) reviewed the PRRB’s decision and held that the stock acquisition transaction was not a change of ownership which would justify stepping up the cost basis of the assets from the historical cost of the assets to Homan & Crimen. That *1206 decision was in turn challenged in federal district court by Medenco, Southwestern General Hospitals, Inc., and Homan & Crimen.

The statute permitting district court review of the Secretary’s reversal of a PRRB decision, 42 U.S.C.A. § 1395oo(f), 3 applies only to fiscal years ending on or after June 30, 1973. Social Security Amendments of 1972, Pub.L. 92-603, § 243(c), 86 Stat. 1329 (1972), as amended by Act of Oct. 26, 1974, Pub.L. 92-484, § 3, 88 Stat. 1459 (1974). As to earlier fiscal years, we held in Dr. John T. McDonald Foundation v. Califano, 571 F.2d 328 (5th Cir.) (en banc), cert. denied, 439 U.S. 893, 99 S.Ct. 250, 58 L.Ed.2d 238 (1978), that the district court has no jurisdiction to hear providers’ appeals but that such cases may be transferred to the Court of Claims. Pursuant to that opinion, the district court ordered the claim for fiscal year 1972 transferred to the Court of Claims. That order is not appealed here.

The plaintiffs’ claims for fiscal year 1973 were reviewed by the district court. The court, under the standard of review in 5 U. S.C.A. § 706, 4 found the Secretary’s interpretation to be in conflict with the statute requiring that costs related to delivery of services to Medicare patients not be borne by non-Medicare patients. The district court reversed the determination of the Secretary and directed that the decision of the PRRB be reinstated. This appeal followed.

Both parties recognize that at the time this dispute arose, no single provision of the Medicare regulations explicitly resolved the issue. On February 5, 1979, the Secretary published amendments to the regulations which specifically resolved the conflict in favor of the Secretary’s interpretation. 44 Fed.Reg. 6912 (1979). The amendments by their own terms have prospective application only, so they do not control here.

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Bluebook (online)
626 F.2d 1201, 1980 U.S. App. LEXIS 13523, Counsel Stack Legal Research, https://law.counselstack.com/opinion/homan-crimen-inc-v-patricia-roberts-harris-secretary-of-health-and-ca5-1980.