Humana, Inc. v. Margaret M. Heckler, Secretary, Department of Health and Human Services. (Four Cases) Humana of South Carolina, Inc., Doing Business as Coleman-Aimar Hospital, a Corporation v. Margaret M. Heckler, Secretary, Department of Health and Human Services

758 F.2d 696
CourtCourt of Appeals for the D.C. Circuit
DecidedApril 26, 1985
Docket82-1986
StatusPublished

This text of 758 F.2d 696 (Humana, Inc. v. Margaret M. Heckler, Secretary, Department of Health and Human Services. (Four Cases) Humana of South Carolina, Inc., Doing Business as Coleman-Aimar Hospital, a Corporation v. Margaret M. Heckler, Secretary, Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humana, Inc. v. Margaret M. Heckler, Secretary, Department of Health and Human Services. (Four Cases) Humana of South Carolina, Inc., Doing Business as Coleman-Aimar Hospital, a Corporation v. Margaret M. Heckler, Secretary, Department of Health and Human Services, 758 F.2d 696 (D.C. Cir. 1985).

Opinion

758 F.2d 696

244 U.S.App.D.C. 376, 9 Soc.Sec.Rep.Ser. 176,
Medicare&Medicaid Gu 34,572

HUMANA, INC., et al., Appellants,
v.
Margaret M. HECKLER, Secretary, Department of Health and
Human Services. (Four Cases)
HUMANA OF SOUTH CAROLINA, INC., doing business as
Coleman-Aimar Hospital, a corporation, Appellant,
v.
Margaret M. HECKLER, Secretary, Department of Health and
Human Services.

Nos. 82-1986, 82-1987, 82-1989, 82-1994 and 82-1995.

United States Court of Appeals,
District of Columbia Circuit.

Argued April 22, 1983.
Decided April 2, 1985.
As Amended April 26, 1985.

Appeals from the United States District Court for the District of Columbia (D.C. Civil Action Nos. 78-00175, 81-01311, 75-00302, 81-00853, 78-00584)

Lee Calligaro, Washington, D.C., with whom Thomas H. Brock, Washington, D.C., was on the brief, for appellants.

David B. Palmer, Atty. Dept. of Health and Human Services, Washington, D.C., of the Bar of the District of Columbia Court of Appeals, pro hac vice, by special leave of Court, with whom Juan A. del Real, Gen. Counsel and Lynne K. Zusman, Deputy Gen. Counsel, Dept. of Health and Human Services, and Henry R. Goldberg, Atty. Dept. of Health and Human Services, Washington, D.C., were on the brief for appellee.

Stanley S. Harris, U.S. Atty., Washington, D.C., at the time the brief was filed, Royce C. Lambert, R. Craig Lawrence and Nathan Dodell, Asst. U.S. Attys., Washington, D.C., entered appearances for appellee.

Before WALD and SCALIA, Circuit Judges, and BAZELON, Senior Circuit Judge.

Opinion for the Court PER CURIAM.

PER CURIAM:

Petitioners Humana, Inc. and sixty-four of its subsidiary acute care proprietary hospitals appeal from a district court decision limiting reimbursement under the Medicare Act, Title XVIII of the Social Security Act.1 Humana argues that reimbursement should be calculated by means of a formula based on all of the costs it actually incurred in providing services to Medicare beneficiaries. The district court, upholding the decision of the Secretary of Health and Human Services (the Secretary), held that certain of these costs were not necessary in the efficient delivery of needed health services and therefore denied reimbursement.

We affirm disallowance of reimbursement for 1) stock maintenance costs, 2) income taxes, and 3) the inclusion of income tax liability in the calculation of equity capital. We also find that the rate of return on equity capital prescribed by the Secretary was reasonable. We vacate the district court's holding disallowing reimbursement for stock acquisition costs when an acquired corporation is liquidated or merged into the acquiring corporation.

I. BACKGROUND

A. The Medicare Statutory Scheme

In 1965, Congress enacted the Medicare Act2 (the Act), which created an extensive program of health insurance for the aged and disabled. Part A of the Act3 entitled participating hospitals to reimbursement for the reasonable costs of medical services with such costs being limited to "the cost actually incurred, excluding therefrom any part of the incurred cost found to be unnecessary in the efficient delivery of needed health services."4 Under the statutory scheme, reimbursable costs include both direct and indirect costs of patient care.5 Direct costs are those directly related to patient care such as nursing services and medication. Indirect costs include such items as return on equity capital and depreciation of plant and equipment. The Secretary is charged with developing regulations "establishing the methods or method to be used and the items to be included in determining [reasonable] costs."6

These appeals challenge the Secretary's determinations regarding certain of these indirect costs: 1) reimbursement of stock maintenance costs, 2) reimbursement of income taxes, 3) the treatment of tax liability in calculating equity capital, 4) the allowable rate of return on equity, and 5) stock acquisition costs.

B. Proceedings Below

All of these appeals, with the exception of Humana of South Carolina v. Mathews,7 began as the subject of administrative proceedings before the Provider Reimbursement Review Board (PRRB).8 While Humana of South Carolina was pending, Humana's fiscal intermediaries9 disallowed the reimbursement of certain costs to the hospitals. The hospitals appealed to the PRRB challenging the fiscal intermediaries' disallowance in three areas: 1) the cost of federal and state income taxes, 2) stock maintenance costs, and 3) costs incurred in acquiring new facilities by purchasing one hundred percent of the capital stock of another corporation.

The PRRB held that: 1) Humana was not entitled to reimbursement for income taxes, nor could it exclude income tax liability from the calculation of equity capital; 2) it was entitled to reimbursement for stock maintenance costs; and 3) subsequent to the acquisition of one hundred percent of the capital stock of other hospitals, five of the hospitals in question were entitled to increase their asset valuation while seven were not. The Administrator of the Health Care Financing Administration (HCFA) later reviewed and reversed the portions of the PRRB's decision which ruled in Humana's favor. Humana appealed these adverse decisions of both the PRRB and the HCFA and filed identical claims for the fiscal years ending in 1974 and 1975. In August 1979, Humana amended its complaint10 to include additional claims in which the PRRB decision represented final agency action.11 The district court issued its memorandum opinion in August 1982, affirming the Secretary's decision on all issues.

II. ANALYSIS

A. Standard of Review

The Medicare Act itself12 incorporates the standard of review set out in section 706 of the Administrative Procedure Act.13 As a reviewing court, we are permitted to set aside the Secretary's decision only if it is "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law."14 It is undisputed that Congress, in the statute, granted broad discretion to the Secretary to develop the "reasonable cost" concept through regulations.15 The Secretary's interpretations of the statutes that she administers are entitled to great deference.16 With this standard of review in mind, we consider each of the claims.

B.

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