In Re Consumer Health Services of America, Inc.

171 B.R. 917, 31 Collier Bankr. Cas. 2d 1497, 1994 Bankr. LEXIS 1502, 1994 WL 513295
CourtDistrict Court, District of Columbia
DecidedAugust 5, 1994
DocketBankruptcy 87-00168
StatusPublished
Cited by4 cases

This text of 171 B.R. 917 (In Re Consumer Health Services of America, Inc.) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Consumer Health Services of America, Inc., 171 B.R. 917, 31 Collier Bankr. Cas. 2d 1497, 1994 Bankr. LEXIS 1502, 1994 WL 513295 (D.D.C. 1994).

Opinion

DECISION RE MOTION OF SECRETARY OF HEALTH AND HUMAN SERVICES RIGHT TO RECOUP

S. MARTIN TEEL, Jr., Bankruptcy Judge.

The Secretary of Health and Human Services (“Secretary”) has filed a motion requesting that the court affirm his right to make recoupment under a Health Insurance Benefits Agreement (“Provider Agreement”) with the Debtor and in the alternative, if this court deems it necessary, to grant the Secretary relief from the automatic stay to make such recoupment. The Trustee, Roger Schlossberg, has responded on the merits fully opposing the motion. 1 The court heard the parties argue the matter by telephone. At oral argument, the Secretary, through counsel, stated that what the Secretary seeks is a ruling that the Secretary may "withhold the sums owed the Debtor. The court has determined to deny such relief.

FACTS

This contested matter involves Title XVIII of the Social Security Act (42 U.S.C. §§ 1395 through 1395cec) entitled “Health Insurance *919 for Aged and Disabled” and commonly referred to as the Medicare program. As part of its business, the Debtor provided services to Medicare beneficiaries as a home health agency. On October 15,1976, the Debtor, by its president, executed the Provider Agreement which the Secretary accepted on June 14, 1977. 2 The Agreement merely recites that the Debtor agrees not to charge, except to the extent permitted by § 1866(a)(2) of the Social Security Act (42 U.S.C. § 1395cc(a)(2)) and regulations issued thereunder, any individual or any other person for items and services with respect to which the provider of services is precluded by reason of § 1866(a)(1) (42 U.S.C. § 1395cc(a)(l)) from charging such individual or person and “to return any moneys incorrectly collected from such individual or such person, or to make such other disposition as may be specified in regulations.” The Secretary’s acceptance of the Agreement established the Debtor’s eligibility for payment from the Medicare program which provides for estimated payments to providers (called interim payments) pending final determination of the actual amount that the provider is entitled to based on the reasonable cost of services to beneficiaries. See 42 C.F.R. §§ 413.60, 413.64(a), 413.64(b) and 413.64(f)(1). Pursuant to 42 U.S.C. § 1395g(a) the Secretary shall make payment to the provider of the amounts determined due “with necessary adjustments on account of previously made overpayments or underpayments.” In 1984, the Secretary through a financial intermediary (Independence Blue Cross) determined that the provider in this case owes the Medicare program the amounts of $15,442.28 and $16,916.00 which represent overpayments for the fiscal'years of 1980 and 1981, respectively, or a total of $32,352.28. 3

This case was commenced as a Chapter 11 case on March 4, 1987. The Debtor continued to provide Medicare services after the filing of the petition and thereafter submitted a number of claims to the financial intermediary for processing. The intermediary expects that these claims after processing will generate approximately $15,000 in Medicare payments owed to the debtor. 4 The Trustee asserts that the Secretary continued to make payment after the petition date of other claims submitted by the Debtor. The case was converted to Chapter 7 on October 21, 1988.

DISCUSSION

The court addresses three principal issues. First, did the debtor, as a debtor-in-possession exercising the powers of a trustee, assume the contract as an executory contract such that pursuant to the terms of the contract the Secretary may exercise the contractual right to first recover the overpayments? Second, if the contract was not assumed, may the Secretary alternatively make recoupment on the basis of equitable recoupment principles? Third, if the contract was not assumed and the Secretary may not exercise equitable recoupment, is the debtor nevertheless not entitled to recover the payments on the basis urged by the Secretary that without assumption of the contract no contractual right to payment exists? Following principally the reasoning of In re University Medical Center, 973 F.2d 1065 (3d Cir.1992), the court answers these questions in favor of the debt- or.

A. ASSUMPTION OF THE CONTRACT

It is a well established principle that assumption of an executory contract requires *920 the debtor to accept its burdens as well as its benefits. University Medical Center, 973 F.2d at 1075; Lee v. Schweiker, 739 F.2d 870, 876 (3d Cir.1984); In re Monsour Medical Center, 8 B.R. 606, 615-16 (Bankr.W.D.Pa.1981), aff 'd, 11 B.R. 1014, 1017-18 (W.D.Pa.1981); In re Tidewater Memorial Hospital, 106 B.R. 876, 884 (Bankr.E.D.Va.1989). And as the Trustee acknowledges, the Provider Agreement between the Secretary and Debt- or established a right in the Secretary “that payment for services shall be reduced to account for prior overpayments.” Trustee’s opposition, par. 1. Thus, if the Provider. Agreement is an executory contract which the estate is found to have assumed, the contract would be enforceable upon assumption and the Secretary’s withholding of payments would merely be the exercise of a contractual right. Although some courts would label this as contractual recoupment, in reality it is merely an acknowledgment that upon assumption, contract rights can be enforced against the debtor. As the court in University Medical stated, upon assumption “there is no question that HHS could withhold [debtor’s] post-petition reimbursement in order to recover pre-petition overpay-ments without violating the automatic stay.” University Medical, 973 F.2d at 1075. Thus, the court must determine whether the Provider Agreement constitutes an executory contract and, if so, whether it has been assumed by the estate.

1. Executory Contract Nature of the Provider Agreement

The majority of courts that have addressed the issue of whether the Provider Agreement under the Medicare scheme is an executory contract have answered in the affirmative. University Medical, 973 F.2d at 1075 n. 13; Monsour Medical, 8 B.R. at 615-16; In re Advanced Professional Home Health Care, Inc., 94 B.R. 95 (E.D.Mich.1988); Tidewater Memorial Hospital, 106 B.R. at 883; In re Memorial Hospital, 82 B.R. 478, 481 (W.D.Wisc.1988). Compare Lee v. Schweiker,

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171 B.R. 917, 31 Collier Bankr. Cas. 2d 1497, 1994 Bankr. LEXIS 1502, 1994 WL 513295, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-consumer-health-services-of-america-inc-dcd-1994.