Lifestar Ambulance Service, Inc. v. United States

211 F.R.D. 688, 2003 U.S. Dist. LEXIS 1313, 2003 WL 202325
CourtDistrict Court, M.D. Georgia
DecidedJanuary 16, 2003
DocketNo. 4:02-CV-127-1(CDL)
StatusPublished
Cited by1 cases

This text of 211 F.R.D. 688 (Lifestar Ambulance Service, Inc. v. United States) is published on Counsel Stack Legal Research, covering District Court, M.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lifestar Ambulance Service, Inc. v. United States, 211 F.R.D. 688, 2003 U.S. Dist. LEXIS 1313, 2003 WL 202325 (M.D. Ga. 2003).

Opinion

ORDER

LAND, District Judge.

The Court presently has pending before it Defendants’ Motion to Dismiss, Defendants’ Motion for Summary Judgment, Plaintiffs’ Motion for Summary Judgment, and Plaintiffs’ Motion for Class Certification. These motions have been fully briefed and argued by the parties. The Court finds that it has subject matter jurisdiction of this case and that Plaintiffs are entitled to a writ of mandamus as a matter of law. Accordingly, Defendants’ Motion to Dismiss and Motion for Summary Judgment are denied, and Plaintiffs’ Motion for Summary Judgment is granted in part.1 The Court also finds that a Rule 23(b)(2) class should be certified, and therefore, Plaintiffs’ Motion for Class Certification is granted.

I. FACTUAL BACKGROUND

This case arises from a dispute over the Medicare reimbursement rates for ambulance service suppliers. The named Plaintiffs, three ambulance suppliers based in Georgia, North Carolina, and Tennessee who provide ambulance services to Medicare recipients, bring this putative class action against the Department of Health and Human Services (“DHHS”), the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), and individuals associated with those entities. Plaintiffs’ Complaint focuses upon Defendants’ alleged failure to comply with congres[691]*691sional mandates establishing the effective dates for certain fee schedules.

Plaintiffs contend that DHHS ignored the clear direction of Congress, as expressed in the Balanced Budget Act of 1997 (“BBA”), by failing to adopt a fee schedule applying to ambulance services furnished from January 1, 2000, through March 31, 2002. Plaintiffs also maintain that DHHS has failed to properly implement certain mileage fee schedules applicable to services provided from July 1, 2001, through March 31, 2002, as required by the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (“BIPA”). Plaintiffs seek injunctive relief ordering DHHS to adopt a fee schedule covering ambulance services supplied to Medicare recipients as described in the BBA and a fee schedule for mileage as required by the BIPA during the time periods just described.

The Medicare Act, 42 U.S.C. § 1395 et seq., creates a health insurance program for elderly and disabled individuals. The program is administered by the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), on behalf of the Secretary of DHHS, who is ultimately responsible for the program. Medicare Part A authorizes payments for covered inpatient hospital treatment and related services, including skilled nursing home care. Part B, which is applicable in this case, authorizes payment for covered items and services provided to individuals such as physicians’ treatment, clinical laboratory tests, or durable medical equipment. Part B also covers and pays for ambulance services, including those provided by ambulance service suppliers like Plaintiffs. See e.g., Supplementary Medical Insurance (SMI) Benefits, 42 C.F.R. § 410.10® (2001). Plaintiffs contend that Congress specified a time frame during which payments for services furnished to Medicare patients and for certain mileage should be paid in accordance with the fee schedule provisions of the BBA and BIPA. Plaintiffs further contend that DHHS failed to use the appropriate fee schedule in making payments during that period contrary to the expressed intention of Congress. To fully understand Plaintiffs’ claims, a brief review of the evolution of the methodology for reimbursing ambulance suppliers under the Medicare Act is helpful.

A. Methodology Prior to the Adoption of the BBA

Traditionally, Medicare paid for ambulance services furnished by suppliers on a “reasonable charge” basis. See Medicare Program; Fee Schedule for Payment of Ambulance Services and Revisions to the Physician Certification Requirements for Coverage of Non-emergency Ambulance Services, 65 Fed.Reg. 55,078, 55,078 (proposed Sept. 12, 2000) (to be codified at 42 C.F.R. pts. 410 & 414). A “reasonable charge” for ambulance services is determined by the lowest of the customary, prevailing, actual, or inflation indexed charges. Id. Under the “reasonable charge” methodology, different billing and payment methods were in use in different localities. Some methods provided separate charges for items such as individual services, mileage, and supplies. In contrast, one method provided a single, all-inclusive charge for all services, mileage, and supplies. Id.

B. Fee Schedule Under BBA Effective January 1, 2000

In 1997, as part of the BBA, Congress mandated the establishment of a “national” ambulance fee schedule for ambulance services to be paid for under Medicare. Congress required that the fee schedule create more equitable payments for similar services performed in different locations and that it be designed to replace the previous “reasonable charge” methodology. In enacting the BBA, Congress explicitly provided that the fee schedule adopted by DHHS “shall apply to services furnished on or after January 1, 2000.” Pub.L. No. 105-33, § 4531(b)(2) & (3)(codified in part at 42 U.S.C. § 1395m(l)) (emphasis added).

Pursuant to the BBA, DHHS adopted a fee schedule on February 27, 2002, but applied it only to services furnished on or after April 1, 2002, over two years after the effective date mandated by Congress. See generally Medicare Program; Fee Schedule for Payment of Ambulance Services and Revisions to the Physician Certification Requirements for Coverage of Nonemergency Ambu[692]*692lance Services, 67 Fed.Reg. 9,100, 9,100 (Feb. 27, 2002) (to be codified at 42 C.F.R. pts. 410 & 414). Plaintiffs contend that they, along with the other members of the putative class, are entitled to have a fee schedule implemented that applies to services furnished from January 1, 2000, to March 31, 2002, under the terms of the BBA.2 Thus, they seek injunctive relief ordering Defendants to implement such a fee schedule.

C. BIPA Change in Payment of Irtr-County Miles

In addition to the changes in reimbursement fee schedules enacted as part of the BBA, Congress also addressed inequities inherent in compensating ambulance suppliers under the reasonable charge methodology by enacting the BIPA in 2000. Pub.L. No. 106-554, § 423(b)(2), 114 Stat. 2763 (codified in part at 42 U.S.C. § 1395m(1)(2)(E) (2000)). The BIPA provided, in relevant part, that certain ambulance suppliers that had previously not received mileage payments for miles traveled in their home county should begin receiving compensation for those miles. 42 U.S.C. § 1395m(1)(2)(E). Congress made this provision applicable to services furnished on or after July 1, 2001. Medicaid, Medicare and SCHIP Benefits Improvement and Protection Act of 2000 § 423(b)(2).

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Related

Lifestar Ambulance Service, Inc. v. United States
604 F. Supp. 2d 1372 (M.D. Georgia, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
211 F.R.D. 688, 2003 U.S. Dist. LEXIS 1313, 2003 WL 202325, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lifestar-ambulance-service-inc-v-united-states-gamd-2003.