MaineGeneral Medical Center v. HHS, U.S. Secretary

210 F.3d 420

Opinions

ORDER OF COURT

The petition for rehearing by the panel is denied. The panel opinion holds that the statute neither prohibits the Provider Reimbursement Review Board from taking jurisdiction, nor requires it to do so. In its petition, the government asserts that “[permitting providers to entirely bypass the intermediary’s expertise in favor of initial PRRB consideration of cost claims will have potentially disastrous consequences for Medicare’s carefully-constructed system of review of such claims.” (Pet. at 13.) That is not so. As the panel opinion states, the Board may, in its discretion, take steps to prevent providers from bypassing intermediaries. The Board need not review on a case-by-case basis claims not presented to intermediaries; it can adopt an across-the-board policy of refusing to hear such claims. “In light of the statutory scheme here, a rule of consistently refusing to hear inadvertently omitted claims would be rational.... ” MaineGeneral Med. Ctr. v. Shalala, 205 F.3d 493, 501 (1st Cir.2000).