Memorial Hermann Hospital v. Sebelius

882 F. Supp. 2d 882, 2012 WL 3129111, 2012 U.S. Dist. LEXIS 106698
CourtDistrict Court, E.D. Texas
DecidedJuly 31, 2012
DocketCivil Action No. H-11-2771
StatusPublished
Cited by2 cases

This text of 882 F. Supp. 2d 882 (Memorial Hermann Hospital v. Sebelius) is published on Counsel Stack Legal Research, covering District Court, E.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Memorial Hermann Hospital v. Sebelius, 882 F. Supp. 2d 882, 2012 WL 3129111, 2012 U.S. Dist. LEXIS 106698 (E.D. Tex. 2012).

Opinion

[883]*883 MEMORANDUM AND ORDER

NANCY F. ATLAS, District Judge.

This challenge to a final decision of the Secretary of Health and Human Services is before the Court on the Motion for Summary Judgment [Doc. #22] filed by Plaintiff Memorial Hermann Hospital and the Cross-Motion for Summary Judgment [Doc. #23] filed by Defendant Kathleen Sebelius, Secretary of Health and Human Services (“HHS”). Plaintiff filed a Response [Doc. # 25] to Defendant’s Motion for Summary Judgment, and Defendant filed a Reply [Doc. #26]. The Court has reviewed the administrative record and applied persuasive legal authorities, particularly those from various federal appellate courts. The Court denies Plaintiffs Motion for Summary Judgment and grants Defendant’s Motion for Summary Judgment.

I. BACKGROUND

Medicare providers are entitled under the Social Security Act to reimbursement for the “reasonable cost” of furnishing Medicare services, including “an appropriate allowance for depreciation on buildings and equipment used in the provision of patient care.” See 42 C.F.R. § 413.134(a). The appropriate allowance for such depreciation is determined by prorating the “historical cost” of the asset (which is “the cost incurred by the present owner in acquiring the asset”) “over the estimated useful life of the asset.” 42 C.F.R. § 413.134(a), (b). Recognizing that this method provides only an approximation of the actual depreciation, the regulations allow (or require) adjustment in certain circumstances. See Forsyth Memorial Hosp., Inc. v. Sebelius, 639 F.3d 534, 536 (D.C.Cir.2011).

The regulations provide that a merger between two or more unrelated corporations is a circumstance in which the depreciated assets may be revalued. See 42 C.F.R. § 413.134(Z)(2)(i). “If the merged corporation was a provider before the merger, then it is subject to the provisions of paragraphs (d)(3) and (f) of this section concerning recovery of accelerated depreciation and the realization of gains and losses.” Id. If the merger is between two or more related corporations, no revaluation of assets is allowed. See 42 C.F.R. § 413.134(Z)(2)(ii).

To address the application of § 413.134(Z) to non-profit providers, the Centers for Medicare & Medicaid Services (“CMS”) issued a Program Memorandum, PM A00-76, in October 2000. In PM A-00-76, the CMS noted that non-profit providers are often motivated to engage in mergers for reasons that may differ from the traditional for-profit merger. See PM A-00-76. Specifically, mergers involving non-profit providers are often driven more by the charitable interests of the provider and the interests of the community at large than by the interest of the provider in obtaining maximum value for its assets. Id. As a result, the Secretary, through the CMS, interpreted § 413.134(Z) as requiring mergers to involve the equivalent of a bona fide sale.

Hermann Hospital (“Hermann”) began operations as a charitable hospital in 1925, operated by Hermann Hospital Estates, a testamentary trust established under the will of George H. Hermann. Hermann and Memorial Hospital System (“Memorial”) merged on November 4, 1997. Memorial acquired Hermann’s assets and assumed its liabilities. The merged entity, Plaintiff in this lawsuit, requested a depreciation adjustment in the amount of $21,731,800.00, on behalf of Hermann. The “Intermediary” for the Secretary of HHS (“Secretary”)1 concluded that Her[884]*884mann and Memorial, although unrelated before the merger, were not entitled to the depreciation adjustment because they were related after the merger.

Hermann requested review by the Provider Reimbursement Review Board (“PRRB”) in accordance with 42 U.S.C. § 1395oo(a). The PRRB rejected the Intermediary’s reliance on the “related party” requirement in PM A-00-76. The PRRB held that the regulation could not reasonably be interpreted to require that the parties remain unrelated after the merger. The PRRB rejected Hermann’s request for a depreciation adjustment, however, based on the “bona fide sale” requirement in PM A-00-76.

The Administrator of the CMS upheld the PRRB’s decision on the bona fide sale issue, but reversed the PRRB’s decision on the related party issue. The Administrator’s decision constitutes the final decision of the Secretary. See 42 U.S.C. § 1395oo(f).

Plaintiff filed this lawsuit under the Administrative Procedure Act (“APA”), seeking judicial review of the Secretary’s decision. The parties filed cross-motions for summary judgment, which are now ripe for review.

II. APPLICABLE LEGAL STANDARDS UNDER APA

The Court reviews the Secretary’s decision under the APA, which provides that the agency action may be overturned only “if it is arbitrary, capricious, an abuse of discretion, not in accordance with law, or unsupported by substantial evidence on the record taken as a whole.” Buffalo Marine Servs. v. United States, 663 F.3d 750, 753 (5th Cir.2011) (quoting Tex. Clinical Labs, Inc. v. Sebelius, 612 F.3d 771, 775 (5th Cir.2010)). The reviewing court begins with “a presumption that the agency’s decision is valid, and the plaintiff has the burden to overcome that presumption by showing that the decision was erroneous.” Id.

The agency’s findings of fact must be upheld if they are supported by substantial evidence. See id. (citing Alwan v. Ashcroft, 388 F.3d 507, 510-11 (5th Cir.2004)). Substantial evidence is “such relevant evidence as a responsible mind might accept to support a conclusion. It is more than a mere scintilla and less than a preponderance.” Harris v. Apfel, 209 F.3d 413, 417 (5th Cir.2000). The Secretary’s findings, if supported by substantial evidence, “shall be conclusive.” Windsor Place v. U.S. Dept. of Health and Human Servs., 649 F.3d 293, 297 (5th Cir.2011); 42 U.S.C. § 1320a-7a(e).

“The agency’s legal conclusions are reviewed de novo, except for questions of statutory interpretation, where the court owes ‘substantial deference to an agency’s construction of a statute that it administers.’ ” Buffalo Marine, 663 F.3d at 753 (quoting Alwan, 388 F.3d at 511 (citing Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc.,

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882 F. Supp. 2d 882, 2012 WL 3129111, 2012 U.S. Dist. LEXIS 106698, Counsel Stack Legal Research, https://law.counselstack.com/opinion/memorial-hermann-hospital-v-sebelius-txed-2012.