MERCY COMMUNITY HOSPITAL, Plaintiff-Appellant, v. Margaret HECKLER, Secretary, Department of Health and Human Services, Defendant-Appellee

781 F.2d 1552, 1986 U.S. App. LEXIS 22291, 12 Soc. Serv. Rev. 190
CourtCourt of Appeals for the Eleventh Circuit
DecidedFebruary 14, 1986
Docket85-3133
StatusPublished
Cited by12 cases

This text of 781 F.2d 1552 (MERCY COMMUNITY HOSPITAL, Plaintiff-Appellant, v. Margaret HECKLER, Secretary, Department of Health and Human Services, Defendant-Appellee) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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MERCY COMMUNITY HOSPITAL, Plaintiff-Appellant, v. Margaret HECKLER, Secretary, Department of Health and Human Services, Defendant-Appellee, 781 F.2d 1552, 1986 U.S. App. LEXIS 22291, 12 Soc. Serv. Rev. 190 (11th Cir. 1986).

Opinion

HILL, Circuit Judge:

This case involves the recapture by the defendant/appellee Secretary of Health and Human Services (“the Secretary”) of certain depreciation payments made to plaintiff/appellant Mercy Community Hospital (“the Hospital”), a Medicare provider, under the Medicare Act. Those payments were originally made to the Hospital over a period of twelve years to compensate the Hospital for the consumption of its assets caused by the provision of health care services to Medicare beneficiaries. When the Hospital was sold for a price well in excess of the depreciated book value of its assets, the Secretary determined that, under the applicable statutes and regulations, she was entitled to recapture all depreciation payments made with respect to those assets to the extent of the excess of their selling price over book value. The Secretary’s decision resulted in the recapture of approximately three-fourths of the depreciation payments the Hospital had received during its participation in the Medicare program, including 100 per cent of the payments made for depreciation on the hospital building and 96 per cent of the depreciation attributable to its fixed equipment. The Hospital argued that the Secretary was only entitled to recapture that portion of the depreciation payments made that reimbursed the Hospital for consumption of its assets that did not in fact occur. The *1553 Secretary’s decision was upheld by the district court. We reverse.

FACTUAL AND LEGAL BACKGROUND

Under Part A of the Medicare program, hospitals which have executed an agreement with the Secretary and meet various other conditions imposed upon Medicare providers are reimbursed the lesser of their charges or reasonable costs incurred in providing covered services to Medicare beneficiaries. 42 U.S.C. § 1395f(b). The term “reasonable cost” of such services is defined as “the cost actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services.” 42 U.S.C. § 1395x(v)(l)(A). The statute further provides that reasonable costs “shall be determined in accordance with regulations” promulgated by the Secretary "establishing the method or methods to be used, and the items to be included, in determining such costs.” Id. The statute further provides that those regulations “shall (i) take into account both direct and indirect costs of providers of services ... and (ii) provide for the making of suitable retroactive corrective adjustments where, for a provider of services for any fiscal period, the aggregate reimbursement produced by the methods of determining costs proves to be either inadequate or excessive.” Id.

Private organizations commonly act under contract with the Secretary as fiscal intermediaries to determine and issue payments to Medicare providers. See 42 U.S.C. § 1395h. A provider who is dissatisfied with a decision of the fiscal intermediary can appeal that decision to the Provider Reimbursement Review Board (PRRB) if the amount of reimbursement in controversy is $10,000 or more. 42 U.S.C. § 1395 oo. The decision of the PRRB constitutes the final decision of the Secretary, unless the Deputy Administrator of the Health Care Financing Administration (HCFA), exercising authority delegated by the Secretary, reverses, affirms, or modifies the decision of the PRRB. Id.

The Hospital, built in 1965, participated in the Medicare program at all times from the program’s inception until the Hospital was sold on August 18, 1978. In each of those years the Hospital claimed and received an allowance for depreciation. The allowances were computed utilizing the straight line method of depreciation, the most conservative method of computing depreciation available under the regulations. See 42 C.F.R. § 405.415. After incurring operating losses in 1976 and 1977, the owner of the Hospital decided to sell the facility. The hospital had been underutilized and was becoming increasingly expensive to maintain. Further, periodic inspections by state health and licensing officials were resulting in the discovery of increasingly numerous and serious code deficiencies in the physical plant.

To facilitate the sale of the hospital facility, the owner obtained a detailed appraisal report. The appraiser determined that, as of a date shortly before the sale of the facility, it would have cost over $6.5 million to construct the hospital building and improvements. Because of the consumption those assets had suffered by that date, however, the appraiser found them to be worth $3,759,000. The final sale price of $5,262,500 for the land, building and equipment was based on the fair market value determination made in the appraisal report. Because the net book value of the Hospital’s assets was then only $2,250,976, the owner realized a gain of more than three million dollars on the sale of the facility.

The fiscal intermediary, in its audit of the Hospital’s final cost report, offset the gain realized on the sale of the assets against the depreciation previously allowed and made a net depreciation adjustment of $1,605,573. Because, on the average, 22.-681 per cent of the Hospital’s utilization was attributable to Medicare beneficiaries, this resulted in a net reimbursement to the Hospital for its final cost year of $364,274 less than it claimed. The intermediary made this adjustment pursuant to the regulation now codified at 42 C.F.R. § 405.-415(f), which during the relevant cost year provided as follows:

Gains and losses realized from the disposal of depreciable assets while a provider is participating in the program, or *1554 within 1 year after the provider terminates participation in the program, are to be included in the determination of allowable cost. The extent to which such gains and losses are includable is calculated on a proration basis recognizing the amount of depreciation charged under the program in relation to the amount of depreciation, if any, charged or assumed in a period prior to the provider’s participation in the program, and in the period after the provider’s participation in the program when the sale takes place within 1 year after termination.

42 C.F.R. § 405.415(f) (1977). 1

The Hospital’s challenge to the intermediary’s decision was adjudicated and resolved against the Hospital in an adversarial proceeding before the PRRB. A three-member majority of the Board upheld the intermediary’s action; two members issued a vigorous dissent. The Deputy Administrator of the HCFA affirmed the Board majority’s decision.

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781 F.2d 1552, 1986 U.S. App. LEXIS 22291, 12 Soc. Serv. Rev. 190, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mercy-community-hospital-plaintiff-appellant-v-margaret-heckler-ca11-1986.