Methodist Hospitals of Memphis v. Sullivan

799 F. Supp. 1210, 71 Rad. Reg. 2d (P & F) 40, 1992 U.S. Dist. LEXIS 12181, 1992 WL 195827
CourtDistrict Court, District of Columbia
DecidedJuly 17, 1992
DocketCiv. A. 92-0009, 92-0041, 92-0870, 92-1120 and 92-0989
StatusPublished
Cited by6 cases

This text of 799 F. Supp. 1210 (Methodist Hospitals of Memphis v. Sullivan) 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.

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Methodist Hospitals of Memphis v. Sullivan, 799 F. Supp. 1210, 71 Rad. Reg. 2d (P & F) 40, 1992 U.S. Dist. LEXIS 12181, 1992 WL 195827 (D.D.C. 1992).

Opinion

MEMORANDUM OPINION

JOHN H. PRATT, District Judge.

These cases concern a Medicare regulation that implements a new statutory payment methodology for graduate medical education (“GME”) costs borne by teaching hospitals. The regulation in question is a retroactive rule published in late 1989 that permits the Secretary of Health and Human Services (“Secretary”) to reaudit hospitals’ 1984 graduate medical education costs. Plaintiffs contend that the Secretary’s regulation is invalid as contrary to the plain meaning of the statute, as an invalid retroactive rule, and as an arbitrary and capricious act.

Defendant claims that this Court lacks subject matter jurisdiction as administrative remedies are not yet final, and that in any ease, the regulation at issue is valid.

Before this Court are defendant’s motion to dismiss, and plaintiffs’ and defendant’s motions for summary judgment. In addition, plaintiffs have filed a motion to compel production. For the reasons that follow, we find that we have jurisdiction over this dispute and consequently deny defendant's motion to dismiss on jurisdictional grounds. On the merits, we grant plaintiffs’ motion for summary judgment with the exception that we deny plaintiffs’ motion for summary judgment with respect to PRRB’s policy not to disclose dissenting opinions in EJR determinations and we deny defendant’s motion for summary judgment.

I. Background

On April 7, 1986, Congress enacted Pub.L. No. 99-272, 100 Stat. 153-55 et seq., 42 U.S.C. § 1395ww(h), which established new rules for reimbursing graduate medical education costs of hospitals participating in Medicare. The law provides for the Secretary to determine for each hospital an approved per resident amount for each cost reporting period beginning on or after July 1, 1985. 1 The per resident amount is the *1212 average amount recognized as reasonable during a base period that began in fiscal year 1984, updated each year by an inflation factor. 2

The regulations implementing the GME reimbursement rules established in the 1986 statute were issued on September 29, 1989. See 54 Fed.Reg. 40286 (codified at 42 C.F.R. § 413.86). Fiscal intermediaries 3 were instructed to determine the base period average per resident amount and hospitals were authorized to appeal the determination within 180 days of the notice. 42 C.F.R. § 413.86(e)(l)(v). The challenged regulations provided that the fiscal intermediaries “verify” or reaudit the hospital’s base period GME costs in fiscal 1984 and “modify” the base period costs that would be used in computing the hospital-specific per resident amount. 42 C.F.R. § 413.86(e)(1)(h). 4 , Under standard Medicare reimbursement procedures, the Secretary has three years from the issuance of the notice of program reimbursement (“NPR”) to correct for inappropriate or misidentified costs. See 42 C.F.R. § 405.-1885. The challenged regulation provides that if the hospital’s cost report for its GME base year is no longer subject to reopening under 42 C.F.R. § 405.1885, the intermediary may apply the results of the reaudit only for purposes of the GME per resident amount methodology and not for the base year itself. 42 C.F.R. § 413.-86(e)(l)(iii). After completing the reaudits, the intermediaries are to issue to each hospital a notice of “its base period average per resident amount”. 42 C.F.R. § 413.-86(e)(l)(v). Hospitals, if dissatisfied with the intermediary’s determination, have 180 days from the date of the notice to file an appeal with the Provider Reimbursement Review Board (“PRRB”). 42 C.F.R. § 413.-86(e)(l)(v).

Plaintiffs in this action are six teaching hospitals whose allowable GME costs were found to be lower on reaudit than their 1984 base year cost report would indicate. 5 The suits were consolidated since the issues presented are identical. They bring this suit against Louis Sullivan, the Secretary of Health and Human Services.

The experiences of Methodist Hospitals of Memphis (“Methodist”) and George Washington University Hospital (“GWU”) are illustrative. On February 26, 1991, Blue Cross and Blue Shield (“BCBS”) of Tennessee sent Methodist a notice of its per resident cost for the fiscal year ending December 31, 1984. BCBS determined that Methodist’s allowable GME costs were $893,841 less than the amount determined by the 1986 audit of Methodist’s 1984 cost report. Methodist did not have to refund the difference for 1984: however, the 1991 notice established the per resident amount to be used in calculating its GME payment for post-July 1, 1985 years. Similarly, GWU’s costs were assessed at $8,861,049 for the fiscal year ending June 30, 1985, $4,236,299 lower than its previous audit.

*1213 These two hospitals appealed on August 12 and August 13, 1991 to the PRRB. 6 While the appeals were pending, the hospitals petitioned the PRRB for a determination that the PRRB had no authority to decide the issue of the validity of the Secretary’s GME regulations, and that Expedited Judicial Review (EJR) would be appropriate. The PRRB found that the appeals involved mixed issues of law and fact and concluded that it should retain jurisdiction of the appeal. It denied the hospitals’ petitions for EJR on November 8, 1991. Two of the five PRRB members dissented from the majority opinion; however, under new PRRB policy, their opinion was not published.

Plaintiffs contend that the Secretary’s regulations are invalid insofar as they permit a determination of allowable GME base year costs for purposes of the per resident amount methodology under section 1886(h) of the Act that differ from the final, audited cost report for the GME base year itself. Specifically, plaintiffs argue that the plain wording of the statute mandates that the GME payment rate be based on the GME costs found to be reasonable for the GME base year, and that the regulation providing otherwise is invalid. They argue that the Secretary did not possess the express authority to issue a retroactive rule and that the reaudit regulation is arbitrary and capricious.

II. Jurisdictional Argument

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799 F. Supp. 1210, 71 Rad. Reg. 2d (P & F) 40, 1992 U.S. Dist. LEXIS 12181, 1992 WL 195827, Counsel Stack Legal Research, https://law.counselstack.com/opinion/methodist-hospitals-of-memphis-v-sullivan-dcd-1992.