MHA, LLC v. BESLER & CO., INC. (L-1867-17, HUDSON COUNTY AND STATEWIDE)

CourtNew Jersey Superior Court Appellate Division
DecidedJuly 13, 2022
DocketA-0789-20
StatusUnpublished

This text of MHA, LLC v. BESLER & CO., INC. (L-1867-17, HUDSON COUNTY AND STATEWIDE) (MHA, LLC v. BESLER & CO., INC. (L-1867-17, HUDSON COUNTY AND STATEWIDE)) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MHA, LLC v. BESLER & CO., INC. (L-1867-17, HUDSON COUNTY AND STATEWIDE), (N.J. Ct. App. 2022).

Opinion

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-0789-20

MHA, LLC, d/b/a MEADOWLANDS HOSPITAL,

Plaintiff-Respondent,

v.

BESLER & COMPANY, INC.,

Defendant-Appellant. __________________________

Submitted February 14, 2022 – Decided July 13, 2022

Before Judges Sumners and Firko.

On appeal from the Superior Court of New Jersey, Law Division, Hudson County, Docket No. L-1867-17.

Gordon Rees Scully Mansukhani, LLP, attorneys for appellant (Mark A. Trokan, of counsel and on the briefs; Stephanie Imbornone, on the briefs).

Mazie Slater Katz & Freeman, LLC, attorneys for respondent (Eric D. Katz, of counsel and on the brief; David M. Estes, on the brief).

PER CURIAM Defendant Besler & Company, Inc. appeals from the Law Division order

confirming the arbitration award in favor of plaintiff MHA, LLC d/b/a

Meadowlands Hospital Medical Center (Meadowlands) entering judgment of

$1,795,260, plus pre- and post-judgment interest, and denying defendant's

request to vacate the arbitration award. The arbitrator determined that defendant

breached its contractual duties in providing consultation services to plaintiff

regarding whether it was financially advisable to implement a stand-alone

residency program at the Meadowlands Hospital. Having considered the record

and applicable law, we affirm.

I.

A.

On January 8, 2010, plaintiff, a New Jersey healthcare service provider,

entered into an agreement with Liberty Riverside Healthcare Inc. and Liberty

Healthcare System, Inc. (collectively "Liberty") to purchase all of Liberty's

assets, including Meadowlands.

Two years later in February 2012, plaintiff contracted with defendant to

prepare plaintiff's Medicare cost report (MCR)1 and state hospital cost report for

1 Each fiscal year, Meadowlands is required to submit a MCR to its Medicare administrative contractor (MAC) regarding the patient care services rendered.

A-0789-20 2 the 2011 fiscal year. Defendant assisted medical centers in recovering Medicare

reimbursements for patient services, preparing and filing annual MCRs, and

obtaining GME reimbursement 2 and indirect medical education (IME)

reimbursement analysis for medical centers seeking to establish residency

programs.

In June 2012, plaintiff decided to create a GME program at Meadowlands.

Plaintiff contracted with defendant to provide a three-year estimate of

Meadowland's GME and IME reimbursements for its proposed resident sharing

program with Palisades Medical Center (Palisades). In pertinent part, the

written agreement provided: "Please be advised this review includes review of

Medicare regulations, which are subject to interpretation. [Defendant's]

findings will be based upon [defendant's] understanding of these regulations ."

The graduate medical education (GME) reimbursement is a component of this report. 2 The Medicare GME payment reimburses teaching hospitals for the cost of resident and teacher salaries and fringe benefits and overhead costs related to the teaching programs.

A-0789-20 3 Within two weeks, defendant––using a per resident amount (PRA) [3]

calculated by Novitas for its reimbursement analysis––provided plaintiff an

estimated reimbursement analysis, projecting an overall net loss. For this PRA

calculation Novitas relied,4 in part, on defendant's incorrect assertion that the

joint residency program with Palisades would be the first time "residents in an

approved GME program trained" at Meadowlands. 5 About a week later,

Meadowlands began its resident sharing program with Palisades.

In early 2013, plaintiff developed a plan to establish a stand-alone GME

program beginning on July 1, 2013. Plaintiff requested defendant estimate the

GME and IME reimbursement analysis for the stand-alone program. Plaintiff

informed defendant it would only implement the stand-alone program if it would

financially "break even" within five years. In June 2013, defendant agreed to

3 The PRA is the "allowable amount paid to [plaintiff] as reimbursement for the GME program" and is used to prepare the MCR. The PRA is calculated and set by the medical center's MAC, Novitas in this case. 4 Novitas relied on information supplied in the 2012 cost report submitted by defendant. 5 Defendant assumed 2012 was the first year Meadowlands had its own residents and used this assumption in their 2012 cost report. In fact, Meadowlands had two podiatry residents in 2002. Because of the 2002 residents, the estimated PRA should have been determined based on the PRA's in place in 2002, updated each year to take into account inflation. This amount was significantly lower than the PRA included in the 2012 analysis and cost report. A-0789-20 4 the engagement and submitted to plaintiff its analyses, but a written agreement

was never executed for its services.

After initially advising plaintiff that the stand-alone program projected to

be an overall net loss, defendant provided plaintiff an amended analysis

estimating net losses for fiscal years 2013 and 2014, but with net profits in fiscal

years 2015 through 2017. Consequently, plaintiff established the stand-alone

program beginning in July 2013. In both of its estimates, defendant used the

same incorrect PRA as it did in its 2012 analysis.

On May 10, 2016, plaintiff sold Meadowlands to NJMHMC LLC. The

parties' agreement stated, in pertinent part:

Section 8.8 Medicare and Medicaid Adjustments.

(a) Buyer and Seller acknowledge and agree that (i) all reimbursements from Medicare . . . and all charges, settlements or setoffs applied by Medicare . . . in respect of services . . . rendered by Seller to patients of . . . [Meadowlands] prior to the Closing, as reflected on the cost reports submitted by Seller to Medicare . . . shall be for the account of Seller . . . .

....

(c) Upon the imposition of Charges against either party (the "Charged Party") which Charges are not for the account of the Charged Party pursuant to Section 8.8(a), the Charged Party shall send written notice to the other party (the "Reimbursing Party") requesting reimbursement for the Charges imposed . . . , together

A-0789-20 5 with a copy of the correspondence provided by Medicare . . . which accompanied and relates to the impositions of the Charges, and such other documentation sufficient to identify the Services to which such Cha[rg]es relate. The Reimbursing Party shall, within seven . . . days of its receipt of the Request for Reimbursement, reimburse the Charged Party for those Charges set forth in the Request for Reimbursement which are properly for the account of the Reimbursing Party pursuant to Section 8.8(a).

At the end of 2016, Novitas audited the residency program for 2015, and

discovered Meadowlands had been overpaid due to the miscalculated PRA. A

subsequent audit of the 2014 cost report recalculated Meadowland's PRA 6 and

prepared an adjustment report dated March 17, 2017. Patrick Metzger, a

consultant for plaintiff, testified that Meadowlands was only entitled to

$3,435,125 but received $5,230,385, thereby owing $1,795,260 in

reimbursements. Meadowlands entered an extended repayment schedule with

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MHA, LLC v. BESLER & CO., INC. (L-1867-17, HUDSON COUNTY AND STATEWIDE), Counsel Stack Legal Research, https://law.counselstack.com/opinion/mha-llc-v-besler-co-inc-l-1867-17-hudson-county-and-statewide-njsuperctappdiv-2022.