North Iowa Medical Center v. Department of Health & Human Services

196 F. Supp. 2d 784, 2002 U.S. Dist. LEXIS 7184, 2002 WL 716162
District Court, N.D. Iowa·Decided March 29, 2002·No. 00CV3070-DEO·Published·Cited by 9 cases

Opinion

ORDER

DONALD E. O’BRIEN, Senior District Judge.

This matter comes before the Court upon what has been designated by the litigants as plaintiffs motion for summary judgment (Docket No. 7) and defendant’s cross motion for summary judgment (Docket No. 18). However, it is really before the Court under the Administrative Procedure Act as an appeal. After careful consideration of the parties’ written briefs and oral arguments, as well as the relevant case law, plaintiffs motion for summary judgment (Docket No. 7) is sustained. Defendant’s motion for summary judgment (Docket No. 18) is denied. These words are used so that the Clerk of this Court can close those motions in their records. Under the Administrative Procedures Act, this ruling reverses the administrator’s decision of June 28, 2000, denying the plaintiffs application for cost reimbursement in the sum of 3.2 million dollars. 1

I. BACKGROUND

Before June 1993, there were two hospitals operating in Mason City, Iowa. North Iowa Medical (plaintiff here, a/k/a Provider) and St. Joseph Mercy Hospital (SJMH). In November 1992, negotiations began for the purpose of consolidating the two hospitals into a new entity. In June 1993, the plaintiff sold its hospital facility to the acquiring entity, the North Iowa Mercy Health Center (NIMHC), for a price substantially below book value 2 . This caused the plaintiff to incur a significant loss totaling $3,256,187.00. At the same time, SJMH also transferred its hospital to NIMHC. Since that time, NIMHC operates the only acute care licensed hospital in Mason City, Iowa.

Under Medicare regulations, a hospital such as plaintiff, can get reimbursed for the loss on the sale of its patient care-related assets. The plaintiff argues that it should be reimbursed for the $3,256,187.00 which it has been trying to recover since the date of the sales transaction. The Department of Health and Human Services (government) has refused to pay the plaintiff this reimbursement.

On April 30, 1996, the Intermediary 3 , Wellmark Blue Cross Blue Shield of Iowa, denied the plaintiffs initial claim for payment, finding that the sales transaction occurred between “related” parties. The plaintiff proceeded to go through the administrative appeals process. On May 2, 2000, the Provider Reimbursement Review Board (PRRB), acting as the sole trier of fact, ruled in favor of the plaintiff here. It found that all the requirements for reimbursement of a loss after a sale were satisfied. (i.e. the sale was at arms’ length; the sale was between unrelated parties; the consideration paid was consistent with fair *787 market value). The next step in the appeal process was to have the decision reviewed by the Health Care Financing Administration (HCFA). This group, after review, reversed the PRRB on June 28, 2000, finding for the defendant here, the government.

The plaintiff then filed this action in this Court pursuant to Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq., and the Administrative Procedure Act, 5 U.S.C. § 551 et seq.

II. STANDARDS OF REVIEW

The Medicare Act states that this Court’s review of the Administrator’s decision is governed by the Administrative Procedure Act (APA), 42 U.S.C. § 1395oo(f)(l). The APA states that an Administrator’s decision must be overturned if its arbitrary and capricious, an abuse of discretion, unsupported by substantial evidence in the record or otherwise contrary to law. 5 U.S.C. § 706.

The Secretary of the Department of Health and Human Services has promulgated regulations on capital costs, including reimbursement regulations for gain or loss on the disposal of depreciable assets rendered to patients under the Medicare program.

III. ARGUMENTS — WAS THERE A BONA FIDE SALE TRANSACTION?

Under 42 C.F.R. § 413.134(f), a sale of depreciable assets is bona fide if (a) fair market value is paid for the assets, and (b) the sale is negotiated (i) at arms’ length (ii) between unrelated parties. In order for the plaintiff to be entitled to receive reimbursement, these factors must be met. The Court will now analyze the record as it pertains to these issues.

A. Fair Market Value

The plaintiff states that the only evidence regarding fair market value was the appraisal done by Valuation Counselors Group, Inc. (VCGI), an independent appraiser. VCGI assessed fair market value of the acquired assets as of June 30, 1993 to be $7,015,100. Therefore, plaintiff argues, the amount of the consideration ($7,015,100.00) for the purchased assets is consistent with the fair market value of the acquired assets. The government argues that there is a disparity of as much as $4 million between the purchase price and the value of the assets transferred. This disparity, according to the government, is so significant that it justifies “the inference that the transaction could not have been the result of an arms’ length bargaining but was the product of a relationship between the parties where one side controlled or significantly influenced the other.” (Defendant’s. Brief at 29). Furthermore, at the PRRB hearing, Mr. Rossman, counsel for plaintiff/provider, stated that he and the Intermediary (Well-mark Blue Cross and Blue Shield of Iowa) had stipulated as to the “accuracy and completeness” of the appraisal of the Provider. (AR 4 89-90).

The government argues that Mr. Grimes, the lawyer for the intermediary Blue Cross and Blue Shield of Iowa, “is not good with numbers” and that “[h]e didn’t stipulate that this was in fact fair market value ... [h]e just stipulated he wasn’t going to contest numbers.” (Tr 4 .47-48).

The Court cannot now conclude that there was a flat out stipulation as to the fair market value that would make this a non-issue. The testimony about what was *788 stipulated to is too iffy for that to carry the day.

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North Iowa Medical Center v. Department of Health & Human Services, 196 F. Supp. 2d 784, 2002 U.S. Dist. LEXIS 7184, 2002 WL 716162 (N.D. Iowa 2002).

196 F. Supp. 2d 784 (North Iowa Medical Center v. Department of Health & Human Services) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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