Regents of University of California v. Shalala

872 F. Supp. 728, 1994 U.S. Dist. LEXIS 20203, 1994 WL 733499
CourtDistrict Court, C.D. California
DecidedSeptember 6, 1994
DocketCV-93-4242-RSWL (Ex)
StatusPublished

This text of 872 F. Supp. 728 (Regents of University of California v. Shalala) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Regents of University of California v. Shalala, 872 F. Supp. 728, 1994 U.S. Dist. LEXIS 20203, 1994 WL 733499 (C.D. Cal. 1994).

Opinion

ORDER

LEW, District Judge.

I. INTRODUCTION

Before the Court are the parties’ cross motions for summary judgment. The matter came up for hearing on the Court’s law and motions calendar on August 29, 1994. Now, having carefully considered all of the papers filed in support of and in opposition to the motions, the Court hereby GRANTS Defendant, Department of Health and Human Services’ cross motion for summary judgment and DENIES Plaintiff, Regents of the University of California’s motion for summary judgment.

II. BACKGROUND

Plaintiff, The Regents of the University of California (“The Regents”) filed its complaint in this case asking the Court to review an administrative decision by the Provider Reimbursement Review Board (“the Review Board”) denying it certain cost reimbursements under the Medicare program. The Regents’ complaint arises out of a dispute over medical care provider reimbursements for its affiliated medical centers. These reimbursements initially are reviewed by a “fiscal intermediary,” which serves as the agent of Defendant, Department of Health and Human Services (“HHS”) and evaluates a provider’s claims for reimbursements at the end of each year. In the present case, Blue Cross/Blue Shield of California acted as the fiscal intermediary, initially denying the reimbursement requests at issue in this case.

Appeals from adverse decisions of a fiscal intermediary are heard by the Review Board, whose decisions are final unless the Secretary of HHS revises or modifies such a decision on her own motion. In this case, the Review Board heard and affirmed Blue Cross/Blue Shield’s initial denial of The Regents’ reimbursement requests and the Secretary took no further action on The Regents’ claims. The Regents (the provider) has a right to judicial review in district court of the Review Board’s final decision or any subsequent action taken by the Secretary. 42 U.S.C. § 1395oo (f). It is in this posture of review that the case is presently before the Court.

Specifically at issue in this case is The Regents’ claim that it is entitled to reimbursement for interest expenses incurred on money it loaned to its UCLA, UC Irvine and UC San Diego medical centers. Defendant claims, and the Review Board held below, that reimbursement for such interest expenses is not available under applicable regulations because the loans at issue were between related parties, that is, the medical centers and The Regents. It is undisputed that the medical centers and The Regents are the same legal entity and thus, related parties for purposes of the relevant regulations. Each UC medical center involved in this case has various claims for interest reim *731 bursement for the years 1982 through 1985. These claims were consolidated for review in the administrative proceedings below, and are consolidated for purposes of this case as well. 1 The total amount of disputed interest expense that The Regents claims to be entitled to in this case is $1.6 million.

It is uncontested that the interest expense claimed on loans made by The Regents to its various medical centers during the years at issue was well below then-existing market rates. 2 Nonetheless, Defendant asserts that its regulation, 42 C.F.R. § 405.419 (1985) (“Regulation 405.419”), 3 prohibits reimbursement of The Regents for this interest because it was incurred through related party borrowing. Defendant justifies its regulation by asserting that it acts as a prophylactic rule to prevent abuses that could occur in lending transactions between related parties. Specifically, Defendant is concerned that without such a prophylactic regulation, unnecessary loans will be made, or excessive rates of interest charged on borrowings between related entities. 4 It is uncontested that there is no evidence of such abuses in this ease. Defendant asserts, however, that its regulation must nonetheless apply. Both parties have thus agreed that the issue presented to the Court is whether Defendant’s application and interpretation of Regulation 405.419 disallowing reimbursement for related organization interest expenses, even when such expenses are in fact proper, was arbitrary and capricious, or otherwise improper under law.

At the administrative level, this case was decided on stipulated facts, with no oral argument having been heard by the Review Board. Thus, the case comes to this Court under the same stipulated factual record. In its motion, The Regents challenges both the Defendant’s interpretation of Regulation 405.419, as well as its promulgation of that regulation under the Medicare statute. In addition, The Regents points to several potential constitutional problems raised by Defendant’s interpretation of the regulation to argue that such interpretation is erroneous. The Regents points to these constitutional issues as support for its argument that Regulation 405.419 must be interpreted not as an absolute, prophylactic bar to reimbursement for related party interest expenses, but rather, as a rebuttable presumption that such expenses are not reimbursable. In this case, The Regents argues, the uncontested fact that its loans were proper serves to rebut that presumption.

III. STANDARD FOR ISSUANCE OF SUMMARY JUDGMENT

Summary judgment is appropriate when there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). The moving party bears the initial responsibility of identifying this absence of a genuine issue of material fact. Celotex v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986). The nonmoving party, on the other hand, is required by Rule 56(e) to go beyond the pleadings and designate specific facts showing that there is a genuine issue for trial. Id. at 324, 106 S.Ct. at 2553. Nonmov-ing parties can meet this requirement by use of affidavits, depositions, answers to interrogatories, or admissions on file. Id. However, conclusory allegations unsupported by factual data are insufficient to create a triable issue of fact so as to preclude issuance of summary judgment. Exxon Corp. v. Federal Trade Comm’n, 663 F.2d 120, 127 *732 (D.C.Cir.1980). The judge must view the evidence in the light most favorable to the nonmovant, with all justifiable inferences drawn in its favor. Anderson v. Liberty Lobby, 477 U.S. 242, 252, 106 S.Ct. 2505, 2512, 91 L.Ed.2d 202 (1986); Pacific Express, Inc. v. United Airlines, Inc.,

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872 F. Supp. 728, 1994 U.S. Dist. LEXIS 20203, 1994 WL 733499, Counsel Stack Legal Research, https://law.counselstack.com/opinion/regents-of-university-of-california-v-shalala-cacd-1994.