Riley Hospital & Benevolent Ass'n v. Bowen

804 F.2d 302, 1986 U.S. App. LEXIS 33523
CourtCourt of Appeals for the Fifth Circuit
DecidedNovember 12, 1986
DocketNo. 85-4855
StatusPublished
Cited by12 cases

This text of 804 F.2d 302 (Riley Hospital & Benevolent Ass'n v. Bowen) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Riley Hospital & Benevolent Ass'n v. Bowen, 804 F.2d 302, 1986 U.S. App. LEXIS 33523 (5th Cir. 1986).

Opinion

GARZA, Circuit Judge:

This case involves a dispute between a provider hospital and the Secretary, acting through an intermediary, concerning the disallowance of certain portions of the provider’s claim for reimbursement pursuant to the Medicare Act. The plaintiffs-appellants in this action, Riley Hospital and Benevolent Association and Meridian-Riley Hospital Coloration, both are Mississippi non-profit hospital corporations located in Meridian, Mississippi. Blue Cross and Blue Shield of Mississippi,1 the intermediary, is a non-profit corporation acting on behalf of Blue Cross Association as a fiscal intermediary of the Medicare Act that makes payments to providers of hospital services pursuant to Part A of that act. 42 U.S.C. § 1395 et seq. In November, 1966, Meridian-Riley Hospital Corporation (Meridian-Riley) was organized to construct and maintain a public hospital. Although the hospital facility involved herein is owned by Meridian-Riley, the Riley Hospital and Benevolent Association (Riley Benevolent) operates the facility under a lease from Meridian-Riley pursuant to the provisions of § 1861(e) of the Medicare Act. 42 U.S.C. § 1395x(e).

For fiscal years 1969-1971 the provider, Riley Benevolent, included as an allowable reimburseable expense on its Medicare cost [304]*304reports the basic rent paid to Meridian-Riley. However, after a determination by the intermediary that the provider (Riley Benevolent) and lessor (Meridian-Riley) were related through common control, the provider included as an allowable cost those elements which represented the cost of ownership, namely depreciation and interest. For fiscal years 1969-1972 audits by certified public accounting firms calculated the depreciable life of the hospital based on a twenty-four year period. However, Riley Benevolent’s cost reports for fiscal years ending September 30, 1973 and September 30, 1974 were audited by Blue Cross & Blue Shield; the intermediary ruled that a forty-year depreciation schedule was proper and therefore decreased the reimbursement payments to Riley Benevolent. This disallowed cost resulted in a loss to the provider of approximately $27,157.00 for fiscal year 1973 and $33,099.00 for the fiscal year ending September 30, 1974, for a total of $60,256.00, plus interest.

The imposition of these adjustments was timely appealed to the Provider Reimbursement Review Board (PRRB or Board) of the Department of Health, Education and Welfare. Following a hearing, the Board upheld the intermediary’s determination that the hospital’s depreciation schedule be calculated over forty years rather than the twenty-four years useful life claimed by Riley Benevolent. On August 20, 1976, appellants filed a complaint in the United States District Court, Southern District of Mississippi, Eastern Division, requesting that the useful life of the hospital for purposes of reimbursement be calculated on a twenty-four year depreciation schedule. The complaint sought damages for the principal amounts denied appellants based on a forty year depreciation schedule, plus interest. The complaint stated that administrative appeals had not yet been exhausted for the fiscal years following fiscal year 1974.

The United States District Court entered its judgment in favor of appellants on the 10th day of April, 1981. The Secretary’s appeal of the district court’s decision was voluntarily dismissed on October 5, 1981. On April 15, 1982, the Secretary filed a Rule 60 Motion to Correct the Judgment of 1981, but the district court denied the Secretary’s motion for relief on August 22, 1983, insofar as it pertained to reduction of the $60,256.00 award. The court did modify the 1981 judgment to conform its award of interest to 42 U.S.C. § 1395oo.

Blue Cross & Blue Shield paid the principal amounts (the costs previously disallowed) due appellants in accordance with the amended order of the district court. Since the intermediary had made depreciation reimbursement adjustments in fiscal years 1975-79 based on the same forty year depreciation schedule, appellees included the previously disallowed depreciation costs for cost-reporting years 1975-79 with the payment. Appellants made repeated requests that appellees pay the interest allegedly due on the principal amounts paid for the years 1975-79, but appellees refused to pay the interest due on the principal amounts for these years.

On August 20, 1985, appellants filed a praecipe for execution in the district court requesting that the court issue a writ of execution against appellees for $48,742.00, a sum representing the interest on the principal amounts owed to appellants for the fiscal cost reporting years 1975-79. By order entered November 1, 1985, the United States District Court denied appellants’ praecipe for execution, finding that “under the terms of the court’s previous orders the plaintiffs’ position is not well taken ... [and] the court is without authority to properly consider this issue.” We agree.

Jurisdiction to review Medicare reimbursement determinations is available only as prescribed in the Medicare Act. Heckler v. Ringer, 466 U.S. 602, 104 S.Ct. 2013, 80 L.Ed.2d 622 (1984); Dr. John T. MacDonald Foundation, Inc. v. Califano, 571 F.2d 328 (5th Cir.1978) (en banc), cert. denied, 439 U.S. 893, 99 S.Ct. 250, 58 L.Ed.2d 238 (1979). The Medicare Act does not have its own statutory section precluding judicial review; rather, § 1395ii incorporates 42 U.S.C. § 405(h), which precludes [305]*305review of decisions under Title II of the Social Security Act.2 Therefore, appeals from adverse determinations on cost reimbursement under the Medicare Act may be had only as specifically set forth by Congress. See American Association of Councils of Medical Staffs of Private Hospitals, Inc. v. Califano, 575 F.2d 1367 (5th Cir.1978), cert. denied, 439 U.S. 1114, 99 S.Ct. 1018, 59 L.Ed.2d 72 (1979). If a provider hospital is dissatisfied with the cost reimbursement determination of the Secretary or the intermediary, then the Medicare statute requires the provider to contest this determination before the PRRB, the administrative appeals board with exclusive jurisdiction to settle Medicare reimbursement claims. 42 U.S.C. § 1395oo (a).

The district courts have jurisdiction to review cost report adjustments under 42 U.S.C. § 1395oo (f)(1), but only after a final decision by the Board. Section 1395oo (f)(1) defines the jurisdiction of district courts and states, in pertinent part, that “[Pjroviders shall have the right to obtain judicial review of any final decision of the Board.” (emphasis added). 42 U.S.C. § 1395o

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Riley Hospital & Benevolent Association v. Bowen
804 F.2d 302 (Fifth Circuit, 1986)

Cite This Page — Counsel Stack

Bluebook (online)
804 F.2d 302, 1986 U.S. App. LEXIS 33523, Counsel Stack Legal Research, https://law.counselstack.com/opinion/riley-hospital-benevolent-assn-v-bowen-ca5-1986.