Rutland Regional Medical Center v. Sullivan

835 F. Supp. 754, 1993 U.S. Dist. LEXIS 14888, 1993 WL 432136
CourtDistrict Court, D. Vermont
DecidedMarch 2, 1993
DocketCiv. 91-177
StatusPublished
Cited by5 cases

This text of 835 F. Supp. 754 (Rutland Regional Medical Center v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, D. Vermont primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rutland Regional Medical Center v. Sullivan, 835 F. Supp. 754, 1993 U.S. Dist. LEXIS 14888, 1993 WL 432136 (D. Vt. 1993).

Opinion

ORDER

BILLINGS, District Judge.

On January 15, 1993, Magistrate Judge Jerome J. Niedermeier issued a Report and Recommendation. On January 28, 1993, plaintiff Rutland Regional Medical Center (“Rutland”) filed objections to the Report. Defendant Louis W. Sullivan, M.D. (“Secretary”) responded on February 4, 1993.

After de novo review of the matter and in light of the decision in Albert Einstein Medical Center v. Sullivan, 830 F.Supp. 846 (E.D.Pa.1992), the Court hereby adopts the Magistrate’s Report and Recommendation in toto. Rutland’s motion for summary judgment is hereby DENIED, the Secretary’s motion for summary judgment is hereby GRANTED and the case is DISMISSED.

SO ORDERED.

MAGISTRATE JUDGE’S REPORT AND RECOMMENDATION

NIEDERMEIER, United States Magistrate Judge.

Plaintiff, Rutland Regional Medical Center, (“Rutland” or the “Hospital) brings this action against the Defendant, the Secretary of Health and Human Services (“Secretary”), pursuant to 42 U.S.C. § 1395oo (a), to re-' quest that the court order the Provider Reimbursement Review Board (the “PRRB” or “Board”) to accept jurisdiction over Rutland’s challenge to the reimbursement amount Rut-land received for Medicare services relating to inpatient days for the 1981 fiscal year. The Secretary contends that the court should affirm the decision of the PRRB that it lacks jurisdiction to consider Rutland’s claim. Rutland and the Secretary have both moved for summary judgment. I recommend the Secretary’s motion for summary judgment be granted and the ease dismissed.

BACKGROUND

Statutory and Regulatory Scheme

The Medicare reimbursement process is well-delineated. After each fiscal year, a provider such as Rutland prepares a cost report for Medicare services furnished during the year and requests reimbursement. 42 C.F.R. § 405.1801(b). The report and reimbursement request are submitted to a fiscal intermediary (“intermediary”) who acts as the Secretary’s agent. 42 U.S.C. § 1395h. The intermediary is usually an insurance company—in this case, Blue Cross. The intermediary reviews the cost report and issues a Notice of Program Reimbursement (“NPR”) which calculates the total reimbursement due the provider for that fiscal year. The NPR also details individually the expenses allowed and disallowed. 42 C.F.R. § 405.1803.

The regulatory process permits a provider to appeal the NPR if dissatisfied. The provider may request a hearing before the PRRB within 180 days of the issuance of the *756 NPR. 42 U.S.C. § 1395oo (a). The PRRB has the authority to affirm, modify, or reverse the determinations of the intermediary. 42 U.S.C. § 1395oo (d). Thereafter, the Secretary, on his own or at the request of the provider, may review the decision of the PRRB within 60 days. 42 U.S.C. § 1395oo (f)(1). The provider may then seek judicial review of the Secretary’s final decision within 60 days of its issuance, regardless of whether the decision came from the Secretary or the PRRB. 42 U.S.C. § 1395oo (f).

The Secretary’s regulations also contain provisions for reopening the NPR after the appeals process has been completed. An NPR “may be reopened with respect to findings on matters at issue in such determination or decision” on motion of the provider, the intermediary, the PRRB or the Secretary. The request for reopening must be made within three years from the date of the last decision or determination. See 42 C.F.R. § 405.1885(a). The entity which rendered the last determination or decision has the jurisdiction to determine whether to reopen its decision. 42 C.F.R. § 405.1885(c). In Rutland’s case, the intermediary rendered the last decision. A revision made after reopening is a “separate and distinct determination or decision.” 42 C.F.R. § 404.1889. Facts

The material facts in this case are not disputed. On January 29, 1982, Rutland filed a timely cost report with the intermediary for Medicare reimbursement for fiscal year 1981. On September 30,1982, the intermediary issued its initial NPR for that fiscal year. Rutland did not appeal that NPR within 180 days. 42 U.S.C. § 1395oo. On August 24, 1983, the intermediary notified Rutland that under 42 C.F.R. § 405.1885 it was reopening the 1981 NPR to correct an understatement of Rutland’s accrued costs for compensated employee absences—an issue unrelated to the current claim. That section permits the NPR to be reopened within three years of the initial NPR. The intermediary then issued a Notice of Correction on September 22, 1983 (“Revised NPR”). The Revised NPR adjusted only reimbursement for compensated employee absences—the issue for which the intermediary reopened the NPR—advising Rutland that it could appeal “adjustments made as a result of this reopening.” No appeal was taken.

The intermediary notified Rutland on September 3, 1986 that it once again was reopening the 1981 NPR (and reopening its determination of reimbursement on Rutland’s cost reports for the subsequent two years) to adjust the apportionment of costs for malpractice insurance premiums to bring them into accord with new regulations included at 42 C.F.R. § 413.56. Again, the reason for reopening was unrelated to the current claim.

After Rutland received the second reopening notice but before the intermediary had issued a second revised NPR, Rutland discovered a mistake in its 1981 cost report, finding that it had wrongly included inpatient Intensive Care Unit days in its total number of general service inpatient days on 1981 cost report, and that it also misreported them on its cost report. This meant Rutland had included the figures for this category in its original cost report but had made a “double counting” error by including these numbers in another category. In the initial NPR the intermediary did not make an adjustment to the number of inpatient days. This mistake had not been the subject of a previous appeal by Rutland from either the initial or first revised NPR.

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835 F. Supp. 754, 1993 U.S. Dist. LEXIS 14888, 1993 WL 432136, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rutland-regional-medical-center-v-sullivan-vtd-1993.