South Hills Health System v. Bowen

864 F.2d 1084, 1988 U.S. App. LEXIS 17726, 1988 WL 139505
CourtCourt of Appeals for the Third Circuit
DecidedDecember 30, 1988
DocketNo. 87-3551
StatusPublished
Cited by6 cases

This text of 864 F.2d 1084 (South Hills Health System v. Bowen) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
South Hills Health System v. Bowen, 864 F.2d 1084, 1988 U.S. App. LEXIS 17726, 1988 WL 139505 (3d Cir. 1988).

Opinion

OPINION OF THE COURT

A. LEON HIGGINBOTHAM, Jr., Circuit Judge.

This case presents the question of whether the district court improperly refused to enjoin the Secretary of the Department of Health and Human Services (“HHS”) from releasing certain Medicare related hospital cost reports to persons requesting them under the Freedom of Information Act, 5 U.S.C. § 552 (1983) (“FOIA”). Appellants are eight hospitals located in Pennsylvania, required by law to submit these annual cost reports to HHS’s Health Care Financing Administration (“HCFA”) as a condition to reimbursement for the health care services they provide to Medicare beneficiaries. The district court granted summary judgment for the Secretary. The court concluded that the disclosure rule was neither inconsistent with applicable regulations, arbitrary and capricious, nor a violation of either the Trade Secrets Act, 18 U.S.C. § 1905 (1983), or the fifth amendment’s guarantee of due process, since a valid HCFA regulation, 42 C.F.R. § 401.135(c) (1987), requires the Secretary to release the cost reports. We agree with the district court that the disclosure regulation is not inconsistent with other agency regulations, and we find that it is authorized by law as required by the Administrative Procedure Act (“APA”). However, we find that a challenge to the regulation as i arbitrary and capricious is premature at ' this time, as the agency has not yet had an opportunity to make a record in response to the appellants’ argument that a significant change in market conditions has rendered the regulation arbitrary. Accordingly, the district court did not have jurisdiction over the arbitrariness and capriciousness challenge brought by the appellants. We will therefore affirm the decision of the district court in part, vacate it in part, and remand with instructions that the district court dismiss in accordance with this opinion.

I. The Procedural History.

Title XVIII of the Social Security Act, 42 U.S.C.A. §§ 1395-1395xx (1983) (“the Act”), established the program of Health Insurance for the Aged and Disabled popularly known as Medicare. The Secretary of Health and Human Services (“the Secretary”) administers the program through the HCFA. Hospitals that participate in the Medicare program are required, by statute and regulation, to submit annual cost reports to the HCFA. See 42 U.S.C.A. § 1395g(a) (1983); 42 C.F.R. § 413.20(b) (1987).1 These reports set forth in detail the costs incurred by hospitals in providing medical services, and enable HCFA to calculate appropriate reimbursement levels for participating health care providers. Since 1975, an HCFA regulation, 42 C.F.R. § 401.135(c) (1987), has made the reports available to any member of the public who requests them in writing.2

In July 1984, South Hills Health System (“South Hills”), which operates a hospital, a home health care agency, and a nursing home, was notified by Blue Cross of West[1087]*1087ern Pennsylvania that several hospitals had made Freedom of Information Act requests for copies of its facilities’ cost reports. Blue Cross also notified South Hills that it planned to provide the information upon receipt of the reports’ copying costs from the requesters. South Hills immediately wrote to Blue Cross, objecting to disclosure. It contended that the information was confidential and, as such, exempt from mandatory disclosure under the FOIA, 5 U.S.C. § 552(b)(4) (1983) (“Exemption 4”).3 Moreover, it claimed that disclosing this information to its competitors would seriously jeopardize its marketplace position.

In support of the latter argument, South Hills asserted that competition in the health care marketplace had increased since the promulgation of the regulations, due in part to a change in the method of calculating Medicare reimbursement to health care providers. In 1983, as part of its general program of reducing the federal budget deficit, Congress passed the Social Security Amendments of 1983. These amendments changed the system of calculating payments to hospitals and other providers participating in the Medicare program from a system based on the providers’ “reasonable costs,” a payment regime based on a hospital’s actual costs, to a “prospective payment system,” a flat rate system. Pursuant to the change, the HCFA reimburses participating hospitals for the costs of inpatient care in accordance with a payment schedule for standard types of patient cases, called Diagnosis Related Groups. 42 U.S.C. § 1395ww(d) (Supp.1985). Congress’s intent in mandating this change was its desire to increase hospital cost efficiency. See Staff of the House Committee on Ways and Means, 98th Cong., 1st Sess., Social Security Act Amendments of 1983 (Comm.Print 1983), reprinted in 382 Medicare and Medicaid Guide 131, 132 (C.C.H.1983). South Hills argues that this change has caused such increased competition in the health care market as to render the disclosure regulation, 42 C.F.R. § 401.135(c), “no longer viable or realistic.” Appellants’ Appendix (“App’ts.App.”) at 26A. South Hills has continued to rely principally on this argument throughout its dealings with the HCFA and in this litigation. Since we hold only that the district court had no jurisdiction to consider an arbitrariness and capriciousness challenge to the regulation until a proper party made a 553(e) petition for reconsideration of the rule, we specifically make no finding as to the accuracy of these assertions.

Blue Cross initially replied that it was required to release the reports absent a court order to the contrary. Upon further discussion with regional HCFA officials, however, Blue Cross agreed to forward the documents to HCFA’s Office of Public Affairs in Baltimore and to allow that office to review the FOIA requests and notify South Hills whether HHS would release the reports. In November 1984, HCFA’s Baltimore public affairs office informed South Hills by telephone that the Medicare cost reports would be released. Shortly thereafter, South Hills representatives met with HCFA Baltimore officials, who agreed to further delay disclosure until they had re-examined the applicable regulation to determine whether release of the reports was authorized. In January 1986, HCFA’s FOIA officer informed South Hills by letter that, although the agency would continue to examine its policy regarding release of Medicare cost reports, South Hills’s cost reports would be released in accordance with 42 C.F.R. § 401.135(c) (1987). HCFA then granted South Hills’s request that it further delay the release of the cost reports so that South Hills could file an appeal from HCFA’s decision.

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Bluebook (online)
864 F.2d 1084, 1988 U.S. App. LEXIS 17726, 1988 WL 139505, Counsel Stack Legal Research, https://law.counselstack.com/opinion/south-hills-health-system-v-bowen-ca3-1988.