St. Elizabeth Hospital v. United States

558 F.2d 8, 214 Ct. Cl. 322, 1977 U.S. Ct. Cl. LEXIS 69
CourtUnited States Court of Claims
DecidedJune 15, 1977
DocketNo. 347-74
StatusPublished
Cited by20 cases

This text of 558 F.2d 8 (St. Elizabeth Hospital v. United States) is published on Counsel Stack Legal Research, covering United States Court of Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. Elizabeth Hospital v. United States, 558 F.2d 8, 214 Ct. Cl. 322, 1977 U.S. Ct. Cl. LEXIS 69 (cc 1977).

Opinion

Kunzig, Judge,

delivered the opinion of the court:

At stake in this Medicare provider case, before the court on cross-motions for summary judgment, is approximately $235,000. Recovery turns on the method of computing St. Elizabeth Hospital’s (plaintiff or St. Elizabeth) depreciation for fiscal years 1967-1969. Plaintiff claims that its depreciation should be based on its actual costs as established by appraisal. Actual cost depreciation would, plaintiff states, greatly increase its reimbursement. Defendant contends that plaintiffs claim of actual cost depreciation costs for 1967-1969 is untimely and that its [324]*324estimated depreciation based on a percentage of operating costs is'binding.

We hold for plaintiff as to its right to recovery. Quantum will be determined in later proceedings.

Plaintiff is a nonprofit, tax exempt corporation which operates a general, short-term hospital in Appleton, Wisconsin. St. Elizabeth is a qualified provider of services under the Medicare Act, 42 U.S.C. § 1395x(e)(l-8)(1970), and has engaged in providing such services from 1966. As a condition of eligibility to receive Medicare benefits, plaintiff filed an agreement with the Secretary of Health, Education and Welfare entitling it to reimbursement for the "reasonable cost” of covered services it furnished to program beneficiaries. 42 U.S.C. § 1395cc (1970). Plaintiff nominated Blue Cross Association (BCA) and its local administering agent, Wisconsin Blue Cross Plan (the Plan), as its fiscal intermediary.

In its role as intermediary, the Plan assumed the duty of determining, by annual audit, the reimburseable costs St. Elizabeth incurred by virtue of providing covered services to Medicare Act beneficiaries.

Section 405.415-18 of Title 20, Code of Federal Regulations (CFR),1 provides an "appropriate allowance” for depreciation, which is defined either as a fixed percentage of operating costs, or as actual depreciation, if a provider can establish the historical, pre-1966, cost of its assets by records or by an appraisal. Plaintiff elected actual depreciation but, lacking adequate records of its costs, accepted reimbursement of estimated depreciation by the percentage method while it procured an appraisal.

With the Plan’s knowledge that plaintiff was securing an appraisal, plaintiff contracted with the Industrial Appraisal Company (IAC) on April 25, 1967 to determine its historical costs. Plaintiff submitted the IAC appraisal to the Plan in June 1970. The Plan found the appraisal report inadequate. After numerous attempts by plaintiff to have IAC correct the deficiencies, plaintiff, at the Plan’s suggestion, contracted with a different appraisal firm. That [325]*325firm, Valuation Counselors Company, prepared a new report showing plaintiffs historical cost data.

The Valuation Counselors’ report was accepted by the Plan following submission in March 1972, but only for the fiscal years ending after 1969 (that is fiscal years ending on June 30, 1970 and June 30, 1971).2 The report was not accepted by the Plan for fiscal years ending in 1967-1969 because the Plan stated that the appraisal was submitted after the time allotted to such submissions, namely two years from the provider’s contract (1966) to perform Medicare services. The two year rule is set forth in Section 128 of the Provider Reimbursement Manual, published in July 1967.

Plaintiff brought the Plan’s decision to the BCA Medicare Provider Appeal Committee, which consists of three BCA representatives and two representatives of providers’ associations. Plaintiff claimed the Plan’s refusal to accept the appraisal as the basis for amended cost reports for 1967-1969 cost plaintiff $235,360.00 — the difference between the amount allowed for depreciation under the estimated percentage method, and the amount reimbursea-ble based on actual depreciation using the Valuation Counselors’ report. The Committee denied plaintiffs appeal on September 28, 1973, and plaintiffs request for reconsideration on January 23, 1975. Plaintiff then filed suit in this court seeking to obtain payment of approximately $235,000 it claims is due.

At this time we are concerned only with plaintiffs right to recover. As mentioned above, the issue of quantum will be deferred to later proceedings, discussed infra.

Plaintiff pursues its case on two principal grounds. First, plaintiff argues that it is entitled to reimbursement for depreciation based on its actual costs on the theory that the applicable statute and regulation published in the Code of Federal Regulations mandate such payment. As a corollary to this argument, plaintiff contends that the two-year limit imposed by the Provider Reimbursement Manual was improperly applied against it. This argument, in [326]*326essence, is that defendant, through the Plan and the BCA, denied plaintiff reimbursement in violation of the Medicare Act.

Second, plaintiff claims the BCA’s appeals procedures and the composition of the Provider Appeals Committee deprive plaintiff of due process of law in violation of the United States Constitution.

Defendant, in response, takes the position that this court is without jurisdiction to hear this case. In addition, it argues that the two-year limit was properly applied to plaintiff, and that the composition and procedures of the Provider Appeals Committee are constitutional.

We hold for plaintiff. This court has jurisdiction over this case. The two-year rule was improperly applied to plaintiff. The issue of possible unconstitutionality of the Provider Appeals Committee’s procedures and composition is not reached as not necessary to our decision.

Before reaching the merits of plaintiffs claim, we must first consider defendant’s contention that the court is without jurisdiction to hear this case. Defendant maintains that the Supreme Court’s decision in Weinberger v. Salfi, 422 U.S. 749, 756-62 (1975), prohibits judicial review of plaintiffs claim. Defendant takes this position, even though this court has already refused to extend Salfi to Medicare cases. Whitecliff, Inc. v. United States, 210 Ct.Cl. 53, 536 F.2d 347 (1976), cert. denied, 430 U.S. 969 (1977).

In view of defendant’s insistence that Salfi precludes judicial review, it is appropriate to restate what this court said in Whitecliff:

We decline the invitation to extend Salfi’s reading of Section 405(h) to this Medicare case. The social security provisions with which the Supreme Court dealt in Salfi authorize appeals of all decisions made after hearings, without limitation as to issues; [footnote omitted] the practical effect of the Salfi decision was simply the enforcement of the Section 405(g) procedures and prerequisites to judicial review. See also Mathews v. Eldridge, 425 U.S. 319, 326-32 (1976). By contrast, the Medicare statute’s express review provisions in effect prior to 1973 apply to extremely limited categories of cases involving providers, [footnote omitted] To import into the Medicare program the

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Bluebook (online)
558 F.2d 8, 214 Ct. Cl. 322, 1977 U.S. Ct. Cl. LEXIS 69, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-elizabeth-hospital-v-united-states-cc-1977.