Summit Nursing Home, Inc. v. United States

572 F.2d 737, 215 Ct. Cl. 581, 1978 U.S. Ct. Cl. LEXIS 61
CourtUnited States Court of Claims
DecidedFebruary 22, 1978
DocketNo. 89-74
StatusPublished
Cited by20 cases

This text of 572 F.2d 737 (Summit Nursing Home, Inc. 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
Summit Nursing Home, Inc. v. United States, 572 F.2d 737, 215 Ct. Cl. 581, 1978 U.S. Ct. Cl. LEXIS 61 (cc 1978).

Opinion

Cowen, Senior Judge,

delivered the opinion of the court:

Plaintiff, a Maryland corporation, is a provider of skilled nursing care to persons eligible for those services under the Social Security Act, 42 U.S.C. §§ 1395, et seq., commonly referred to as the Medicare program. Plaintiff brought this action to recover the sum of $47,189. This amount had been allowed'for accelerated depreciation and paid as a reasonable cost reimbursement owed plaintiff for services as a provider of skilled nursing care under the Medicare program, but the $47,189 was subsequently recaptured by the defendant through its agent, Mutual of Omaha, pursuant to 20 C.F.R. § 405.415(d)(3), issued by the Social Security Administration, Department of Health, Education, and Welfare (HEW).

The case was first argued before the court on defendant’s motion to dismiss and plaintiffs opposition thereto. At that time, the court was informed that a proposed regulation concerning the extent and incidence of retroactivity under 42 U.S.C. § 1395x(v) (Supp. V 1975) had been published in June 1975 (40 Fed. Reg.26535), but we did not know whether that or any other pertinent regulation had been adopted, or what the position of HEW was on the proposed regulation. Accordingly, by order of October 21, 1976, 211 Ct. Cl. 346, we remanded the case to HEW for a renewed determination of plaintiffs claim, in accordance with the present policy and position of HEW. Thereafter, the defendant filed its response to the court’s order, and by means of a letter and affidavit attached, advised the court that the proposed regulation had not been adopted and that no new regulation or instruction had been promulgated or issued by the Secretary of HEW (hereinafter Secretary) which would affect the recapture of accelerated depreciation from a provider because of a decline in the utilization of its facilities by Medicare patients. Following [585]*585the responses to the court’s orders, plaintiff filed its motion for summary judgment and defendant its cross-motion for summary judgment.

After again hearing oral argument and considering the pleadings, motions, and briefs of the parties we have, for the reasons to be set forth, concluded that plaintiff is not entitled to recover and that its petition should be dismissed.

I.

Under the "Medicare” provisions of the Social Security Act, a provider, such as plaintiff, is not paid for its services by the patients. Instead, the provider is reimbursed by the Secretary from the Federal Hospital Insurance Trust Fund, which is financed by special wage taxes. 42 U.S.C. § 1395i. Pursuant to 42 U.S.C. § 1395g, a provider receives interim pre-audit reimbursements not less than monthly based on billings submitted to the Secretary or his designate. At the close of the fiscal year, the provider submits a cost report and the Secretary then determines by audit the actual amount of reimbursement which the provider is entitled to for that year. 20 C.F.R. § 405.451(b)(1). Adjustments are thereafter made in the current interim payments in accordance with the amount determined to be due the provider as shown by the audit. The Medicare program is administered in substantial part by private organizations under contract with the Secretary. 42 U.S.C. § 1395h authorizes a provider to nominate a private organization to act as fiscal intermediary. Plaintiff became a provider of services under the program on January 1, 1967 and nominated Mutual of Omaha. Mutual of Omaha then entered into an agreement with the Secretary to act as fiscal intermediary for plaintiff. The provider submits its bills for all services to the intermediary, who is responsible for their payment as agent for the Secretary. Section 1395f(b) (Supp. V, 1975) provides that the total amount to be paid to a provider shall be "the reasonable cost” of services rendered to Medicare beneficiaries as determined under section 1395x(v). The latter section states that reasonable costs shall be determined in regulations issued [586]*586by the Secretary establishing the methods of cost calculation. Section 1395x(v)(l)(A)(i) further provides that the regulations must take into account direct and indirect costs of providers so that costs for individuals covered by the insurance program will not be borne by individuals not covered, and that costs with respect to individuals not covered will not be borne by the insurance program. Section 1395x(v)(l)(A)(ii) also requires that the regulations must provide for the making of suitable retroactive corrective adjustments where, for a provider of services for any fiscal period, the aggregate reimbursement produced by the methods of determining costs proves to be either inadequate or excessive.”

From 1966 until August 1, 1970, the regulations permitted an allowance for accelerated depreciation on capital assets as a reimbursable cost. 20 C.F.R. § 405.415 (1967). Plaintiff exercised its option to claim an allowance for accelerated depreciation as an item of reimbursable cost and its claims on that basis were approved for the fiscal years ending October 31, 1967 through October 31, 1971.

Beginning in 1969, HEW issued new and more restrictive guidelines to intermediaries for determining the eligibility of persons for Medicare benefits in skilled nursing facilities. As a result, there was a substantial decline in Medicare utilization of plaintiffs facility.1

On February 5, 1970, the Secretary published a proposed regulation regarding depreciation, 35 Fed. Reg. 2593. It was announced that the following changes would be made in the treatment of accelerated depreciation: (a) nursing homes certified after August 1, 1970 could not use that method of calculating depreciated costs; (b) providers then participating in the program could not use the accelerated method for newly acquired assets; (c) on capital assets for which the accelerated method of depreciation had been used prior to August 1, 1970, that method could continue to be used; and of particular pertinence to this litigation (d) if [587]*587a provider terminated its participation in the program, or if the Medicare proportion of its allowable costs decreased substantially, the Secretary could recover "the excess of reimbursable costs determined by using accelerated depreciation methods when these costs had been paid over the reimbursable costs which would have been determined and paid by using the straight-line method of depreciation.” On August 1, 1970, the new regulation promulgated by the Secretary, 20 C.F.R. § 405.415(d)(3), became effective. It provided as follows in relevant part:

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Bluebook (online)
572 F.2d 737, 215 Ct. Cl. 581, 1978 U.S. Ct. Cl. LEXIS 61, Counsel Stack Legal Research, https://law.counselstack.com/opinion/summit-nursing-home-inc-v-united-states-cc-1978.