Sumner v. United States

678 F.2d 202, 230 Ct. Cl. 555, 1982 U.S. Ct. Cl. LEXIS 272
CourtUnited States Court of Claims
DecidedMay 5, 1982
DocketNo. 539-79C
StatusPublished
Cited by4 cases

This text of 678 F.2d 202 (Sumner 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
Sumner v. United States, 678 F.2d 202, 230 Ct. Cl. 555, 1982 U.S. Ct. Cl. LEXIS 272 (cc 1982).

Opinion

PER CURIAM:

This Medicare case comes before the court on the parties’ cross-motions for summary judgment. The two plaintiffs are the former shareholders and directors of Parkview Hospital, Inc., a now dissolved corporation that qualified for the years 1966-68 as a Medicare provider under Part A of the Medicare program, 42 U.S.C. § 1395 et seq. (1976 & Supp. Ill 1979) (the Act).1 Plaintiffs seek to recover $90,471, which the designated fiscal intermediary,2 the Blue Cross Association of Southern California (Blue Cross), assessed against them as sole surviving shareholders of Parkview after a 1972 audit of the hospital’s cost reports.

The plaintiffs allege that the decision making the assessment was arbitrary, capricious, and violated applicable statutes and regulations, and that, in any event, laches barred the Blue Cross 1972 audit upon which the assessment was based. We uphold the assessment and grant the defendant’s motion for summary judgment.

I.

Parkview Hospital ("Parkview”) was a 47-bed, short-term, proprietary hospital which plaintiffs owned and administered. It was a Medicare provider facility from July 1966 through July 1968, when its assets were sold. In accordance with then-existing Medicare regulations, Park-view filed its cost reports for the fiscal years ending June 30, 1967 and July 31, 1968, with Blue Cross on October 16, 1967 and June 12, 1968, respectively. It was reimbursed on the basis of these reports.

On May 4, 1972, Blue Cross notified plaintiffs that the cost reports would be audited. Plaintiffs assert that at that time they first discovered that the successor hospital had destroyed all records for the years, in contravention of an alleged pre-sale agreement requiring the purchaser to maintain the records for six years.

[557]*557On the basis of its audit, Blue Cross concluded that plaintiffs owed the government $90,471. It found, first, that the compensation Parkway had paid to the owners was "grossly excessive,” in view of the nature of their services to the hospital. Second, Blue Cross determined that the plaintiffs improperly had allocated part of the gain on Parkview’s sale to "goodwill,” to avoid recapture of past depreciation deductions. Blue Cross’ Chief Hearing Officer later reduced plaintiffs’ assessment to $77,129.

Plaintiffs appealed the Blue Cross decision to the Blue Cross Providers Appeals Committee ("Appeals Committee”), which sustained the action but increased liability to the previous $90,471 figure.3 The Appeals Committee held that plaintiffs had failed to support their claims with satisfactory evidence, such as records or other data, as required by law, and that the Blue Cross determinations had a reasonable basis.

Plaintiffs, who were responsible for the liabilities of the then-defunct Parkview, paid the assessment to the United States. They then timely filed an action in the United States District Court for the Central District of California to recover the assessment, which that court transferred to this court.

II.

Under Part A of the Medicare Act, providers receive reimbursement payments based on the reasonable costs of their services. 42 U.S.C. § 1395f(b). The Secretary of Health, Education and Welfare (now Health and Human Services) has promulgated a number of regulations4 for determining the "reasonable costs” of services. Particularly significant here are regulations requiring providers to substantiate their reimbursement claims with adequate evidence. 20 C.F.R. § 405.406(a) requires the provider to "maintain [558]*558sufficient financial records and statistical data for proper determination of costs payable under the program.” 20 C.F.R. § 405.453(a) requires that "[providers receiving payment on the basis of reimbursable cost must provide adequate cost data. This must be based on their financial and statistical records which must be capable of verification by qualified auditors.”

Plaintiffs claim that all Parkview records for the period involved in this case were lost or destroyed by the successor hospital. When Blue Cross audited Parkview’s cost reports it therefore was required to use other bases for determining the reasonableness of plaintiffs’ claimed costs. Although plaintiffs rely on these other bases to support their claims, the lack of documentary evidence based upon Parkview’s own records necessarily makes it more difficult for plaintiffs to prove their case.

In considering plaintiffs’ claims, the limited scope of our review in Medicare cases must be respected. We determine ordinarily only whether the administrative proceedings have complied with the Constitution and the applicable statutes. West Seattle General Hospital v. United States, ante at 132; Goldstein v. United States, 201 Ct. Cl. 888, 889-90, cert. denied, 414 U.S. 974 (1973); see also, St. Elizabeth Hospital v. United States, 214 Ct. Cl. 322, 327, 558 F.2d 8, 11-12 (1977); Whitecliff, Inc. v. United States, 210 Ct. Cl. 53, 57-58, 536 F.2d 347, 350-51 (1976), cert. denied, 430 U.S. 969 (1977).

Under this standard of review, we have no basis for overturning Blue Cross’ determinations in this case.

III.

Plaintiffs assert that, because Blue Cross failed to initiate an audit of Parkview’s cost reports until 1972, four years after Parkview submitted the first cost report, laches bars recovery of any reimbursement for amounts paid pursuant to the reports. Plaintiffs urge us to apply retroactively regulations effective three years after Parkview filed its first cost report that require fiscal intermediaries to initiate field audits of providers within three years of the filing of cost reports.

[559]*559Assuming arguendo (1) that laches applies to the initiation of administrative as distinguished from judicial proceedings, (2) that the doctrine properly could be applied against the government in the present situation, and (3) that Blue Cross would be treated as the government — all highly dubious assumptions — we still would not invoke laches here to bar the Blue Cross audit.

Laches is an equitable doctrine that generally is invoked only in actions in equity, not in actions at law. See, e.g., Armstrong v. Maple Leaf Apartments, Ltd., 622 F.2d 466, 474 (10th Cir. 1979); Sun Oil Company v. Fleming, 469 F.2d 211, 213-14 (10th Cir. 1972); Sandobal v. Armour and Company, 429 F.2d 249, 257 (8th Cir. 1970); M. Lowenstein & Sons, Inc.

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Bluebook (online)
678 F.2d 202, 230 Ct. Cl. 555, 1982 U.S. Ct. Cl. LEXIS 272, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sumner-v-united-states-cc-1982.