Sun City Community Hospital, Inc. v. United States

624 F.2d 997, 224 Ct. Cl. 201, 1980 U.S. Ct. Cl. LEXIS 197
CourtUnited States Court of Claims
DecidedMay 28, 1980
DocketNo. 545-78
StatusPublished
Cited by6 cases

This text of 624 F.2d 997 (Sun City Community Hospital, 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
Sun City Community Hospital, Inc. v. United States, 624 F.2d 997, 224 Ct. Cl. 201, 1980 U.S. Ct. Cl. LEXIS 197 (cc 1980).

Opinion

KASHIWA, Judge,

delivered the opinion of the court:

[204]*204This is an action for the recovery of Medicare reimbursements for plaintiffs 1971 and 1972 fiscal years. The case is before the court on the parties’ cross motions for summary judgment. Plaintiff asks us to find it entitled to additional Medicare reimbursements of $19,204 for 1971 and $27,846 for 1972. Defendant asks us to find plaintiff entitled to no additional reimbursements. As explained in more detail infra, a Hearing Officer initially held plaintiff entitled to additional reimbursement. The Hearing Officer was then ordered to reopen and revise his decision. In accordance with this directive, the Hearing Officer rendered a second decision in which he held plaintiff entitled to no additional Medicare reimbursement. For the reasons set out below, we accord finality to the first decision and grant plaintiff recovery, but not in the full amount requested.

Plaintiff is a nonprofit corporation organized under the laws of the State of Arizona, has a fiscal year ending June 30 of each calendar year, and operates the Walter O. Boswell Memorial Hospital. Plaintiff participates in the Medicare program as a "provider,” in accordance with Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. (1970). Pursuant to an agreement filed with the Secretary of Health, Education and Welfare ("HEW”) under 42 U.S.C. § 1395cc, a provider agrees not to charge Medicare beneficiaries directly for services furnished to them, agreeing instead to be reimbursed from the Medicare fund for such services.

To the extent here relevant, 42 U.S.C. § 1395f(b) provides that the reimbursement will be equal to the "reasonable cost,” as defined in 42 U.S.C. § 1395x(v), of providing such services. "The reasonable cost of any services shall be determined in accordance with regulations establishing * * * the items to be included, in determining such costs for various types or classes of institutions * * 42 U.S.C. § 1395x(v)(l). The regulations so authorized are now set out at 42 C.F.R. § 405.101 et seq. (1979).1 42 C.F.R. § 405.415(a) provides that "[a]n appropriate allowance for depreciation [205]*205on buildings and equipment used in the provision of patient care is an allowable cost.” This means an appropriate allowance for depreciation is considered one of the reasonable costs of providing services to Medicare beneficiaries. An amount equal to such allowance is, therefore, included in and increases a provider’s Medicare reimbursement.

Sometime prior to 1971, plaintiff chose Blue Cross Association of Illinois ("BCA”) to act as its fiscal intermediary. BCA in turn had Blue Cross of Arizona, Inc. (the "Plan”) assume, in the first instance, the obligation to service plaintiff. Under plaintiffs agreement with HEW and also pursuant to'42 U.S.C. § 1395h, BCA and the Plan were required to determine the amount of Medicare reimbursement due, and make actual payment to, plaintiff. This in turn required the Plan and BCA to determine plaintiffs reasonable cost of providing services to Medicare beneficiaries.

Plaintiffs hospital was constructed in the late 1960’s. Although there is disagreement as to the motive for doing so, it is undisputed that the general contractor, Del E. Webb Corporation ("Webb”), agreed to forego its usual overhead and profit markup on this construction project. When the hospital facility was completed, it was appraised by a nationally recognized appraisal company. The appraisal indicated the hospital had a date-of-completion fair market value of $5,329,451. The actual cost to plaintiff of constructing the facility was $576,114 less than such fair market value.

Plaintiff took the position that Webb, the subcontractors, and the architect who worked on the hospital facility all made donations of services to plaintiff to aid in plaintiffs acquisition of its hospital. In plaintiffs view, Webb’s donation was its not charging an overhead and profit markup; and the subcontractors and architect made their donations by agreeing to work for less than their normal rates of profit. Plaintiff also assumed the $576,114 difference between fair market value and cost was entirely attributable to, and equaled the total amount of, these various donations. Operating under the assumption that in determining the appropriate allowance for depreciation donations could be added to basis, plaintiff increased its [206]*206basis in the facility by this amount. This in turn increased the allowance for depreciation and, thus, also the reasonable cost of providing services to Medicare beneficiaries by $19,204 for its fiscal year 1971 and $27,846 for its fiscal year 1972.

The Plan determined that none of the $576,114 could be included in plaintiffs basis for its hospital facility. It, therefore, reduced plaintiffs Medicare reimbursement by $19,204 and $27,846 for fiscal 1971 and 1972, respectively. Plaintiff appealed this decision to BCA and a hearing was conducted by BCA’s Chief Hearing Officer. Plaintiff was the only party to offer evidence and testimony at the hearing.

In determining plaintiffs basis in its hospital facility for purposes of determining the appropriate allowance for depreciation, the Hearing Officer looked to the Provider Reimbursement Manual (the "Manual”).2 The Hearing Officer interpreted Manual section 104.15 as articulating a general rule that for Medicare reimbursement purposes, a provider can acquire an asset either entirely by purchase or entirely by donation, but cannot acquire a single asset partially by purchase and partially by receipt of donations. If the provider makes any payment in obtaining an asset, even if the asset was in fact donated in part, the asset is considered acquired entirely by purchase and the donation treated as if it never occurred.3 Since not recognizable, the value of the donation cannot be added to the basis of such asset, limiting the basis to the provider’s cost of acquisition. However, he then went on to interpret Manual section 134.6 as creating an exception to this general rule.4

[207]*207The Hearing Officer viewed the first sentence of the second paragraph of section 134.6 as stating that where a provider constructs an asset and in fact receives a donation of material, labor, or services in conjunction with such construction, the donation is recognizable for Medicare purposes and the asset’s basis includes both the fair market value of such donation as well as the cost actually incurred by the provider. The Hearing Officer then interpreted the first paragraph of Manual section 134.6 as authorizing the use of an appraisal to determine the fair market value of the donated material, labor, or services.

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Bluebook (online)
624 F.2d 997, 224 Ct. Cl. 201, 1980 U.S. Ct. Cl. LEXIS 197, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sun-city-community-hospital-inc-v-united-states-cc-1980.