Temple University v. Commonwealth, Department of Public Welfare

480 A.2d 1267, 83 Pa. Commw. 516, 1984 Pa. Commw. LEXIS 1543
CourtCommonwealth Court of Pennsylvania
DecidedJuly 6, 1984
DocketAppeals, Nos. 770 C.D. 1982 and 1111 C.D. 1982
StatusPublished
Cited by3 cases

This text of 480 A.2d 1267 (Temple University v. Commonwealth, Department of Public Welfare) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Temple University v. Commonwealth, Department of Public Welfare, 480 A.2d 1267, 83 Pa. Commw. 516, 1984 Pa. Commw. LEXIS 1543 (Pa. Ct. App. 1984).

Opinion

Opinion by

Judge Williams, Jr.,

Temple University (Temple), a member of the Commonwealth ¡System of Higher Education, has appealed a final adjudication by the Department of Public Welfare (Department) disallowing certain claims for reimbursement of costs under Pennsylvania’s Medical Assistance (Medicaid) Program, Section 443.1 of the Public Welfare Code, Act of June 13, 1967, P.L. 31, as amended, added by Section 5 of the Act of July 31, 1968, P.L. 904, as amended, 62 P.S. §443.1.1

[518]*518Temple is the owner and operator of Temple University Hospital (Hospital), a public general hospital and a provider of inpatient medical care to low-income persons under the Pennsylvania Medicaid Program. As a provider, Temple is entitled to reimbursement by the Commonwealth of certain allowable costs associated with its provision of services to Medicaid patients.2 The Pennsylvania Department of Public Welfare, the agency authorized to administer Pennsylvania’s Medicaid Program, conducts annual audits of Temple’s recordkeeping and cost reports, and based on those audits, determines the level of reimbursement to be made.

In this appeal, covering three fiscal years, Temple contends that the Department improperly disallowed reimbursement for interest expenses incurred in order to satisfy the operational needs of the Hospital. Temple also contends that the Department improperly [519]*519determined the formula for reimbursement for physician services provided by staff of the Medical School of Temple University (Medical School).

Before addressing the substantive issues, the unusual procedural history of this case warrants recitation. The case began with an audit by the State Auditor General of Temple’s Medical Assistance cost reports for the twelve-month periods ending June 30, 1975 and June 30, 1976. The Auditor General disallowed portions of Temple’s asserted costs for interest expense on the grounds that Temple’s accounting methods did not provide sufficient verification for all of the expenses claimed. The Auditor General’s report was subsequently adopted by the Department for purposes of determining Temple’s entitlement to reimbursement under the Medicaid Program. Temple appealed from the determination, and was granted a hearing on December 13,1979 before Harvey S. Miller, a hearing examiner attached to the Department’s Office of Hearings and Appeals.3 Examiner Miller issued his findings and recommendation that Temple’s appeal be sustained. That recommendation, however, was never acted upon by the Office of Hearings and Appeals or by the Secretary of Welfare because the Department, on November 25, 1980, filed a petition to reopen the proceedings and consolidate them with an appeal which Temple had lodged from the Department’s disallowance of claims for reimbursement for the fiscal year ending June 30, 1977. In the more recent appeal, Temple challenged the disallowance of a portion of its claim for interest expense as well as the [520]*520formulas applied by the Department to reimburse for emergency-room and staff physician services.

The Office of Hearings and Appeals denied tbe Department’s petition to reopen and consolidate tbe proceedings, on tbe grounds that tbe Department bad asserted no basis which would justify granting tbe petition. Notwithstanding tbe denial by tbe Office of Hearings and Appeals of tbe Department’s petition, then-Secretary of Welfare Helen B. O’Bannon, on December 31, 1980, granted tbe Department’s petition, and ordered tbe appeal for fiscal years 1974-1975 and 1975-1976 reopened and consolidated with tbe appeal for fiscal year 1976-1977. In ordering tbe reopening and consolidation, tbe Secretary stated:

Tbe issue at band is one that continues to be challenged. Additional information and consolidation appear to be in tbe public interest. However, I hereby direct the bearing examiner to rule on tbe accuracy, validity and reasonableness of tbe interest allocation apportionment used by tbe agent for tbe Auditor General. This finding shall be an explicit part of any subsequent decision of the Office of Hearings and Appeals in tbe now consolidated Temple case.
(Emphasis in original.)

Tbe consolidated appeals were assigned to Examiner John P. Currie, who, after further bearing, issued a recommendation denying Temple’s appeal with respect to the allocation of interest costs and the formula for calculating reimbursement for individual patient services performed by staff physicians, but sustaining Temple’s appeal as to reimbursement for emergency-room services. The Office of Hearings and Appeals, on March 8, 1982, entered a final order adopting tbe examiner’s recommendation. Tbe Secretary denied cross-petitions for reconsideration. This appeal by Temple followed.

[521]*521 Interest Expense

The substantive difficulty relative to Temple’s claim for reimbursement of interest expense arose from the fact that the Hospital, an operating division of Temple, has no separate corporate existence.4 As such, the Hospital has no capacity to borrow the substantial sums it requires for working capital; such borrowing can only be done by Temple on behalf of the Hospital. Up until February 1, 1977, monies borrowed by Temple to cover the operational needs of the Hospital were not specially earmarked or segregated for that purpose. Rather, the borrowed funds were maintained in accounts with Temple’s general corporate funds. When monies were needed to meet the financial obligations of the Hospital, Temple would make interest-free “loans” to the Hospital of the funds Temple had borrowed. From 1975 onward, each transfer of funds from Temple’s general accounts to or on behalf of the Hospital was evidenced by a demand note, and was reflected on the Hospital’s books as a loan payable to Temple. There is no dispute over the fact that these notes did not represent “loans” in the conventional sense, since Temple and the Hospital are the same corporate entity, but rather served as an accounting device for intracorporate transfers of funds. There also appears to be little controversy that the bank loans obtained by Temple during the period in question were primarily and substantially for the working capital needs of the Hospital. The divergence of opinion resides in whether Temple’s accounting methodology allowed the Auditor General and the Department to distinguish monies borrowed by Temple for the operational needs of the Hospital from funds [522]*522borrowed and used by Temple for other corporate obligations.

Examiner Miller, based on voluminous documentation and expert testimony presented by Temple, concluded that Temple had shouldered its burden of substantiating its entire claim for interest expense for fiscal years 1974-1975 and 1975-1976. Upon reopening and consolidation of the proceeding with Temple’s appeal from a partial disallowance of its claim for reimbursement of cost claimed for fiscal year 1976-1977, Examiner Currie concluded that Temple’s accounting methodology was inadequate to allow complete differentiation between bank loans applied to the legitimate needs of the Hospital and those applied to other purposes.

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Related

Temple University v. Commonwealth
521 A.2d 986 (Commonwealth Court of Pennsylvania, 1987)
Commonwealth v. Divine Providence Hospital
516 A.2d 82 (Commonwealth Court of Pennsylvania, 1986)
Northwestern Institute of Psychiatry v. Commonwealth
513 A.2d 495 (Commonwealth Court of Pennsylvania, 1986)

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Bluebook (online)
480 A.2d 1267, 83 Pa. Commw. 516, 1984 Pa. Commw. LEXIS 1543, Counsel Stack Legal Research, https://law.counselstack.com/opinion/temple-university-v-commonwealth-department-of-public-welfare-pacommwct-1984.