The Faulkner Hospital Corporation v. Richard S. Schweiker, Secretary of Health and Human Services

702 F.2d 22, 1 Soc. Serv. Rev. 295
CourtCourt of Appeals for the First Circuit
DecidedMarch 10, 1983
Docket82-1528
StatusPublished
Cited by6 cases

This text of 702 F.2d 22 (The Faulkner Hospital Corporation v. Richard S. Schweiker, Secretary of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
The Faulkner Hospital Corporation v. Richard S. Schweiker, Secretary of Health and Human Services, 702 F.2d 22, 1 Soc. Serv. Rev. 295 (1st Cir. 1983).

Opinion

PER CURIAM.

In this case Faulkner Hospital seeks Medicare reimbursement for certain capital costs that it incurred as the result of the construction of its new hospital facility in Jamaica Plain, Massachusetts. Faulkner claims that it is entitled to a depreciation allowance for advances made to cover the operating deficit of Doctors Hospital. These advances were made by Faulkner because it was required to phase out all inpatient services at Doctors Hospital under the certificate of need for its new hospital. The Provider Reimbursement Review Board (PRRB) affirmed the decision, 537 F.Supp. 1058 of Blue Cross of Massachusetts, the fiscal intermediary for the Secretary of Health and Human Services, denying Faulkner reimbursement. The District Court reversed the PRRB on the ground that its findings were not supported by substantial evidence and were contrary to law. We agree with the reasoning set forth in the District Court’s opinion and affirm.

The controversy in this case arose as a result of Faulkner’s decision to replace and expand its existing hospital facilities. As is required under Massachusetts law, Faulkner submitted to the Department of Public Health (DPH) an application for a certificate of need for the construction of the new hospital. The DPH determined that there was a need for the replacement of Faulkner’s 186-bed facility, but conditioned approval of its expansion from 186 to 240 beds on Faulkner’s purchase of Doctors Hospital, a 115 bed proprietary hospital located in Faulkner’s primary service area. The DPH also conditioned Faulkner’s expansion proposal on the permanent termination of all inpatient services at Doctors Hospital and the development of plans for the future use of the Doctors Hospital facility.

In 1973 Faulkner organized the Faulkner Health Care Corporation (FHCC) to own and operate Doctors Hospital. From February 13, 1973 until March 16, 1976 FHCC operated the Doctors facility and, as contemplated by Faulkner’s certificate of need determination, gradually reduced its number of licensed beds. During this phase-out process, Doctors Hospital incurred operating losses of $1,169,235. To meet these deficits Faulkner advanced $1,241,000 to FHCC. On March 16, 1976 FHCC merged with Faulkner and all inpatient services at Doctors Hospital were terminated. At the time of the merger, Faulkner had not recovered the advances it had made to FHCC.

The contested reimbursement issue presented by this case arose from Faulkner’s attempt to treat its advances to FHCC as capital expenditures incurred in setting up its new facility, aná to claim a depreciation allowance for these advances. In its Medicare cost report for fiscal year 1976, Faulkner treated the amount of its unre-covered advances as part of the cost basis of its new facility and began to amortize this cost over the 40 year useful life of the new facility. Blue Cross denied reimbursement for that portion of the depreciation claim representing advances to FHCC. It was that decision, which was affirmed by the PRRB, but reversed by the District Court, that spawned this litigation.

*24 The general Medicare reimbursement principles governing this case are well established. As a provider of health care services to Medicare patients, Faulkner is entitled to reimbursement for the reasonable cost of the services it renders. See 42 U.S.C. § 1395x(v)(l)(A). According to the regulations defining this statutory mandate, reasonable cost includes all necessary and proper costs incurred in rendering services. 42 C.F.R. § 405.451(a). Necessary and proper costs are defined as costs “which are appropriate and helpful in developing and maintaining the operation of patient care facilities and activities. They are usually costs which are common and accepted occurrences in the field of the provider’s activity.” Id. § 405.451(b). Depreciation on the buildings and equipment used in providing patient care to Medicare beneficiaries may be an allowable cost. Id. Depreciation is based upon the “historical cost” of an asset, which includes costs, such as architectural fees, consulting fees and legal fees, that would be capitalized under generally accepted accounting principles. Medicare Provider Reimbursement Manual, Part 1, § 104.10.

The PRRB held that Faulkner’s advances to FHCC were not “necessary and proper” for two reasons. First, it found that the cost for which Faulkner was claiming reimbursement was the operating deficit of Doctors Hospital and, as such, did not relate to the care of patients at Faulkner Hospital. Second, the PRRB found that the costs were not common costs accepted in the provider’s field of activity. Faulkner, it reasoned, could have decided merely to replace rather than to expand its facilities. Paying the operating deficit of Doctors was therefore unnecessary. The issue on this appeal is whether the District Court was correct in rejecting both the PRRB’s reasons for denying Faulkner reimbursement as not based on substantial evidence and contrary to law. See 5 U.S.C. § 706(2).

The District Court, in a thorough and well reasoned opinion, properly rejected the defendant’s argument that Faulkner cannot claim reimbursement for the capital costs of its expansion because the expansion was unnecessary. We agree with the District Court’s conclusion that:

[E]ven if the PRRB had found that Faulkner’s expansion was unnecessary, such a finding would have been improper. First, it would have been plainly inconsistent . .. with the allowance of other costs in this case which were also related to plaintiff’s expansion. Second, we believe it was not , within the agency’s authority under the Medicare program to determine the need for expansion involved in this particular case. That determination was properly made by the Public Health Council, which approved Faulkner’s expansion under certain conditions that the record indicates were intended to improve the quality of health care provided to all patients, Medicare and non-Medicare alike. The question for the PRRB’s determination was not whether it was reasonable for Faulkner to expand, but rather, whether given that decision, the cost incurred in effecting such expansion was reasonable. Faulkner Hospital Corporation v. Schweiker, 537 F.Supp. 1058, 1066 (D.Mass.1982).

The fact that DPH approval was conditional does not mean, as defendant suggests, that Faulkner created the need for its expansion by purchasing Doctors Hospital. Defendant-Appellant Brief at 14-15. Rather, as the DPH found, at the time of Faulkner’s application for a certificate of need, there existed a need to replace Doctors Hospital with a new and improved facility. Faulkner’s expansion fulfilled this need, it did not create it.

We also agree with the District Court’s conclusion that the fact that Faulkner made advances to FHCC to cover the operating deficit at Doctors Hospital during its phaseout does not mean that these advances were unrelated to the care of patients at Faulkner’s new facility. Faulkner Hospital Corp. v. Schweiker, 537 F.Supp. at 1066-67.

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Bluebook (online)
702 F.2d 22, 1 Soc. Serv. Rev. 295, Counsel Stack Legal Research, https://law.counselstack.com/opinion/the-faulkner-hospital-corporation-v-richard-s-schweiker-secretary-of-ca1-1983.