United States v. Clawson Medical Rehabilitation & Pain Care Center, P.C.

722 F. Supp. 1468, 1989 U.S. Dist. LEXIS 11679, 1989 WL 115563
CourtDistrict Court, E.D. Michigan
DecidedSeptember 27, 1989
Docket89-70172
StatusPublished
Cited by5 cases

This text of 722 F. Supp. 1468 (United States v. Clawson Medical Rehabilitation & Pain Care Center, P.C.) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Clawson Medical Rehabilitation & Pain Care Center, P.C., 722 F. Supp. 1468, 1989 U.S. Dist. LEXIS 11679, 1989 WL 115563 (E.D. Mich. 1989).

Opinion

MEMORANDUM AND ORDER

COHN, District Judge.

I.

This is essentially a collection case. Defendant Ira Snider (Snider) was chief executive officer and sole shareholder of the Clawson Medical, Rehabilitation, and Pain Care Center (Clawson), which operated a chain of Part A Medicare clinics from 1979 to 1981. During these years, the United States overpaid Clawson by about $1,900,-000 for services rendered to Medicare beneficiaries. Clawson filed for reorganization in 1980 and currently has no assets. On January 16, 1989, the United States filed this action, demanding a judgment against Clawson for the overpayment plus accumulated interest (Count I) and a judgment against Snider personally on an alter ego theory (Count II). Snider has moved for summary judgment as to personal liability on the grounds that the six year federal statute of limitations relating to an action to recover medicare overpayments has run. He says that Clawson was technically the debtor and the bankruptcy stay did not bar an action as to him personally. The United States opposes the motion on the grounds that, as to Snider, this is an action to enforce a judgment against Clawson and the federal contracts statute of limitations does not apply to an enforcement action. The Court agrees that the government’s claim *1469 against Snider is an action for the collection of a judgment; Snider’s motion for summary judgment will therefore be denied.

II.

A.

The Medicare program employs two distinct reimbursement mechanisms, Part A and Part B. Part B compensates individual health care providers on a reasonable charge basis; Part A compensátes hospitals and other institutional providers based on the lesser of the customary charge or the reasonable cost of such services. 42 U.S.C. sec. 1395f(b). Because it is difficult to estimate in advance what a Part A provider’s ultimate costs will be, the program has established a system of interim estimated payments, subject to a year-end accounting to adjust for underpayments or overpayments. 42 U.S.C. sec. ^Sg. 1

In order to begin the annual accounting process, the provider must supply a detailed cost report at the close of the fiscal year. 42 C.F.R. sec. 413.24. After reviewing the report, the intermediary determines which costs are properly reimbursable under the terms of the program. A Notice of Program Reimbursement (NPR) is then issued reflecting the intermediary’s determination of allowable reimbursement and reflecting the amount to be recouped or added to the interim payments previously made. 42 C.F.R. sec. 1803(a). If the provider disagrees with the intermediary’s determination and the amount in controversy exceeds $10,000, the provider may appeal the decision to the Provider Reimbursement Review Board (PRRB). 42 U.S.C. sec. 1395oo. An aggrieved provider may appeal the decision of the PRRB directly to a United States district court. 42 U.S.C. sec. 1395oo (f)(1).

B.

Snider purchased Clawson in 1978 as a going business. Clawson negotiated interim reimbursement rates with Blue Cross and began operations. Blue Cross paid $311,000 in interim payments for the period from April 1, 1978 to March 31, 1979. On September 5, 1980, Blue Cross sent Claw-son an NPR informing it that it had disallowed $192,986 in interim charges and demanding reimbursement. On October 7, 1980, Clawson filed for a Chapter 11 bankruptcy petition and a trustee was appointed. An NPR covering the period from April 1,1979 to March 31, 1980 was sent to Clawson on November 20, 1981, which indicated that a total of $923,690 in over-payments were due. On December 18, 1981, Clawson ceased doing business. A final NPR covering the period from April 1, 1980 to March 31, 1981 was sent to Claw-son on January 23, 1983, which indicated a balance due of $589,468. During the period from April 1, 1981 to December 18, 1981, Blue Cross paid Clawson $245,834. Because Clawson failed to provide the required cost reports, the entire sum was deemed an overpayment. It is not clear if and when an NPR was sent regarding this period. The Chapter 11 proceeding was converted to a Chapter 7 proceeding on October 1, 1985.

Following the cessation of Clawson’s business operations, the United States filed numerous motions to dismiss the bankruptcy petition or lift the automatic stay in order to allow it to sue on the outstanding debt. Each time, the motion was opposed by attorneys representing Snider and/or Clawson. On January 10, 1989, the bankruptcy court finally lifted the stay as a consequence of an order of the district court. 2 This suit was commenced seven days later.

*1470 III.

The United States moves for judgment on Count I for the full amount of the debt against Clawson. In support of its motion, the United States has filed a brief detailing the basis for the obligation and its right to prejudgment interest. Clawson contests the award of prejudgment interest on reimbursement for fiscal 1981 on the grounds that the United States unreasonably delayed the entry of a final determination of Clawson’s liability for four months. Presumably, this argument is premised on the theories of estoppel and laches. Yet it is well settled that in order to prevail on these theories, some kind of affirmative prejudice must be shown. See Heckler v. Community Health Services, 467 U.S. 51, 104 S.Ct. 2218, 81 L.Ed.2d 42 (1984) (estoppel); Ruiz v. Shelby County Sheriffs Department, 725 F.2d 388 (6th Cir.), cert. denied, 469 U.S. 1016, 105 S.Ct. 428, 83 L.Ed.2d 355 (1984) (laches). Clawson has failed to carry this burden. There is no allegation that had the intermediary furnished the NPR for fiscal 1981 in a timely manner, reimbursement would have been forthcoming. Indeed, the fact that Claw-son was under the protection of the bankruptcy court at that time of the alleged delay conclusively negates this possibility. Under the circumstances, the Court can see no good reason for denying the United States the full measure of interest demanded and judgment against Clawson in the amount of $2,458,610 is therefore GRANTED.

Since Clawson has no assets, the real issue in this case is Snider’s personal liability for Clawson’s debts. Snider moves for summary judgment on Count II on the grounds that suit is barred by the general federal six year statute of limitations which is applicable to actions to recover medicare overpayments. 28 U.S.C. sec. 2415(a). Snider says that any tolling of the statute by the entry of the bankruptcy stay applied to actions against the debtor, Clawson, and that no such tolling can be imputed to a personal action against a co-defendant. See Lynch v. Johns-Manville Sales Corp., 710 F.2d 1194 (6th Cir.1983). The United States contends that the claim against Snider is not barred because the federal contracts limitations period does not apply to actions for enforcement of a judgment.

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Cite This Page — Counsel Stack

Bluebook (online)
722 F. Supp. 1468, 1989 U.S. Dist. LEXIS 11679, 1989 WL 115563, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-clawson-medical-rehabilitation-pain-care-center-pc-mied-1989.