United States v. Contemporary Health Management of Hardin County, Inc.

807 F. Supp. 47, 1992 U.S. Dist. LEXIS 17782, 1992 WL 341395
CourtDistrict Court, E.D. Texas
DecidedNovember 5, 1992
Docket1:91-CV-0773
StatusPublished
Cited by5 cases

This text of 807 F. Supp. 47 (United States v. Contemporary Health Management of Hardin County, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. Contemporary Health Management of Hardin County, Inc., 807 F. Supp. 47, 1992 U.S. Dist. LEXIS 17782, 1992 WL 341395 (E.D. Tex. 1992).

Opinion

MEMORANDUM OPINION

COBB, District Judge.

The United States, plaintiff, brings suit against Hardin County, Texas, defendant, to recover overpayments made to Contemporary Health Management of Hardin County, Inc., (d/b/a Hardin Memorial Hospital and Hardin Medical Center), defendant, under the Social Security Act (Medicare), 42 U.S.C. § 1395 et seq. The United States and Hardin County move for summary judgment.

Hardin Memorial Hospital, Kountze, Texas, was constructed as a county hospital under Vernon’s Ann.Civ.St. at 4478. From its inception in 1966 until March 1982, it was owned and operated by Hardin County, Texas, which maintained the hospital’s status as a Medicare “provider” under the Medicare Act, 42 U.S.C. § 1395g.

On March 17, 1982, Hardin County leased the hospital (later renamed Hardin Medical Center) to Contemporary Health Management of Hardin County, Inc., (“CHM”), for a period of twenty years. Government regulations under Medicare stipulate that while provider status is automatically transferred from lessor to lessee, the lessee must obtain recertification and execution of a new provider agreement. 42 C.F.R. § 489.18.

Under the lease agreement, Hardin County agreed to assist CHM in obtaining recertification of the hospital as a Medicare provider (Lease § 20.2), to retain liability for Medicare payments prior to the lease (§ 20.1); and, in relevant part, to appoint a Community Advisory Board “to provide” information concerning the community’s health care needs, “to provide” information concerning the overall performance of the hospital, “to participate” in a quality assurance program, “to assist” in the development of a program for the medically indigent of the county, and “to provide” review of that program (§ 20.5).

For its part, CHM agreed, inter alia, to be liable for Medicare payments subsequent to the lease (§ 20.1) and to use its best efforts to obtain certification as a Medicare provider (§ 20.3). On July 13, 1982, CHM obtained recertification of the hospital’s provider status by the Department of Health and Human Resources. Defendant’s Exhibit A.

The hospital participated in the Medicare program until April 16, 1986. Blue Cross and Blue Shield, the fiscal intermediary making interim payments to CHM for services rendered under Medicare, 42 U.S.C. § 1395f(b), 42 C.F.R. § 413.64, determined that CHM had been overpaid for fiscal years 1983, 1984, 1985 and 1986. These debts remained unpaid, and the government commenced suit for reimbursement on August 21, 1991.

The defendant asserts the statute of limitations as an affirmative defense. The government’s cause of action is barred “unless the complaint is filed within six years after the right of action accrues,” 28 U.S.C. § 2415(a), excluding periods during which “facts material to the right of action are not known and reasonably could not be known by an official of the U.S. charged with the responsibility to act in the circumstances,” 28 U.S.C. § 2416.

No duty is owed to the United States under § 2415 until the rights and liabilities of the parties are determined. United *49 States v. Withrow, 593 F.2d 802, 805 (7th Cir.1979). Under the Medicare Act, the Department of Health and Human Resources is notified of overpayments made or reimbursements due by the fiscal intermediary’s Notice of Payment Reports. 42 C.F.R. § 405.1803(a), (c). In this case, for the fiscal years 1983 and 1984, overpayment reports were issued on April 25, 1986, and March 5, 1986, respectively. As the government brought this action on August 21, 1991, its suit as to those years is not barred. See, United States v. Robert’s Nursing Home, Inc., 710 F.2d 1275 (7th Cir.1983).

Notice of Payment Reports are predicated on the Medicare provider’s cost reports, which must be submitted no later than three months after a cost period. 42 C.F.R. §§ 405.406(b), 405.453(f)(2). The Fifth Circuit has held that failure to file a cost report is a cause of action. U.S. v. Upper Valley Clinic Hospital, Inc., 615 F.2d 302 (5th Cir.1980). Consequently, as the provider has three months to file, it is upon the expiration of that period that the government’s cause of action accrues.

Here, the hospital did not submit cost reports for fiscal years 1985 and 1986. For the cost period ending December 31, 1985, the hospital’s cost report was due by March 31, 1986; for the period ending April 15, 1986, the cost report was due by July 15, 1986. 42 C.F.R. § 405.453(f)(2), and (f)(2)(iii). Thus, the six-year limitations commenced to run on April 1, 1986, and July 16, 1986, for fiscal years 1985 and 1986, respectively. As the government brought this action on August 21, 1991, the suit as to those years is not barred.

Both the United States and Hardin County have moved for summary judgment. A party is entitled to summary judgment only if it meets “the exacting burden of demonstrating that there is no actual dispute as to any material fact in the case.” Landry v. Air Line Pilots Association International AFL-CIO, 901 F.2d 404, 424 (5th Cir.1990) (citing Impossible Electronics Techniques, Inc. v. Wackenhut Protective Systems, Inc., 669 F.2d 1026, 1031 (5th Cir. Unit B 1982)). The court must view the evidence and all factual inferences in the light most favorable to the opposing party, resolving all reasonable doubts in its favor. If any factual issues exist, or if reasonable minds might differ on the inferences arising from undisputed facts, the motion for summary judgment must be denied. However, once the movant has made and supported its motion, the adverse party may not rest upon “mere allegations or denials” but must “set forth specific facts showing that there is a genuine issue for trial.” Id.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
807 F. Supp. 47, 1992 U.S. Dist. LEXIS 17782, 1992 WL 341395, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-contemporary-health-management-of-hardin-county-inc-txed-1992.