United States v. Normandy House Nursing Home, Inc.

428 F. Supp. 421, 1977 U.S. Dist. LEXIS 17333
District Court, D. Massachusetts·Decided February 16, 1977·No. Civ. A. 75-950-F·Published·Cited by 11 cases

Opinion

ORDER

FREEDMAN, District Judge.

This matter is before the Court on motions by both defendants for dismissal. Defendant Normandy House Nursing Home, Inc. (Normandy House) argues that plaintiff’s action was commenced after the expiration of the statute of limitations. Defendant William D’Annolfo, in addition to raising the statute of limitations defense, claims that plaintiff’s complaint fails to state a cause upon which relief can be granted, and that the complaint is based upon a written agreement between plaintiff and Normandy House as to which D’Annolfo was not a party. After consideration of the arguments by all the parties, as well as the record and relevant authorities, I am of the opinion that both motions to dismiss should be denied.

Pursuant to the program set forth in the Health Insurance for the Aged Act, 42 U.S.C. § 1395, et seq., more commonly known as Medicare, defendant Normandy House entered into an agreement dated December 19, 1966, with the Department of Health, Education, and Welfare (HEW) to provide services to beneficiaries in its nursing home in return for HEW making payments to reimburse it for the costs incurred. In order to carry out the agreement, HEW entered into another contract with Massachusetts Blue Cross, Inc. 42 U.S.C. § 1395g and 20 C.F.R. § 405.454 require that regular payments be made to providers “not less often than monthly” and prior to any audit of their cost statements. Blue Cross was to provide Normandy House with such payments and, at the end of the reporting period, to make an audit to determine whether Normandy House had been underpaid or overpaid for the services it provided.

Under the Medicare program, a provider of services such as Normandy House sub *423 mits an annual cost report. It is then granted immediate payments prior to an audit being conducted. The rationale for this procedure is that a provider should be reimbursed as quickly as possible. 20 C.F.R. § 405.454(f)(2). One of the program’s main concerns is that providers of services be given a steady flow of money so that they will have the finances to take care of Medicare’s beneficiaries in an uninterrupted manner. By allowing annual cost reports to be submitted and initially relied upon, not only can this be achieved, but providers can also “keep pace with growing needs and . . . make improvements.” Id. § 405.402(b)(6).

Another concern of the program whereby providers receive payments is that the government pay only the reasonable cost of the services rendered to beneficiaries. Thus, in the case of each provider, an audit must ultimately be made to determine the final liability of the program and make possible a final adjustment, id. § 405.-454(f)(2), whether it be for underpayment or overpayment. 42 U.S.C. § 1395g.

Under its 1966 agreement with HEW, Normandy House operated as a provider during the years 1967, 1968, and 1969. On the basis of cost reports submitted for those years, Normandy House was paid almost two million dollars. In 1970, an audit was completed by Blue Cross on Normandy House’s 1967 cost report. Audits for the 1968 and 1969 reports were completed in 1971. As alleged in plaintiff’s complaint, these audits determined that Normandy House had been overpaid $259,074.00 for the years 1967 through 1969. Plaintiff further claims that despite demands, defendants have failed to return that amount.

As already stated, both defendants argue that the statute of limitations bars plaintiff from bringing this action against them. I do not agree. The applicable statute provides in pertinent part:

Subject to the provisions of section 2416 of this title, . . . every action for money damages brought by the United States or an officer or agency thereof which is founded upon any contract express or implied in law or fact, shall be barred unless the complaint is filed within six years after the right of action accrues . ...

28 U.S.C. § 2415(a). Section 2416, to which the above section refers, states in part:

For the purpose of computing the limitations periods established in section 2415, there shall be excluded all periods during which—
(c) facts material to the right of action are not known and reasonably could not be known by an official of the United States charged with the responsibility to act in the circumstances

Defendants take the position that plaintiff’s right of action accrued at the time the overpayments were made. Plaintiff makes the obvious response that prior to the making of an audit, Medicare payments such as those involved herein “are deemed to be interim and subject to later adjustments.” It continues that since “[t]he actual amounts owed to Normandy were only determined, as contemplated by statute, in 1970 and 1971, . . . only at these dates did the government’s right of action for overpayments arise.” I believe that this is the proper approach to the statute of limitations issue. By the very nature of the procedure for Medicare payments, already discussed, it cannot be said that plaintiff knew or reasonably could have known of the facts material to its right of action prior to the time the appropriate audits were made. To this position, defendants claim that “[t]o follow the plaintiff’s argument, if the governmental agency decided to perform an audit ten years after the alleged overpayment, the statute would be tolled until such audit.” In such an instance, defendants’ argument might have some validity. That is not the case here, however. Plaintiff was not acting unreasonably in having audits made at the time it did. Before that time, it could not have known that there had been overpayments to Normandy House. Plaintiff’s cause of action did not, therefore, arise until the audits of Normandy House’s cost reports had been completed. *424 The statute of limitations does not bar plaintiff’s suit.

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United States v. Normandy House Nursing Home, Inc., 428 F. Supp. 421, 1977 U.S. Dist. LEXIS 17333 (D. Mass. 1977).

428 F. Supp. 421 (United States v. Normandy House Nursing Home, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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