University Medical Center v. Sullivan

122 B.R. 919, 1990 U.S. Dist. LEXIS 17653, 1990 WL 255594
CourtDistrict Court, E.D. Pennsylvania
DecidedDecember 28, 1990
DocketCiv. A. 89-0411
StatusPublished
Cited by21 cases

This text of 122 B.R. 919 (University Medical Center v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
University Medical Center v. Sullivan, 122 B.R. 919, 1990 U.S. Dist. LEXIS 17653, 1990 WL 255594 (E.D. Pa. 1990).

Opinion

OPINION

GAWTHROP, District Judge.

This is an appeal by the Secretary of Health and Human Services from a ruling of the bankruptcy court in which the bankruptcy judge found that the Secretary violated the automatic stay provision of the bankruptcy code by acting post-petition to recover pre-petition overpayment made under the Medicare program to the University Medical Center. The Secretary also appeals the bankruptcy court’s award of attorneys fees and prejudgment interest. For the following reasons, I shall affirm the decision of the bankruptcy court as to the violation and reverse as to fees and interest.

BACKGROUND

The University Medical Center, (“UMC”), is a general care hospital that filed a voluntary petition in bankruptcy under Chapter 11 of the United States Code on January 1, 1988 and ceased to do business on March 31, 1988. While in business, UMC provided services to Medicare beneficiaries under an agreement with the United States Department of Health and Human Services, (“HHS”). This “Provider Agreement”, executed in 1966 between the Broad Street Hospital and the Secretary of Health, Education and Welfare — the predecessors in interest to UMC and HHS respectively — is similar to provider agreements entered into by hospitals and health care facilities across the country. The authority of the HHS to enter into agreements with health care providers is granted in 42 U.S.C. § 1395cc. By signing the Provider Agreement, Broad Street Hospital/UMC agreed to charge Medicare beneficiaries only as allowed by statute and to comply with civil rights laws in providing services, in exchange for eligibility to receive payment under Title XVIII of the Social Security Act for services provided to Medicare patients.

HHS reimburses Medicare providers through a fiscal intermediary on a periodic basis. The statute provides that payments be made at least once a month and otherwise at the discretion of HHS. 42 U.S.C. § 1395g(a). The usual method is for the intermediary to make periodic interim payments to providers upon application of the provider at the discharge of each Medicare patient. Payments made are estimates of actual expenditures. The intermediary conducts an annual audit of the actual expenditures of each provider to determine whether the provider has been overpaid or underpaid across the year. HHS is authorized to adjust current payments to account for the prior overpayment or underpayment. 42 U.S.C. § 1395g(a).

On January 8, 1988, one week after UMC’s bankruptcy filing, Blue Cross of Greater Philadelphia (“Blue Cross”), UMC’s fiscal intermediary, informed UMC by letter that UMC had been overpaid by $276,042.00 for Medicare services provided in 1985. The letter stated that Blue Cross would begin 100% withholding of interim payments that became due unless UMC made repayment or agreed to a long-term repayment schedule. UMC did not respond. On February 8, 1988, Blue Cross sent a second letter, again stating that 100% withholding of interim payments would begin unless other arrangements for return of the overpayment were made. On February 18, Blue Cross withheld a $58,000 payment.

In response to the withholding, officials of UMC met with a Blue Cross representative and orally agreed to provide Blue Cross with documentation demonstrating UMC’s need. for an extended repayment schedule, and, in the interim, to repay the 1985 overpayment at a rate of $15,000 per month over a period of 18 months. UMC officials apparently consented to this arrangement to keep Medicare revenues flowing, which the hospital needed to meet its payroll obligations. On March 4, 1988, UMC issued a $15,000 check to Blue Cross, after which Blue Cross released the $58,-000 it had withheld. However, UMC then failed to provide Blue Cross with the documentation of need, and on March 28, 1988, Blue Cross announced that it would resume 100% withholding.

*923 HHS, through Blue Cross, withheld over $312,000, including the $15,000 payment, in claims by UMC for Medicare services which had been provided after UMC filed the bankruptcy petition. Meanwhile, Blue Cross determined that, in addition to the 1985 overpayment, UMC had been overpaid by $470,894 in 1986 and $65,447 in 1987.

PRIOR PROCEEDINGS

UMC brought an adversary proceeding against HHS in bankruptcy court on June 17, 1988, alleging that HHS’s actions, in demanding payment for previous overpayment, and in withholding current payments to recover the amounts overpaid, violated the automatic stay provision of the bankruptcy code, 11 U.S.C. § 362. Defendant answered by claiming the affirmative defense of contractual recoupment, as well as by filing a separate motion for relief from the automatic stay.

The bankruptcy judge resolved this dispute by finding that HHS’s demand for return of overpayment in exchange for continued Medicare payments violated the anti-discrimination provision of the bankruptcy statute, 11 U.S.C. § 525(a). 1 In doing so, the bankruptcy judge relied heavily on his opinion in an unrelated case, In re St. Mary Hospital, 89 B.R. 503 (Bankr.E.D.Pa.1988), which was decided while the present action was pending. St. Mary Hospital also involved a Medicare provider that had filed under Chapter 11 and had been overpaid by HHS. In that case, the same bankruptcy judge found § 525(a) to apply to the Secretary’s withholding of interim payments and granted an injunction preventing this withholding. Id., at 512. HHS appealed the St. Mary Hospital ruling. On appeal of that case and in the present action, HHS continued to assert that withholding was proper.

On December 7, 1988, the bankruptcy court followed St. Mary Hospital and ruled in the case at bar that HHS's withholding of Medicare payments from UMC violated the automatic stay provision. In re University Medical Center, 93 B.R. 412, 416-417 (Bankr.E.D.Pa.1988). Finding withholding to be impermissible under § 525(a), the bankruptcy judge also refused to grant relief from the stay under 11 U.S.C. § 362(d), and thus he ordered HHS to return to UMC the $15,000 payment made by UMC in accord with the tentative repayment agreement, and to pay UMC the amount that UMC was due for post-petition Medicare services. Id. at 417-18. The court also awarded UMC prejudgment interest and attorneys’ fees, finding that HHS’s pressing of the litigation after St. Mary Hospital was a wilful violation of the court’s interpretation of the statute. Id. at 418-19.

On appeal to this court, Judge Ditter vacated the bankruptcy judge’s order in St. Mary Hospital, disposing of the action by approving a settlement agreement between the parties and without reaching the merits of the case.

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Cite This Page — Counsel Stack

Bluebook (online)
122 B.R. 919, 1990 U.S. Dist. LEXIS 17653, 1990 WL 255594, Counsel Stack Legal Research, https://law.counselstack.com/opinion/university-medical-center-v-sullivan-paed-1990.