University of Cincinnati, D/B/A University Hospital v. Secretary of Health and Human Services

809 F.2d 307, 1987 U.S. App. LEXIS 1031, 37 Educ. L. Rep. 66
CourtCourt of Appeals for the Sixth Circuit
DecidedJanuary 15, 1987
Docket85-3651
StatusPublished
Cited by7 cases

This text of 809 F.2d 307 (University of Cincinnati, D/B/A University Hospital v. Secretary of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
University of Cincinnati, D/B/A University Hospital v. Secretary of Health and Human Services, 809 F.2d 307, 1987 U.S. App. LEXIS 1031, 37 Educ. L. Rep. 66 (6th Cir. 1987).

Opinions

WILLIAM K. THOMAS, Senior District Judge.

The Board of Trustees of the University of Cincinnati operates University Hospital (Hospital). Hospital is a provider of services under the Medicare Act, 42 U.S.C. §§ 1395 et seq. The controversy between the Hospital and the Secretary involves the Provider Reimbursement Review Board’s (Board or PRRB) denial of jurisdiction to hear an appeal of the Hospital relating to three annual cost reports filed by the Hospital with its fiscal intermediary, Blue Cross Association-Blue Cross of Southwest Ohio.

Pursuant to 42 U.S.C. § 1395oo (f), Hospital brought a civil action to obtain judicial review of the Board’s denial of jurisdiction. The United States District Court for the Southern District of Ohio granted summary judgment for the University of Cincinnati, plaintiff-appellee. The district court declared that “the Provider Reimbursement Review Board has jurisdictional authority for the 1979, 1980 and 1981 cost years concerning the self-disallowed costs of the interns’ and the residents’ education and related overhead in connection with the Family Practice Clinic and Central Psychiatric Clinic issues.” The Secretary appeals the district court’s final judgment for the plaintiff.

On or about October 30, 1979, October 30,1980, and October 30,1981 the Hospital, as a provider of hospital services, filed its cost reports as required by the Medicare Act and regulations thereunder, “reporting that it had incurred certain expenses reimbursable under the Medicare Act” during the fiscal years ending mid-1979, mid-1980, and mid-1981. The Hospital reported in each of the cost reports the expenses, described by the district court, for which no Medicare reimbursement was sought, because the Hospital “mistakenly believed them to be non-reimbursable.” 1

[309]*309The Secretary’s fiscal intermediary thereafter engaged in audits and carried on negotiations with the Hospital. On September 30, 1982 the Intermediary issued a Notice of Program Reimbursement (NPR) for each of the cost years in question.

The Hospital, on March 25, 1983, filed a request for hearing before the Provider Reimbursement Review Board for the fiscal years here in question. 42 U.S.C. § 1395oo (a), hereafter discussed, makes provision for establishment of the Provider Reimbursement Review Board and authorizes a provider of services “which has filed a required cost report within the time specified in regulations” to obtain a hearing “with respect to such cost report” by the Board. As the text set forth in the margin discloses,2 section 1395oo (a) provides for appeals to the Board only by providers. The section does not grant a fiscal intermediary the right to appeal to the Board. Nor would it make any sense to allow such an appeal. After all, it is the final determination of the intermediary which has passed on the provider’s cost report that is the subject of an appeal to the Board. The Board may only consider such a determination when a provider has properly brought an appeal from such determination.

I.

A.

Before analyzing the question of the Board’s jurisdiction over providers’ appeals, the court needs to note the standard of review applied by the trial court in its consideration of the case below. That same standard of review must likewise control this court’s analysis of the jurisdictional question.

42 U.S.C. § 1395oo (f) specifies that a civil action for judicial review of a final decision of the Board “shall be tried pursuant to the applicable provisions under Chapter 7 of title 5 [the Administrative [310]*310Procedure Act], notwithstanding any other provisions in section 405 of this title.” Under the Administrative Procedure Act’s standard of review, the decision of the Secretary or Board may be set aside only if it is “ ‘arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.’ 5 U.S.C. § 706(2)(A) (1976).” Richey Manor, Inc. v. Schweiker, 684 F.2d 130, 133-34 (D.C.Cir.1982); Home Health Services v. Schweiker, 683 F.2d 353, 356 (11th Cir.1982).

Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. 467 U.S. 837, 842-843, 104 S.Ct. 2778, 2781-82, 81 L.Ed.2d 694 (1984), considering the principles a court must follow in reviewing “an agency’s construction of the statute which it administers,” declares that if “the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency must give effect to the unambiguously expressed intent of Congress.” However, if the court determines that the “statute is silent or ambiguous with respect to the specific issue, the question for the court is whether the agency’s answer is based on a permissible construction of the statute.”

Further, in Securities Industry Association v. Board of Governors, 468 U.S. 137, 142-43, 104 S.Ct. 2979, 2983, 82 L.Ed.2d 107 (1984), the Court has made clear that “deference is not to be a device that emasculates the significance of judicial review.” Rather, judicial deference to an agency’s interpretation of a statute “only sets ‘the framework for judicial analysis; it does not displace it.’ ” Id. at 143, 104 S.Ct. at 2983. (quoting United States v. Vogel Fertilizer Co., 455 U.S. 16, 24, 102 S.Ct. 821, 827, 70 L.Ed.2d 792 (1982), quoting United States v. Cartwright, 411 U.S. 546, 550, 93 S.Ct. 1713, 1716, 36 L.Ed.2d 528 (1973)). A reviewing court “must reject administrative constructions of [a] statute, whether reached by adjudication or by rulemaking, that are inconsistent with the statutory mandate or that frustrate the policy that Congress sought to implement.” Securities Industry Association, 468 U.S. at 143, 104 S.Ct. at 2983 (quoting Federal Election Commission v. Democratic Senatorial Campaign Committee, 454 U.S. 27, 32, 102 S.Ct. 38, 42, 70 L.Ed.2d 23 (1981)).

B.

Mindful of these principles of judicial review, we must decide whether the Provider Reimbursement Review Board’s jurisdictional interpretation of section 1395oo is “based on a permissible construction of the statute,” or, on the other hand, is “inconsistent with the statutory mandate” or “frustrate[s] the policy that Congress sought to implement.”

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809 F.2d 307, 1987 U.S. App. LEXIS 1031, 37 Educ. L. Rep. 66, Counsel Stack Legal Research, https://law.counselstack.com/opinion/university-of-cincinnati-dba-university-hospital-v-secretary-of-health-ca6-1987.