UPMC-Braddock Hospital v. Sebelius

592 F.3d 427, 2010 U.S. App. LEXIS 1167, 2010 WL 174284
CourtCourt of Appeals for the Third Circuit
DecidedJanuary 20, 2010
Docket08-4247
StatusPublished
Cited by8 cases

This text of 592 F.3d 427 (UPMC-Braddock Hospital v. Sebelius) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
UPMC-Braddock Hospital v. Sebelius, 592 F.3d 427, 2010 U.S. App. LEXIS 1167, 2010 WL 174284 (3d Cir. 2010).

Opinions

OPINION OF THE COURT

RENDELL, Circuit Judge.

UPMC-Braddoek Hospital appeals from the order of the District Court for the Western District of Pennsylvania granting summary judgment in favor of appellee Kathleen Sebelius, Secretary of the United States Department of Health and Human Services (“Secretary”), denying a reimbursement claim for loss on depreciable assets resulting from the merger between Braddock Medical Center (“BMC”) and University of Pittsburgh Medical Center System (“UPMCS”). A statutory merger may result in a depreciation adjustment— a reassessment of the value of assets— under Medicare regulations, but only if the merger was between “unrelated parties” and constituted a “bona fide sale.” The Distriet Court here determined that the merger between BMC and UPMCS was not a bona fide sale, but did not reach the issue of whether the merger was between unrelated parties. We conclude that the District Court’s determination that the merger was not a bona fide sale was not based on substantial evidence, in light of errors made in determining the value of certain assets. Thus, remand is required in order for the agency to consider the bona fide sale issue anew. However, we will also address the issue of whether the parties were “related” because, if they were, the merger cannot satisfy the two prong test and remand would be a useless act.

We find that the Secretary’s interpretation of the related party regulations — requiring examination of whether the parties were related pre- and post-merger — is contrary to the plain language of the regulations, and we conclude that, under the proper, pre-merger test, the parties were not related at the time of the transaction. We will therefore vacate the District Court’s order and remand for further proceedings consistent with this opinion.

I.

We recently confronted one of the issues raised in this appeal, regarding whether the transaction was a “bona fide sale,” in a similar context. See Albert Einstein Med. Ctr. v. Sebelius, 566 F.3d 368 (3d Cir.2009). While Einstein informs our analysis as to that aspect of the case, the facts here are markedly different.

On November 30, 1996, Heritage Health Systems (“Heritage”) and its subsidiaries, BMC and the Heritage Health Foundation (“Foundation”), entered into an Agreement to Merge and Affiliate with UPMCS. [429]*429BMC was a nonprofit corporation located in Pittsburgh, Pennsylvania, with Heritage as its sole corporate member. UPMCS is a nonprofit corporation also based in Pittsburgh. The Foundation is a Pennsylvania nonprofit corporation with a pre-merger purpose of providing support of a charitable nature to BMC through fund-raising and other similar activities. As part of the agreement, BMC transferred its assets and liabilities to UPMCS pursuant to a merger of BMC into a to-be-formed subsidiary of UPMCS that was named UPMC-Braddock. The Agreement also provided for the structure of the governing board of UPMC-Braddock and for various other rights and responsibilities pertaining to the governance of the newly created UPMC-Braddock. Specifically, two-thirds of the voting directors of the board of UPMC-Braddock were to be appointed by UPMCS, and not less than one-third of the voting directors were to be appointed by the Foundation. At the same time, the Foundation entered into a separate agreement with UPMCS setting up a Fund consisting of $3 million dollars that was “subject to exclusive supervision and control” of the Foundation, but which was to be used to “support” various activities of UPMC-Braddock. App. 592-93, 601. Following the merger, UPMC-Braddock, acting as BMC’s successor, filed a claim with Medicare for reimbursement of losses related to the transfer of depreciable medical equipment through the merger pursuant to 42 C.F.R. § 413.134(f) and 413.134(£ X2).1 As is discussed more fully below, the regulations permit the loss adjustment only if the transaction was a “bona fide sale” between “unrelated parties.” The claim was denied by Medicare’s fiscal intermediary, Veritus Medicare Services (“Intermediary”). UPMC-Braddock subsequently appealed the Intermediary’s denial of its claim to the Provider Reimbursement Review Board (“PRRB”).

The PRRB ruled in favor of UPMCBraddock, disagreeing with the Intermediary’s conclusion and determining that the statutory merger between BMC and UPMCS was not between related parties. In particular, the PRRB rejected the Intermediary’s argument that the phrase “between related parties” in the regulations applies not only to the relationship between the pre-merger entities, but also to the relationship that exists between the pre-merger entities and the entity that results post-merger — in this case, the rela[430]*430tionship between BMC and UPMC-Braddock. The PRRB concluded that the Intermediary’s reading of the related parties requirement was contrary to the plain language of the regulation, which was “unambiguous in its meaning that the related party concept will be applied to the entities that are merging as they existed prior to the transaction.” App. 756 (emphasis in original). The PRRB dealt with the bona fide sale requirement in conclusory terms, stating that “the merger is not required to meet the bona fides of sales transactions addressed in 42 C.F.R. § 413.134(f)(2).” App. 755. The PRRB remanded several issues regarding consideration to the Intermediary, but only for purposes of computing the reimbursable loss.

The PRRB’s ruling was then reversed by the Deputy Administrator (“Administrator”) of Centers for Medicare and Medicaid Services (“CMS”), who denied UPMC-Braddock’s claim for reimbursement, disagreeing with the PRRB on both the related parties issue and the bona fide sale issue. The Administrator found that the bona fide sale requirement did apply to the merger, and that the difference between the value of the transferred assets and the consideration received for them in the course of the merger indicated the absence of a bona fide sale. App. 50-52. Additionally, the Administrator found that the transaction was not consummated at “arm’s length,” as required by the bona fide sale provision. App. 50. The Administrator further concluded that the PRRB’s interpretation of the “related parties” provision was incorrect and adopted the Intermediary’s position that the related parties inquiry should properly consider the relationship between both the pre- and post-merger entities. App. 41-47. Using this interpretation of the related parties provision, the Administrator concluded that BMC and UPMC-Braddock were “related parties,” and disallowed the loss claim. App. 48. The Administrator’s decision became the final decision of the Secretary.

UPMC-Braddock appealed the Administrator’s decision to the District Court pursuant to the Administrative Procedures Act (“APA”), 5 U.S.C. §§ 551-59, and the parties consented to the exercise of jurisdiction by the Magistrate Judge pursuant to 28 U.S.C. § 636(c) and Fed.R.Civ.P. 73.2

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

Related

Via Christi Hospitals Wichita v. Sylvia Burwell
820 F.3d 451 (D.C. Circuit, 2016)
Via Christi Regional Medical Center, Inc. v. Sebelius
78 F. Supp. 3d 416 (District of Columbia, 2015)
Memorial Hermann Hospital v. Sebelius
882 F. Supp. 2d 882 (E.D. Texas, 2012)
Whidden Memorial Hospital v. Sebelius
828 F. Supp. 2d 218 (District of Columbia, 2011)
Jeanes Hospital v. Secretary of Health & Human Services
448 F. App'x 202 (Third Circuit, 2011)
Jeanes Hospital v. SIBELIUS
747 F. Supp. 2d 416 (E.D. Pennsylvania, 2010)
Zia Hospice, Inc. v. Sebelius
723 F. Supp. 2d 1347 (D. New Mexico, 2010)
UPMC-Braddock Hospital v. Sebelius
592 F.3d 427 (Third Circuit, 2010)

Cite This Page — Counsel Stack

Bluebook (online)
592 F.3d 427, 2010 U.S. App. LEXIS 1167, 2010 WL 174284, Counsel Stack Legal Research, https://law.counselstack.com/opinion/upmc-braddock-hospital-v-sebelius-ca3-2010.