Justia Public Benefits Opinion Summaries

After Hermann Hospital merged with Memorial Hospital System, creating the Memorial Herman Hospital System (MHHS), the Administrator denied MHHS's request for a Medicare loss payment under 42 C.F.R. 413.134(l). The court joined all other circuits that have ruled on the issue by holding that statutory mergers must be bona fide sales in order to be eligible for a depreciation adjustment under 42 U.S.C. 413.134(l). The court found that substantial evidence supported the Administrator's conclusion that the merger at issue failed to constitute a bona fide sale and, therefore, affirmed the judgment of the district court. View "Memorial Hermann Hospital v. Sebelius" on Justia Law

In 1995, two non-profit hospitals consolidated to form Pinnacle. Pinnacle subsequently submitted a Medicare reimbursement claim for the losses the hospitals had incurred through the sale of their depreciable assets in the consolidation. The Administrator denied Pinnacle's claim, and that order became the final decision of the Secretary. On Pinnacle's Administrative Procedure Act (APA), 42 U.S.C. 12101 et seq., challenge, the district court upheld the Secretary's decision in full. Because the Secretary's interpretation of the relevant Medicare regulations was not plainly erroneous or inconsistent with the regulation, the court concluded that the Secretary reasonably applied the bona fide sale requirement to a reimbursement request from a participant in a "statutory merger." The court also held that the Secretary's finding that the bona fide sale requirement applied to consolidations involving non-profit Medicare providers, like Pinnacle, was not plainly erroneous or inconsistent with the regulation. Finally, substantial evidence supported the Secretary's finding that Pinnacle did not satisfy the bona fide sale requirement. Accordingly, the court affirmed the district court's judgment. View "Pinnacle Health Hospitals v. Sebelius" on Justia Law

Forsyth Memorial Hospital, Inc. and other providers (collectively "appellants") appealed the district court's grant of summary judgment in favor of the Secretary of Health and Human Services ("HHS") upholding the denial of their reimbursement claims arising from the merger of Presbyterian Health Services Corporation ("Presbyterian") and Carolina Medicorp, Inc. ("Carolina"). At issue was whether the denial of the reimbursement claims was arbitrary and capricious, an abuse of discretion, contrary to law, or unsupported by substantial evidence. The court affirmed the denial of the reimbursement claims and held that the district court properly concluded that it was neither arbitrary and capricious nor contrary to law for the Administrator of the Centers for Medicare & Medicaid Services ("Administrator") to find that appellants were not entitled to reimbursement where, in the merger between Carolina and Presbyterian, no bona fide sale took place and the parties were related.