UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA ) HEALTHALLIANCE HOSPITALS, ) INC., et al., ) ) Plaintiffs, ) ) v. ) No. 1:17-cv-917 (KBJ) ) ALEX M. AZAR, ) Secretary of Health and Human Services, ) ) Defendant. ) ) MEMORANDUM OPINION Legal issues that arise under the federal government’s Medicare and Medicaid programs tend to be “significantly more difficult to describe than to decide[.]” Cooper Hosp./Univ. Med. Ctr. v. Burwell, 179 F. Supp. 3d 31, 36 (D.D.C. 2016) (internal quotation marks and citation omitted). The instant matter is no exception; it involves a claim by twelve Massachusetts hospitals (“the Hospitals” or “Plaintiffs”) that the Secretary of the Department of Health and Human Services (“HHS” or “Defendant”) did not fully compensate the Hospitals in the manner that the Medicare program prescribes for a one-year period, from October 1, 2008, to September 30, 2009. (See Compl., ECF No. 1, ¶ 45.) Invoking the Administrative Procedure Act (“APA”), 5 U.S.C. § 706(2), as well as a federal law that prescribes additional payments to hospitals that serve a “disproportionate number of low-income patients” under the Medicare program, 42 U.S.C. § 1395ww(d)(5)(F)(i)(I), the Hospitals allege that they are entitled to $6 million more from the federal government than they received during the relevant timeframe for their service to low-income individuals, because HHS miscalculated the percentage of patients who are eligible for Medicaid and similar services within the meaning of the applicable regulations and thus improperly lowered the amount of money that the federal government owes. (See Compl. ¶¶ 2, 45.) Whether these contentions have merit turns on a relatively narrow dispute over the meaning of an HHS regulation that delineates how the agency will determine the proportion of low-income individuals that a hospital serves. See 42 C.F.R. § 412.106(b)(4). This regulation establishes a formula that requires consideration of “the number of the hospital’s patient days of service” for two categories of low-income individuals: (1) Medicaid-eligible patients, and (2) patients who are “deemed eligible for Medicaid” for the purpose of the regulation because they are “eligible for inpatient hospital services . . . under a waiver authorized under section 1115(a)(2) of the [Social Security Act.]” Id. § 412.106(b)(4)(i). The Hospitals contend that HHS has incorrectly interpreted this regulation to exclude from the second category those patients who are insured under a Massachusetts-run health insurance program for low-income individuals known as Commonwealth Care, which received a section 1115(a)(2) waiver from HHS and thereby indisputably “expand[s] upon the traditional Medicaid program eligibility criteria[.]” (Compl. ¶¶ 2, 45.) Before this Court at present are the parties’ cross-motions for summary judgment. (See Pls.’ Mem. in Supp. of Mot. for Summ. J. (“Pls.’ Mem.”), ECF No. 12; Def.’s Mem. in Supp. of its Cross-Mot. for Summ. J. & Opp’n to Pls.’ Mot. for Summ. J. (“Def.’s Mem.”), ECF No. 14-1.) 1 In its papers, HHS argues that, in order to 1 Page-number citations to the documents that the parties have filed refer to the page numbers that the ...
Original document
Source: All recent Immigration Decisions In All the U.S. Courts of Appeals