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Hospitals seek Medicare reimbursement

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Several Indiana hospitals are suing the Secretary of the U.S. Department of Health and Human Services over a Medicare reimbursement dispute.

Twenty-four hospitals claim the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program as an agent of the Secretary of HHS, has made inadequate payments to the hospitals. The hospitals include Bloomington Hospital, Indiana University Medical Center, Memorial Hospital of South Bend, and Wishard Memorial Hospital.

The suit, Ball Memorial Hospital, et al., v. Kathleen Sebelius, Secretary of U.S. Department of Health and Human Services, No. 1:11-CV-81, was filed Tuesday in the Southern District of Indiana, Indianapolis Division. The suit says Congress has required CMS to pay hospitals on a prospective basis for inpatient services provided to Medicare beneficiaries. Congress has also mandated an adjustment in prospective payments for hospitals that serve a disproportionate number of low-income patients through the Disproportionate Share Hospital program.

To be eligible for the DSH payment, hospitals must meet a disproportionate patient percentage as defined in the Medicare statute. It’s determined by adding two statutorily defined fractions – Medicare and Medicaid fractions. The proper calculation of the plaintiffs’ Medicaid fraction is at issue. The fraction is made up of the “hospital’s total patient days for such period which consists of patients who (for such days) were eligible for assistance under a State plan approved under Title XIX [the Medicaid Program] but who were not entitled benefits under Part A of this title.”

At issue in the instant case are the patient days for patients covered under the state’s “Hospital Care for the Indigent” program. The program was a part of Indiana’s Medicaid program and for all the years in dispute – which aren’t defined in the suit – was included in the state plan submitted by Indiana and was approved by the Secretary of HHS under Title XIX.

The hospitals argue that the patient days related to the HCI program meet the statutory requirements for inclusion in the numerator of the Medicaid Proxy when determining a hospital’s eligibility and payment under the DSH program. They also claim for the years in dispute that the Secretary of HHS arbitrarily, capriciously, and not in accordance with the law refused to include those days related to the HCI program. The suit claims that HHS has a history of failing to implement the DSH program and refusing to count “Medicaid eligible days” as mandated by law.

The hospitals appealed the decision to the Provider Reimbursement Review Board, which issued an adverse decision to the plaintiffs. The hospitals filed this suit seeking a court finding that CMS and the fiscal intermediary erred in excluding HCI patient days when determining DSH eligibility and payments, that the CMS needs to recalculate the eligibility and payments to include those days, and that the hospitals receive all funds, including interest due.

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  1. People have heard of Magna Carta, and not the Provisions of Oxford & Westminster. Not that anybody really cares. Today, it might be considered ethnic or racial bias to talk about the "Anglo Saxon common law." I don't even see the word English in the blurb above. Anyhow speaking of Edward I-- he was famously intolerant of diversity himself viz the Edict of Expulsion 1290. So all he did too like making parliament a permanent institution-- that all must be discredited. 100 years from now such commemorations will be in the dustbin of history.

  2. Oops, I meant discipline, not disciple. Interesting that those words share such a close relationship. We attorneys are to be disciples of the law, being disciplined to serve the law and its source, the constitutions. Do that, and the goals of Magna Carta are advanced. Do that not and Magna Carta is usurped. Do that not and you should be disciplined. Do that and you should be counted a good disciple. My experiences, once again, do not reveal a process that is adhering to the due process ideals of Magna Carta. Just the opposite, in fact. Braveheart's dying rebel (for a great cause) yell comes to mind.

  3. It is not a sign of the times that many Ind licensed attorneys (I am not) would fear writing what I wrote below, even if they had experiences to back it up. Let's take a minute to thank God for the brave Baron's who risked death by torture to tell the government that it was in the wrong. Today is a career ruination that whistleblowers risk. That is often brought on by denial of licenses or disciple for those who dare speak truth to power. Magna Carta says truth rules power, power too often claims that truth matters not, only Power. Fight such power for the good of our constitutional republics. If we lose them we have only bureaucratic tyranny to pass onto our children. Government attorneys, of all lawyers, should best realize this and work to see our patrimony preserved. I am now a government attorney (once again) in Kansas, and respecting the rule of law is my passion, first and foremost.

  4. I have dealt with more than a few I-465 moat-protected government attorneys and even judges who just cannot seem to wrap their heads around the core of this 800 year old document. I guess monarchial privileges and powers corrupt still ..... from an academic website on this fantastic "treaty" between the King and the people ... "Enduring Principles of Liberty Magna Carta was written by a group of 13th-century barons to protect their rights and property against a tyrannical king. There are two principles expressed in Magna Carta that resonate to this day: "No freeman shall be taken, imprisoned, disseised, outlawed, banished, or in any way destroyed, nor will We proceed against or prosecute him, except by the lawful judgment of his peers or by the law of the land." "To no one will We sell, to no one will We deny or delay, right or justice." Inspiration for Americans During the American Revolution, Magna Carta served to inspire and justify action in liberty’s defense. The colonists believed they were entitled to the same rights as Englishmen, rights guaranteed in Magna Carta. They embedded those rights into the laws of their states and later into the Constitution and Bill of Rights. The Fifth Amendment to the Constitution ("no person shall . . . be deprived of life, liberty, or property, without due process of law.") is a direct descendent of Magna Carta's guarantee of proceedings according to the "law of the land." http://www.archives.gov/exhibits/featured_documents/magna_carta/

  5. I'm not sure what's more depressing: the fact that people would pay $35,000 per year to attend an unaccredited law school, or the fact that the same people "are hanging in there and willing to follow the dean’s lead in going forward" after the same school fails to gain accreditation, rendering their $70,000 and counting education worthless. Maybe it's a good thing these people can't sit for the bar.

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