ILNews

Hospitals seek Medicare reimbursement

Back to TopCommentsE-mailPrintBookmark and Share

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.

ADVERTISEMENT

Post a comment to this story

COMMENTS POLICY
We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
 
You are legally responsible for what you post and your anonymity is not guaranteed.
 
Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in Indiana Lawyer editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
 
No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
 
We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
 

Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

Sponsored by

facebook - twitter on Facebook & Twitter

Indiana State Bar Association

Indianapolis Bar Association

Evansville Bar Association

Allen County Bar Association

Indiana Lawyer on Facebook

facebook
ADVERTISEMENT
Subscribe to Indiana Lawyer
  1. Hail to our Constitutional Law Expert in the Executive Office! “What you’re not paying attention to is the fact that I just took an action to change the law,” Obama said.

  2. What is this, the Ind Supreme Court thinking that there is a separation of powers and limited enumerated powers as delegated by a dusty old document? Such eighteen century thinking, so rare and unwanted by the elites in this modern age. Dictate to us, dictate over us, the massess are chanting! George Soros agrees. Time to change with times Ind Supreme Court, says all President Snows. Rule by executive decree is the new black.

  3. I made the same argument before a commission of the Indiana Supreme Court and then to the fedeal district and federal appellate courts. Fell flat. So very glad to read that some judges still beleive that evidentiary foundations matter.

  4. KUDOS to the Indiana Supreme Court for realizing that some bureacracies need to go to the stake. Recall what RWR said: "No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we'll ever see on this earth!" NOW ... what next to this rare and inspiring chopping block? Well, the Commission on Gender and Race (but not religion!?!) is way overdue. And some other Board's could be cut with a positive for State and the reputation of the Indiana judiciary.

  5. During a visit where an informant with police wears audio and video, does the video necessary have to show hand to hand transaction of money and narcotics?

ADVERTISEMENT