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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. Such things are no more elections than those in the late, unlamented Soviet Union.

  2. It appears the police and prosecutors are allowed to change the rules halfway through the game to suit themselves. I am surprised that the congress has not yet eliminated the right to a trial in cases involving any type of forensic evidence. That would suit their foolish law and order police state views. I say we eliminate the statute of limitations for crimes committed by members of congress and other government employees. Of course they would never do that. They are all corrupt cowards!!!

  3. Poor Judge Brown probably thought that by slavishly serving the godz of the age her violations of 18th century concepts like due process and the rule of law would be overlooked. Mayhaps she was merely a Judge ahead of her time?

  4. in a lawyer discipline case Judge Brown, now removed, was presiding over a hearing about a lawyer accused of the supposedly heinous ethical violation of saying the words "Illegal immigrant." (IN re Barker) http://www.in.gov/judiciary/files/order-discipline-2013-55S00-1008-DI-429.pdf .... I wonder if when we compare the egregious violations of due process by Judge Brown, to her chiding of another lawyer for politically incorrectness, if there are any conclusions to be drawn about what kind of person, what kind of judge, what kind of apparatchik, is busy implementing the agenda of political correctness and making off-limits legit advocacy about an adverse party in a suit whose illegal alien status is relevant? I am just asking the question, the reader can make own conclsuion. Oh wait-- did I use the wrong adjective-- let me rephrase that, um undocumented alien?

  5. of course the bigger questions of whether or not the people want to pay for ANY bussing is off limits, due to the Supreme Court protecting the people from DEMOCRACY. Several decades hence from desegregation and bussing plans and we STILL need to be taking all this taxpayer money to combat mostly-imagined "discrimination" in the most obviously failed social program of the postwar period.

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