24 results for 'nos:"Medicare Act - Contract"'.
J. Becerra dismisses the hospitals' suit alleging that a misreading of the Medicare Act led to underpayment. The hospitals failed to exhaust their administrative remedies before bringing suit, since the Provider Reimbursement Review Board has not yet made a decision on their appeal of a Notice of Program Reimbursement. Additionally, had the hospitals exhausted those remedies, their challenges to Medicare and Social Security administration are barred by case law.
Court: USDC District of Columbia, Judge: McFadden, Filed On: August 30, 2024, Case #: 1:22cv1509, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care, Medicare
J. Nichols grants the federal government's motion to dismiss the oncology practice advocacy group's suit challenging guidance issued in the form of "FAQs" stating that a physician cannot mail prescription drugs to their patients without violating the Stark Law. The advocacy group has not shown that the FAQs substantively changed regulations, since the original statute and its existing implementing regulations bar physicians from referring patients to entities to which they have a financial stake, with an exemption only for services that a physician is furnishing to the patient in person. Mailing drugs does not fall under this exemption under the most natural reading of the law.
Court: USDC District of Columbia, Judge: Nichols, Filed On: August 30, 2024, Case #: 1:23cv2168, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care
J. Bates finds in favor of the Centers for Medicare and Medicaid Services in the hospitals' action seeking an order requiring it to recalculate 23 years' payments based on a now-defunct regulation regarding reimbursements for the training of medical residents and fellows. The regulations, which replaced the defunct one, do not impose a clear, non-discretionary duty to reopen hospitals' cost reports.
Court: USDC District of Columbia, Judge: Bates, Filed On: August 6, 2024, Case #: 1:23cv1382, NOS: Medicare Act - Contract, Categories: Administrative Law, Medicaid, Medicare
Want access to unlimited case records and advanced research tools? Create your free CasePortal account now. No credit card required to register.
Try CasePortal for Free
J. AliKhan dismisses as moot the Medicare beneficiary's suit arguing that a Local Coverage Determination limiting coverage for a compression device to "severe and chronic lymphedema" and imposing numerous prerequisites is invalid. The LCD has been revised, and the Medicare officials have offered reimbursement for the beneficiary's device. The prospect of injury should the LCD be further revised is not sufficient to establish jurisdiction.
Court: USDC District of Columbia, Judge: AliKhan, Filed On: August 1, 2024, Case #: 1:17cv797, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care, Medicare
J. Bates grants summary judgment to the Health and Human Services Secretary in the breast cancer testing laboratory's challenge of an HHS regulation requiring adjudicators to give "substantial deference" to coverage determinations developed by private Medicare contractors. Following a finding by the Ninth Circuit that the regulation does not unconstitutionally delegate lawmaking authority and that the Medicare Act does not require local coverage determinations to undergo a notice-and-comment process, the laboratory's claims on those issues are precluded by prior litigation and issue preclusion. It is not barred from arguing that five administrative decisions are individually not supported by substantial evidence, but fails to adequately do so.
Court: USDC District of Columbia, Judge: Bates, Filed On: July 26, 2024, Case #: 1:22cv3242, NOS: Medicare Act - Contract, Categories: Administrative Law, Civil Procedure, Medicare
J. Bates revises a prior opinion to omit an analysis of the diagnostic testing laboratory's substantive challenge to the Department of Health and Human Services' "substantial deference" rule, which requires Medicare adjudicators to give such deference to local coverage determinations developed by private Medicare contractors. In light of the Supreme Court's recent decision in "Loper Bright Enterprises v. Raimondo," which overruled the authority of 1984's "Chevron U.S.A. v. Natural Resources Defense Council," the underpinnings of the court's holding on that point have been called into question, but the court's determination that claim preclusion barred the laboratory's challenge is undisturbed.
Court: USDC District of Columbia, Judge: Bates, Filed On: July 26, 2024, Case #: 1:22cv3242, NOS: Medicare Act - Contract, Categories: Civil Procedure, Medicare
J. Friedrich denies the hospital's petition for review of a 2015 decision by the Provider Reimbursement Review Board on its reimbursement requests for costs associated with its employment of resident physicians. The Board reasonably found that the hospital forfeited several of those reimbursement claims by failing to timely identify them "in their particulars." It also acted reasonably in declining to hear a bed-count claim because that claim was not raised with the hospital's fiscal intermediary.
Court: USDC District of Columbia, Judge: Friedrich, Filed On: June 26, 2024, Case #: 1:16cv1276, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care, Medicare
J. Moss partially grants the Medicare Advantage plan providers' motion for summary judgment in a suit alleging that the Centers for Medicare and Medicaid Services' calculation of its 2024 "star ratings" for such plans was contrary to its own regulations. The Centers' changes to their method of calculating such ratings, which involved removal of far-outlying plans from its data set, improperly changed the lines between particular star ratings by more than the maximum of 5% without changing the rule which set that maximum. The plan provider's star ratings are set aside and the Centers are ordered to redetermine them.
Court: USDC District of Columbia, Judge: Moss, Filed On: June 7, 2024, Case #: 1:23cv3902, NOS: Medicare Act - Contract, Categories: Administrative Law, Medicaid, Medicare
J. Nichols grants the healthcare provider's motion for summary judgment in in its suit alleging that its 2024 Star Rating was improperly calculated. The Centers for Medicare and Medicaid Services failed to properly amend its regulations to reflect a decision to account for changes in its statistical methods for calculating star ratings for private Medicare providers in the year 2023, when it stopped counting distant outliers in its dataset and waived a rule that kept the benchmarks between half-star counts from moving by more than 5% year over year.
Court: USDC District of Columbia, Judge: Nichols, Filed On: June 3, 2024, Case #: 1:23cv3910, NOS: Medicare Act - Contract, Categories: Administrative Law, Medicare
J. Kelly grants the hospital's motion for summary judgment in its suit against the Secretary of Health and Human Services challenging an administrative finding that the Provider Reimbursement Review Board could not review the hospital's full-time equivalent resident cap for the years from 2004-2007, in which it inadvertently omitted four programs from reimbursement calculations. The Board's decision was based on a flawed reading of the Medicare Modernization Act. The hospital's full-time equivalent resident cap was not an unreviewable "determination" made by the Secretary. Even if it was, the 2006 and 2007 caps are not precluded from review, since the Secretary only used the hospital's 2002 cap in determining the hospital's "otherwise applicable resident limit."
Court: USDC District of Columbia, Judge: Kelly, Filed On: March 30, 2024, Case #: 1:20cv3160, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care
J. Jackson dismisses, for lack of subject matter jurisdiction, three hospitals’ lawsuit against the Department of Health and Human Services for how it calculated the funds due to the hospitals under Medicare’s disproportionate share hospital adjustment. The hospitals did not exhaust their administrative remedies before suing.
Court: USDC District of Columbia, Judge: Jackson, Filed On: March 29, 2024, Case #: 1:22cv2272, NOS: Medicare Act - Contract, Categories: Administrative Law, Jurisdiction, Medicare
[Consolidated.] J. Lipman denies the laboratory company's summary judgment motion and partially grants the government defendant's competing motion in this lawsuit concerning the company's reimbursements "received on Medicare Part B claims" and an auditor's conclusions that the company was overpaid. The court concludes that the two counts regarding "a potential due process violation around the universe of claims and the failure to include zero-paid claims in the sampling" should be dismissed.
Court: USDC Western District of Tennessee , Judge: Lipman, Filed On: March 26, 2024, Case #: 2:22cv2770, NOS: Medicare Act - Contract, Categories: Government, Health Care
J. Scarsi grants an insurance company's motion to dismiss an insured's claims of breach of contract and elder abuse for not receiving benefits that he alleges he is due under his insurance policy. The insured has not exhausted Medicare’s administrative review procedures for his breach of contract or breach of the implied covenant of good faith and fair dealing claims. The insured is granted leave to amend his elder neglect claim.
Court: USDC Central District of California, Judge: Scarsi, Filed On: January 24, 2024, Case #: 2:23cv6324, NOS: Medicare Act - Contract, Categories: Insurance, Medicare, Contract
J. Kollar-Kotelly finds, in part, for a group of hospitals on their appeal of the Provider Reimbursement Review Board's dismissal of their administrative appeal challenging the Medicare compensation they received. Contrary to the board's determination, it had jurisdiction over their appeal, as the Centers for Medicare & Medicaid Services' publications are considered final determinations.
Court: USDC District of Columbia, Judge: Kollar-Kotelly, Filed On: October 31, 2023, Case #: 1:17cv545, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care, Medicare