Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Allina Health Servs. v. Burwell

United States District Court, D. Columbia

October 29, 2015

ALLINA HEALTH SERVICES, et al., Plaintiffs,
v.
SYLVIA M. BURWELL, Secretary United States Department of Health and Human Services, Defendant

          For Allina Health Services, doing business as ABBOTT NORTHWESTERN HOSPITAL, Allina Health Services, doing business as UNITED HOSPITAL, Allina Health Services, doing business as UNITY HOSPITAL, Florida Health Sciences Center, Inc., doing business as TAMPA GENERAL HOSPITAL, Montefiore Medical Center, Montefiore Medical Center, New York Hospital Medical Center of Queens, New York Methodist Hospital, New York And Presbyterian Hospital, doing business as NEW YORK PRESBYTERIAN HOSPITAL/WEILL CORNELL MEDICAL CENTER, All Plaintiffs, Plaintiffs: Stephanie Ann Webster, AKIN GUMP STRAUSS HAUER & FELD LLP, Washington, DC USA.

         For Sylvia M. Burwell, Defendant: Kyle Renee Freeny, LEAD ATTORNEY, U.S. DEPARTMENT OF JUSTICE, Federal Programs Branch, Washington, DC USA; Tamra Tyree Moore, LEAD ATTORNEY, U.S. DEPARTMENT OF JUSTICE, Civil Division/Federal Programs Branch, Washington, DC USA.

Page 18

         MEMORANDUM OPINION

         Gladys Kessler, United States District Judge.

         Plaintiffs Allina Health Services, et al. (" Plaintiffs" ), bring this action against Sylvia M. Burwell, in her official capacity as Secretary of the United States Department of Health and Human Services (" Secretary" or " Defendant" ), challenging the calculation of certain disproportionate share hospital (" DSH" ) payments as procedurally and substantively invalid.

         This matter is before the Court on the Defendant's Motion to Dismiss for Lack of

Page 19

Jurisdiction or in the Alternative for Voluntary Remand [Dkt. No. 15]. Upon consideration of the Motion, Opposition [Dkt. No. 16], Reply [Dkt. No. 18], the entire record herein, and for the reasons set forth below, the Motion shall be denied.

         I. Background

         A. Factual Overview[1]

         In Allina Health Services v. Sebelius, a group of hospitals, including the Plaintiffs in the present case, challenged a 2004 rulemaking by the Secretary (" 2004 Final Rule" ) pertaining to calculations for Disproportionate Share Hospital (" DSH" ) payment determinations under Medicare. See No. 10-cv-1463 (D.D.C.). In November 2012, the Court (Collyer, J.) granted summary judgment for the plaintiffs, finding that the 2004 Final Rule violated the procedural requirements of the Administrative Procedure Act (" APA" ) and vacating the rule. See Allina Health Servs. v. Sebelius, 904 F.Supp.2d 75 (D.D.C. 2012) (" Allina I" ).

         On appeal, our Court of Appeals affirmed the part of the Allina I Court's decision vacating the 2004 Final Rule. But, the Court of Appeals held that the Allina I Court erred when it directed the Secretary to calculate the DSH payments in a particular manner, rather than simply remanding. See Allina Health Servs. v. Sebelius, 746 F.3d 1102, 1111, 409 U.S.App.D.C. 133 (D.C. Cir. 2014).

         Plaintiffs allege that after the D.C. Circuit's opinion, the Secretary published calculations for federal fiscal year 2012 DSH payments (" 2012 DSH Calculations" )[2] based on the 2004 Final Rule that had been vacated. Plaintiffs also allege that the new 2012 DSH Calculations are procedurally invalid. Compl. ¶ ¶ 47-49. Plaintiffs timely appealed to the Provider Reimbursement Review Board (" PRRB" ) challenging the 2012 DSH Calculations, see Compl. ¶ ¶ 36-39, and requested that the PRRB grant expedited judicial review. Id. ¶ 41.

         The PRRB is an independent administrative tribunal that resolves disputes regarding hospital reimbursement determinations by Medicare contractors or the Centers for Medicare & Medicaid Services (" CMS" ). See 42 U.S.C. § 1395oo(a). The PRRB may resolve certain payment disputes without following low-level policy guidance, see 42 C.F.R. § 405.1867; however, it is bound by agency regulation and rulings, id., and cannot decide " question[s] of law or regulations." 42 U.S.C. § 1395oo(f) (1). Section 1395oo(f) gives providers " the right to obtain judicial review of any action . . . which involves a question of law or regulations . . . whenever the [PRRB] determines . . . that it is without the authority to decide the question." Id.

         By letter dated August 13, 2014, the PRRB granted Plaintiffs' request for expedited judicial review, finding that " it is without the authority to decide the legal question of whether the regulation regarding the [2012 DSH Calculations] is valid and whether the Secretary's actions subsequent to the decision in Allina [I] are legal." Letter from the Provider Reimbursement Review Board to Stephanie

Page 20

Webster 6 (Aug. 13, 2014) [Dkt. No. 14-1] (" PRRB Decision" ).

         B. ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.