Tri-County Hospice, Inc. v. Sebelius

Filing 34

ORDER by Judge Ronald A. White: denying 26 plaintiff's Motion to Alter Judgment; denying 27 defendant Kathleen Sebelius' Motion to Alter or Amend Judgment (cjt, Deputy Clerk)

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF OKLAHOMA
T R I -C O U N T Y HOSPICE, INC., P l a in tif f , v. KATHLEEN SEBELIUS, Secretary o f the U.S. Department of Health and H u m a n Services, D e f e n d a n t. ) ) ) ) ) ) ) ) ) ) )

C a s e No. CIV-09-407-RAW

ORDER Before the court are the motions of the parties to alter or amend judgment. On M a rc h 8, 2010, this court entered an Order and Judgment. The court found that the

c h a lle n g e d Medicare regulation was invalid and enjoined the defendant from using the r e g u la tio n to calculate overpayment determinations. d e f e n d a n t for further proceedings. In its motion, plaintiff asks the court to address the questions of (1) funds already c o llec ted and (2) interest. Plaintiff asks the court to direct defendant to return to plaintiff all m o n ies collected under the invalid regulation, with interest , or in the alternative to require d e f e n d a n t to credit funds already collected to valid new determinations. The position is wella rg u e d and not unreasonable, but the court declines to do so. Defendant maintains that under w h a te v e r calculation method, HHS has overpaid plaintiff for the cost years at issue and p la in tif f will still ultimately owe a significant amount of money to HHS even under The matter was remanded to the

p l a in t if f ' s legal theories and calculations. T h e court clings to its analogy (stated in a previous order) of the certification of a q u e stio n of law to a state's highest court. In the face of a similar request, Judge Brack of th e District of New Mexico stated: "Granting Plaintiff's request for monetary relief would b e extremely difficult for this Court and likely require extensive fact-finding and hearings. T h e Court has no information before it indicating that Plaintiff is entitled to a return of all, o r any, of the payments it made to HHS for fiscal years 2006 and 2007. Even using a

fra ctio n al method of calculation to determine Hospice of New Mexico's statutory re im b u rs e m e n t cap, it is possible that Plaintiff exceeded its cap for fiscal years 2006 and 2 0 0 7 and HHS is entitled to a repayment of some of the Medicare benefits it paid out to H o s p ic e of New Mexico. HHS is clearly better suited to performing these complex

c a lc u la tio n s than this Court." Hospice of New Mexico, LLC v. Sebelius, 2010 WL 773229 at *17 (D.N.M.). J u d g e Brack went on to state: "The Court has only found that 42 C.F.R. § 4 1 8 .3 0 9 (b )(1 ) is invalid and Plaintiff would be better off under a fractional calculation as re q u ire d by the statute. The Court was only asked by the PRRB to review the validity of the re g u la tio n ." Id. (Emphasis added). That is this court's view of its limited role as well. F o r defendant's part, its motion asks the court to expressly dismiss plaintiff's claim w ith respect to the 2005 cost year because plaintiff failed to properly exhaust administrative rem ed ies for that fiscal year. The court might be persuaded to do so if the matter were

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u n d isp u ted , but plaintiff has objected with a rather convoluted argument that fiscal years in th is context should be viewed as inextricably intertwined * . Again, the court is persuaded th a t such threading or un-threading of beads is better handled by the administrative agency. T h is court's limited task is concluded. It is the order of the court that the motion of the plaintiff (#26) and the motion of the d e f e n d a n t (#27) are hereby DENIED. IT IS SO ORDERED this 8th day of JUNE, 2010.

Dated this 8th Day of June 2010.

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In the course of its opposition to defendant's motion, plaintiff effectively makes a second motion of its own, asking the court to alter the judgment to include FY 2005 and FY 2008. (Opposition at 2). This is not procedurally appropriate, and is denied on the merits in any event. 3

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