Skip to main content

Hospital Can't Revive Medicare Reimbursement Case, DC Circuit Rules

By Jonathan R. Tung, Esq. on December 07, 2015 | Last updated on March 21, 2019

The D.C. Circuit dismissed the appeal by Canonsburg General Hospital (CGH) involving Medicare reimbursements. In the appeal, the hospital sought to have a 2001 decision reheard. The circuit court wasn't convinced.

This latest ruling against CGH is probably the most significant against the hospital because it essentially closes any future attempts to revive reimbursement claims for procedures "atypical in nature and scope."

Medicare Reimbursements

In 2001, CGH failed in its attempt to have the Department of Health and Human Services re-evaluate some of the Medicare reimbursement services reductions that were put into place in 1994.

In that suit, CGH sued HHS and asked it to reimburse the hospital for the cost differences between the old rates and the new rates, contending that the new rates actually were in violation of the Administrative Procedures Act. The District Court of Western Pennsylvania rejected that argument and handed down a summary judgment in favor of HHS.

The Past Comes Back to Haunt CGH

This was not the first time the CGH attempted and failed to find a sympathetic ear for reimbursements. CGH was almost out the door with full reimbursement through a full HHS appeals process in the mid-90s, but had its full victory overturned by the Center for Medical Services which deemed the reductions to the hospital to be "reasonable and appropriate."

Preclusion

When CGH appealed to the D.C. District Court, that court issued a summary judgment in favor of HHS on the grounds of preclusion: the issue had already been decided and settled previously in Pennsylvania. The Federal Circuit overturned the lower court's order for summary judgment because HHS did not even raise the Pennsylvania case as a defense. However, the preclusion effect would be enough to foreclose any possibility of CGH successfully bringing such a claim against HHS.

Most likely, this marks the final time CGH can bring a claim against HHS for reimbursement of the 1994 reductions, unless new claims can be based reasonably not in reimbursement for alleged injuries decades old.

Related Resources:

Copied to clipboard