Jewish Hosp. v. DEPT. OF HEALTH & HUMAN SERV.

• Decision Date: 16 March 1992
• Docket Number: Civ. A. No. C 90-0791-L(A).
• Citation: 791 F. Supp. 168
• Parties: JEWISH HOSPITAL, INC., Plaintiff, v. SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES, Defendant.
• Court: U.S. District Court — Western District of Kentucky

791 F. Supp. 168

JEWISH HOSPITAL, INC., Plaintiff, v. SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES, Defendant.

Civ. A. No. C 90-0791-L(A).

United States District Court, W.D. Kentucky, at Louisville.

March 16, 1992.

R. Thomas Carter, Edward L. Schoenbaechler, Jan M. West, Goldberg & Simpson, Louisville, Ky., for plaintiff.

General Counsel, Dept. of Health & Human Services, Washington, D.C., Donald F. Dickey, Dept. of Health & Human Services, Baltimore, Md., James H. Barr, Asst. U.S. Atty., Louisville, Ky., for defendant.

MEMORANDUM OPINION

ALLEN, Senior District Judge.

This action is submitted to the Court on cross motions for summary judgment. Fed.R.Civ.P. 56. For the reasons set forth below, the defendant's motion will be granted, and the plaintiff's motion will be denied.

Plaintiff is a provider of hospital services as defined in 42 U.S.C. § 1395x(e) & (u). The defendant, Secretary of the Department of Health and Human Services, is a federal officer responsible for the administration of the Medicare Act.

In 1985 Congress enacted the Comprehensive Omnibus Budget Reconciliation Act of 1985 (hereinafter "COBRA"). Title 42 U.S.C. § 1395ww(d)(5)(F)(vi)(I) provides:

(vi) In this subparagraph, the term "disproportionate patient percentage" means, with respect to a cost reporting period of a hospital, the sum of —

(I) the fraction (expressed as a percentage), the numerator of which is the number of such hospital's patient days for such period which were made up of patients who (for such days) were entitled to benefits under part A of this title i.e., Medicare and were entitled to supplemental security income benefits (excluding any State supplementation) under title XVI of this Act i.e., Supplemental Security Income, and the denominator of which is the number of such hospital's patient days for such period which were made up of patients who (for such days) were entitled to benefits under part A of this title i.e., Medicare, and

(II) the fraction (expressed as a percentage), the numerator of which is the number of such hospital's patient days for such period which consist of patients who (for such days) were eligible for medical assistance under a State plan approved under title XIX of this chapter i.e., Medicaid, but who were not entitled to benefits under part A of this title i.e., Medicare, and the denominator of which is the total number of the hospital's patient days for such period.

The Secretary's interpretation of this statute appears at 42 C.F.R. 412.106 and is to the effect that the hospital patient days which are to be used as the numerator under the formula include only those days for which benefits are payable under Medicaid and that any other patient days spent by persons who are in the Medicaid program but which are not reimbursed by Medicaid are not to be considered hospital patient days for purposes of computing the numerator. For example, if a patient is hospitalized for 15 days and eligible for Medicaid benefits for 10 days, only the 10 covered days are to be considered as Medicaid patient days for purposes of determining a hospital's disproportionate patient percentage.

Plaintiff contends that the statute is clear and that it is entitled to reimbursement under ¶ II for the hospital stay of all Medicaid patients, even though these patients were not reimbursed for Medicaid for all of their stay but only for a portion thereof. Plaintiff points out that there is a difference between the word, "eligible," and the word "entitled," both of which are used in the statute.

We believe that the statute supports the Secretary's interpretation. However, even if that were not the case, we believe the most that could be said concerning the statute is that it is ambiguous. The parties agree that if the statute is ambiguous, the Secretary can legally choose the interpretation. We also are of the opinion that the statute, as drafted, by including the words, "for such days," means that the hospital may recover only for those days on which Medicaid patients were actually reimbursed. Had Congress intended the result sought by the plaintiff it would have left out "for such days" and made it clear that all patients on Medicaid were to be counted as part of the numerator regardless of whether they were days on which Medicaid benefits were actually paid.

The plaintiff also contends that the Secretary's interpretation is irrational and that it results in the lowest of disproportionate share of payments being received by hospitals that arguably need payment the most because of restrictive Medicare policies. This...