U.S. v. Horton
| Citation | 622 F.2d 144 |
| Decision Date | 23 July 1980 |
| Docket Number | No. 78-3584,78-3584 |
| Parties | UNITED STATES of America, Plaintiff-Appellee, v. Ernestine HORTON, d/b/a Pine View Manor Nursing Home, Defendant-Appellant. |
| Court | United States Courts of Appeals. United States Court of Appeals (5th Circuit) |
Alton O. Paulk, Panama City, Fla., for defendant-appellant.
William Kanter, Linda Jan S. Pack, Dept. of Justice, Civil Div., App. Staff, Washington, D. C., for plaintiff-appellee.
Appeal from the United States District Court for the Northern District of Florida.
Before WISDOM, RONEY and HATCHETT, Circuit Judges.
Appellant appeals a judgement for the government in an action to recover Medicare overpayments made to appellant's nursing home from 1967 through 1969, when the nursing home was a "provider" facility under the Medicare Act, 42 U.S.C. § 1395 et seq. After two jury trials and two trials to a special master, the district court awarded the government $98,167, with interest from the date of judgment plus costs, in a final judgment which incorporated four partial summary judgments. Because we find that the district court did not abuse its discretion in granting a new trial or appointing a special master, correctly entered the four partial summary judgments, and was otherwise correct in its rulings, we affirm.
Appellant, Ernestine Horton, owned and operated the Pine View Manor Nursing Home which, from January, 1967, through May, 1969, was certified as a "provider of services" under the Medicare program. 42 U.S.C. § 1395x(v). Horton designated Aetna Life and Casualty Insurance Company (Aetna) to be her "financial intermediary." 42 U.S.C. § 1395h. Under this arrangement, Horton submitted bills for services to Aetna. Aetna then paid the bills in its capacity as agent for the Secretary of Health and Human Resources. Aetna also served as the Secretary's agent for purposes of auditing Horton. After reviewing and auditing the payments made to Horton during the two and a half year period Pine View Manor participated in the Medicare program, Aetna determined that certain costs claimed by Horton were not allowable and that overpayments had been made. Horton refused to pay the refund demanded by both Aetna and the Secretary. Settlement of the government's claim was discussed, and in November, 1974, a regional official of Health and Human Resources signed a purported release. Subsequently, the government contended, and the district court agreed, that this release was invalid because the regional official lacked authority to issue it.
The government filed suit in federal district court in 1975, seeking recovery of its overpayments.
The district court proceedings were exceedingly complex and protracted. The case involved an accounting dispute, contractual in nature. There were seven "line items" in Horton's cost report in dispute. The trial judge granted a jury trial over the government's objections. The judge cast his order for a jury trial such that the jury would make factual determinations on each of the seven line items and then the judge would incorporate these findings of fact into a final judgment which would have to be written with the aid of accountants. The judge eventually held two jury trials and two trials to a special master.
The first trial was held in 1977. Seven "line items" in the Pine View Manor cost reports were at issue: interest expense on loans; bad debts; Horton's compensation as owner-operator; general and administrative expense; depreciation for 1967 and 1968; depreciation at time of sale in 1969; "grossing-up" charges to equalize the cost for Medicare in non-Medicare patients in 1967. Extensive testimony was presented to explain the Medicare regulations and the contested "line items."
Shortly after retiring to consider its answers to interrogatories in the special verdict, the jury submitted to the judge a question evincing confusion on the computation of depreciation. A clarifying answer was sent to the jury, which then returned a special verdict. On six of the seven interrogatories, the jury's answers were favorable to Horton; the seventh question, Horton's compensation, was answered in the government's favor.
Judgment was not entered immediately since the government was required to re-cast Horton's cost reports in light of the verdict. One week after the verdict, the government moved the court to set aside the jury verdict and grant a new trial under Rule 59, Fed.R.Civ.P., on the grounds that the verdict included allowances not permitted by law, was inconsistent with the court's instructions, and was not supported by the weight of the evidence. The government also suggested that the court reconsider its ruling granting a jury trial. Horton opposed the government's motion, but the judge granted a new trial, again with a jury. The new trial was limited, in that it would not reconsider the matter of Horton's compensation, the one issue on which it was apparent the jury had had sufficient evidence on which to make its determination.
On the same day he ordered a new trial, the judge notified the parties of his conclusion that a special master should be utilized "to aid and assist the jury with the new trial of this case." A special master was appointed, with instructions to make specific findings of fact on the six "line items" for which a new trial had been granted. The special master examined the entire record and conducted a hearing, in which extensive testimony was presented on the Medicare cost reimbursement system and on Horton's cost reports. The special master's findings supported the government's allegations of overpayments on five of the six issues. On the sixth issue, interest expense, the special master's finding was favorable to Horton, but did not allow Horton the full amount claimed in her cost reports.
After the special master's report was filed, the government moved for partial summary judgment, asserting that as a result of the special master's report and other record material, including Horton's responses to requests for admissions, there were no longer questions of material fact on certain issues, so that the government was entitled to judgment on those issues as a matter of law. While Horton filed a general objection to the special master's report, she did not specify any errors in the findings of fact and did not respond to the government's motion for partial summary judgment. The judge entered summary judgment for the government on several issues: bad debts; depreciation; general and administrative expense; gain on sale of nursing
home; and a portion of the interest expense. The judge stated that this partial summary judgment would be included in the final judgment when it was entered.
While seeking a partial summary judgment on several issues, the government had objected to the special master's finding on interest expense, asserting that the finding was not consistent with Medicare regulations. The interest expense was referred back to the special master for further findings, with instructions that Horton be permitted to introduce evidence to support her interest expense claim, if she chose to do so. The special master's second report and findings again specified that Horton should be allowed interest expense and recommended an amount slightly lower than that recommended in the first report.
The court entered two summary judgments, one for the government and another for Horton, on the remaining portions of the interest expense issue. The government's objection to the special master's report was overruled and there was no further evidence to be presented on the issue. There was no further question as to material facts, so that the parties were entitled to judgments as a matter of law.
The only issue remaining for a jury determination was whether the government had been correct in "grossing-up" Horton's disparate charges for services in order to equalize the costs attributed to Medicare and non-Medicare patients during 1967. After a one day trial, the jury found that the "grossing-up" procedure had been correct.
The court entered a final judgment summarizing the complex proceedings and issues in the case. That order incorporated the prior partial summary judgments, as well as interlocutory rulings on crucial matters such as the mode of trial. The final...
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