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Medicare: The Home Office of Medicare Providers May Not Rely on the Approval of an Alternative Cost Allocation Approved by a Medicare Fiscal Intermediary — Mercy Home Health v. Leavitt
Published online by Cambridge University Press: 06 January 2021
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References
1 2006 WL 259609 (3rd Cir. Feb. 3, 2006).
2 Id. at *1.
3 Id. at *10 n.2.
4 CENTER FOR MEDICARE AND MEDICAID SERVICES, THE PROVIDER REIMBURSEMENT MANUAL, PUB. 15-1 [hereinafter PRM].
5 Where evidence indicates that the use of a more sophisticated allocation basis would provide a more precise allocation of pooled home office costs to its subsidiaries, the home office must obtain approval from an intermediary before any substitute basis may be used. The home office must make a written request and provide justification to the intermediary. Upon approval from the intermediary, the change must be applied to the accounting period for which the request was made, and to all subsequent periods unless the intermediary approves a subsequent change. PRM §2150.3(D)(2)(b)).
6 Mercy, 2006 WL 259609 at *3.
7 Id. at *3-4.
8 Id. at *4.
9 Id.
10 Id.
11 Id.
12 Id. Adjustments made to the 1997-1999 cost reports were not specified.
13 Id.
14 Id. at *4-5.
15 Id. at *5; 42 U.S.C. § 1395x(v)(1)(A) (2005).
16 Mercy, WL 259609 at *5.
17 Id.
18 Id.
19 Id. at *6.
20 Id.
21 Id.
22 Id; see also Chevron U.S.A. v. Natural Resources Defense Council, 467 U.S. 837, 842-43 (1984).Google Scholar
23 Id.
24 Mercy, WL 259609 at *6.
25 Id. at *7
26 Id. at *6-7
27 Id. at *7.
28 Id.
29 Id. at *7-*8.
30 Id. at *8.
31 Id.
32 Id.
33 The Court examined the following statutes: PRM § 2150.3(D)(2)(b) which places the burden on providers to make a written request with its justification to the intermediary when seeking to utilize an alternative method; 42 U.S.C. § 1395g(a) (2005) which prohibits the payment of reimbursements unless the provider has furnished such information as the Secretary may request; and 42 C.F.R. § 413.24(a)(2006) and 42 C.F.R. § 413.24 (c)(2006) which requires providers receiving reimbursements to provide adequate cost data and that such data must be capable of being audited and be accurate and sufficient in detail to accomplish repayment. Id. at *9.
34 Id.
35 Id.
36 Id.
37 Id.