News & Analysis as of

Department of Health and Human Services (HHS) Provider Reimbursement Review Board

King & Spalding

Court Finds Hospitals’ Lawsuit Challenging HHS’s Calculation of the IPPS Standardized Amount Was Premature and Remands to the PRRB

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On September 27, 2023, Judge Royce Lamberth of the United States District Court for the District of Columbia dismissed a lawsuit challenging HHS’s calculation of the standardized amount used in calculating Medicare Inpatient...more

King & Spalding

D.C. Circuit Affirms Order Directing CMS to Produce Evidence in Case Alleging SSI Data Matching Errors

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On September 1, 2023, the D.C. Circuit affirmed the D.C. District Court’s decision in Pomona Valley Hosp. Med. Ctr. v. Azar, 2020 WL 5816486, at *1 (D.D.C. Sept. 30, 2020) requiring CMS to produce affirmative evidence as to...more

King & Spalding

D.C. District Court Dismisses a Hospital’s Challenge of Another Hospital’s Failure to Provide Wage Documentation to CMS

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On March 21, 2017, the U.S. District Court for the District of Columbia ruled that a hospital lacked standing to challenge a decision of the Provider Reimbursement Review Board (the “PRRB”), since the hospital failed to...more

Baker Donelson

Court Rules in Favor of Hospitals in Bad Debt Collection Effort

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On July 25, 2016, the United States District Court for the District of Columbia issued an opinion favoring provider flexibility in the reasonable collection of Medicare bad debt. Winder HMA, LLC, et al. v. Sylvia Burwell. The...more

Faegre Drinker Biddle & Reath LLP

Another Blow to Medicare “Self-Disallowance” Rule

You can tell by its name that you won’t like the Medicare “self-disallowance” rule. The federal district court for D.C. didn’t like it, either, and gave a group of Banner Health hospitals summary judgment that the rule was...more

Baker Donelson

Court Allows 'Retroactive' Application of 2005 Wage Index Rule Limiting Reimbursement for Pension Plan Costs

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On February 22, 2016, in Regents of the University of California v. Burwell, the U.S. District Court for the District of Columbia granted summary judgment in favor of the Secretary of Health and Human Services (the Secretary)...more

King & Spalding

Government Reopens with Affordable Care Act in Place

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On October 17, President Obama signed the bill titled the “Continuing Appropriations Act, 2014” (the “Act”) ending the 16-day government shutdown and lifting the nation’s debt limit. The Senate voted 81-18 in favor of the...more

King & Spalding

Government Shutdown Continues

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Medicare claims processing activities continue during the shutdown. PRRB appeal deadlines, although temporarily suspended, will become due immediately on the day the government reopens. Federal court deadlines remain in...more

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