In the wake of the disappointing (and brief) decision in Adena Regional Medical Center v. Leavitt (527 F.3d 176 (D.C. Cir. 2008)), providers were left to wish for a court to thoroughly address the tangled knot of issues presented by Medicare Disproportionate Share Hospital (DSH) Reimbursement for "Charity Care" days. They should have been more careful what they wished for. In the recently released Cooper University Hospital v. Sebelius, (No. 08-3781, slip op. (D.N.J. Sept. 28, 2009)) the United States District Court for the District of New Jersey wrote a detailed and thorough opinion that rejected the provider's arguments at every turn. Thomas W. Coons and Joshua J. Freemire of Ober|Kaler explain.