Twenty-five Ohio hospitals won a legal battle with the federal government this month over $79 million plus interest in Medicare disproportionate-share hospital payments they argued the CMS was low-balling.
U.S. District Judge Louis Oberdorfer in Washington on June 11 granted the hospitals summary judgment in a lawsuit claiming that the CMS was too narrow in its reading of the law that lays out how to calculate Medicare assistance for hospitals that pull the most weight caring for low-income patients.
The hospitals New Jersey-based attorney, Murray Klein of the firm Reed Smith, said he would be stunned if the government doesnt appeal the decision.
The sum is for 1994 through 2000.
The CMS did not respond to requests for comment.
The case comes down to a few disputed words. Ohios Medicaid DSH program, the Hospital Care Assurance Program, pools assessments collected from the hospitals to leverage federal matching funds.
The statutory language describing the Medicare DSH calculation, meanwhile, asks for the number of patient days for which the patients were eligible for medical assistance under a state plan approved under the Medicaid subchapter of the Social Security Act.
The CMS has interpreted those words to mean Medicaid-eligible patients, and no more. But HCAP dollarssome flowing from Medicaidend up paying for the care of indigent and low-income patients who dont qualify for Medicaid coverage.
The hospitals are making the contention that because these HCAP days are paid under the Medicaid DSH program, they are actually Medicaid days, said Charles Cataline, senior director of health policy at the Ohio Hospital Association.
This will make Medicare DSH dollars available to hospitals that otherwise may not have qualified, and legally sowere not pulling any shenanigans here, Cataline said.