Justia Health Law Opinion Summaries

Plaintiffs seek a writ of mandamus compelling the Secretary to act within Congress's prescribed specific time frames, 42 U.S.C. 1395ff, for the Secretary to reach decisions on various stages of administrative appeals of Medicare reimbursement claim denials. The district court concluded that mandamus relief was unwarranted. The court concluded that the statute imposes a clear duty on the Secretary to comply with the statutory deadlines, that the statute gives the Association a corresponding right to demand that compliance, and that escalation—the only proposed alternative remedy—is inadequate in the circumstances of this case. Because the Association has demonstrated that the threshold requirements for mandamus jurisdiction are met, and because the Secretary’s other jurisdictional arguments fail, the court reversed the district court’s dismissal for lack of jurisdiction. On remand, the district court should determine whether “compelling equitable grounds” now exist to issue a writ of mandamus. View "American Hospital Ass'n v. Burwell" on Justia Law

The Hospital challenged the method used by the Secretary to calculate its reimbursement for services it provided during 2003 and 2004 - the two years after statutory caps on reimbursements for psychiatric hospitals expired but before psychiatric hospitals were moved to a prospective-payment system. The court affirmed the district court's denial of the hospital's motion for summary judgment and grant of HHS's cross-motion for summary judgment because HHS’s interpretation was not only reasonable but also the best interpretation of the controlling statute, 42 U.S.C. 1395ww, and regulation, 42 C.F.R. 413.40. View "Washington Regional Medicorp v. Burwell" on Justia Law