Supreme Court to Hear Medicare Case

The Supreme Court said yesterday it would decide whether the 180-day limit placed on hospitals appealing Medicare reimbursement edicts can be equitably tolled. Eighteen hospitals want an review of reimbursement decisions dating back as far as 1987.

Back in 2006 – the wheels of justice move slowly for hospitals too – 18 hospitals attempted to appeal the Department of Health and Human Services’ determination of their annual Medicare reimbursement rate for elderly and disabled patients from 1987-94.

The hospital knew the appeals were, to say the least, late but claimed that equitable estoppel should toll the claims because because the Centers for Medicare and Medicaid Services refused to inform them that their Supplemental Security Income percentages were incorrectly understated for 1987 through 1994. The whole thing came up as a result of another case that CMS had paid hospitals less than they were due because it had miscalculated the DSH percentage owed.


So the hospitals sued.The district court rejected equitable tolling on the ground that “plaintiffs have proffered nothing suggesting that Congress intended to authorize equitable tolling for provider claims. The Federal Circuit reversed, finding that there is a presumption of equitable tolling that should be applied here. Now the Supreme Court can figure it out.

This case does not apply to personal injury claims. But I feel the hospitals’ frustration. Dealing with Medicare/Medicaid can be such an unbelievable hassle when trying to get a handle on liens for product liability, malpractice and car crash cases when Medicare is asserting their lines.. Ultimately, they seem perfectly willing to be completely unreasonable and, instead of arguing that they are being reasonable, simply shrugging their shoulders and saying, “That’s the way it is.” It is frustrating. I hope the Supreme Court does not disturb this ruling.

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