In a turn of events reminiscent of a high-stakes legal thriller, the U.S. Department of Health and Human Services (HHS) has approached a federal court in Washington D.C., seeking to end a contentious lawsuit. This move comes on the heels of the court’s decision to deny a consortium of hospitals’ plea to extend a freeze on the case. The hospitals, spearheaded by Tarzana Providence Health System, had challenged Medicare’s method of calculating payments for treating low-income patients.
HHS Payment Rule Suit Exit : Calculating Care for the Underprivileged
The core of the conflict lies in the Medicare Disproportionate Share Hospital (DSH) payment—a critical lifeline for hospitals serving impoverished communities. This payment is meticulously calculated using two fractions: one based on Medicare Part A and supplemental security income beneficiaries’ hospital days, and the other focusing on patients covered by state Medicaid plans but not Medicare Part A. The hospitals contended that HHS’s interpretation of the term “entitled” in the DSH statute led to an unjust reduction in their payments.
HHS Payment Rule Suit Exit : Strategy and Counter-Strategy
In a narrative twist, both parties initially agreed to pause the litigation, watching closely as similar cases unfolded in higher courts. The D.C. Circuit’s Advocate Christ Medical Center v. Becerra and the Supreme Court’s Becerra v. Empire Health Foundation decisions, both favoring HHS, have since influenced the trajectory of this lawsuit.
