13-year Medicare payment dispute will return to HHS, court rules

A 13-year Medicare payment dispute over a formula for calculating supplemental reimbursements will head back to HHS to be reevaluated, The U.S. District Court for the District of Columbia ruled Feb. 8.

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The legal dispute between Empire Health Foundation and HHS first began in 2009. Empire Health Foundation sued HHS, arguing that a change in the formula used by the department to calculate disproportionate share hospital payments caused it to lose out on reimbursement it was owed. 

Specifically, the lawsuit takes issue with a Medicare policy change that included a new methodology for allocating Medicare Part C days in the disproportionate share hospital formula.

The court ruled that sending the case back to HHS is the “most efficient course” for resolving the case, in light of a forthcoming rule from the agency addressing the calculation in question. 

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