Appeals court says no Medicare reimbursement for "pure research"

The U.S. Court of Appeals for the Seventh Circuit has ruled Rush University Medical Center in Chicago cannot bill Medicare for time spent on "pure research" unrelated to direct patient care.

Rush University Medical Center wanted to bill Medicare for the time its residents and interns spent on medical research. Rush requested Medicare reimbursements for this type of research for fiscal years 1993 to 1996.

Since 1983, HHS has interpreted the Medicare Act as excluding pure research from other compensable medical education costs. However, because the Patient Protection and Affordable Care Act has made some research activities compensable, Rush sued HHS for retroactive reimbursement of its pure-research costs, according to the opinion.

A federal judge ruled in favor of Rush, and held Congress intended the new reimbursement scheme to have retroactive application and to include costs for pure research. Subsequently, HHS issued its view of the PPACA, which included a guideline to continue the exclusion of pure-research costs.

The appeals court ruled against Rush, stating HHS has the final say on which costs will be reimbursed by Medicare. The court said for HHS' interpretation to not be upheld, the court would have to find the interpretation was based on an incorrect reading of the law, which the court stated was not the case.

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