22 January 2013

SCOTUS in Plain English: Sebelius v. Auburn Regional Medical Center

This is one in a series of posts designed to describe Supreme Court decisions in plain English. For more detail and background on the legal issues, see the link to the case at SCOTUblog below. For similar posts, click here.

Sebelius v. Auburn Regional Medical Center

Hospitals that serve a disproportionally large number of low-income patients are eligible for a higher amount of Medicare reimbursement from the federal government based upon a formula. Hospitals can appeal this determination as long as they do so within 180 days (this can be extended up to three years with good cause) if they feel their reimbursement amount wasn't sufficient. A Department of Health and Human Services review board found errors in the Medicare reimbursement calculations, but didn't disclose them for over ten years. The hospital argued that the statute of limitations should have been delayed (in legal terminology, this is called "equitable tolling") because they didn't know about the error. The Supreme Court found that the statute of limitations did not apply to the 180 day limit, partly because it was an internal agency appeals process. In other words, the hospitals needed to appeal within 180 days of when they were denied the reimbursement adjustment, not years later when they found out about the error. The practical impact of this decision is that the government will not have to pay hospitals the Medicare reimbursements they were rightly due--the lawsuits (and there are many of them) were simply filed too late.
Post a Comment