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11-1231 SEBELIUS, SEC. OF HEALTH AND HUMAN SERVICES V. AUBURN REGIONAL MEDICAL CENTER DECISION BELOW: 642 F.3d 1145 ORDER OF JULY 23, 2012 JOHN F. MANNING, ESQUIRE, OF CAMBRIDGE, MASSACHUSETTS, IS INVITED TO BRIEF AND ARGUE THIS CASE, AS AMICUS CURIAE, IN SUPPORT OF THE POSITION THAT THE 180-DAY STATUTORY TIME LIMIT FOR FILING AN APPEAL WITH THE PROVIDER REIMBURSEMENT REVIEW BOARD FROM A FINAL MEDICARE PAYMENT DETERMINATION MADE BY A FISCAL INTERMEDIARY, 42 U.S.C. § 1395OO(A)(3), MAY NOT BE EXTENDED FOR ANY PERIOD. CERT. GRANTED 6/25/2012 QUESTION PRESENTED: Whether the 180-day statutory time limit for filing an appeal with the Provider Reimbursement Review Board from a final Medicare payment determination made by a fiscal intermediary, 42 U.S.C. 1395oo(a)(3), is subject to equitable tolling. LOWER COURT CASE NUMBER: 10-5115
In the 2012 case of Kathleen Sebelius, Secretary of Health and Human Services v. Auburn Regional Medical Center et al., the U.S. Supreme Court ruled that hospitals cannot appeal Medicare reimbursement decisions more than three years after they are made, even if the government used inaccurate data to calculate those payments. The dispute arose when a group of 18 hospitals claimed they were shortchanged by Medicare because it miscalculated their reimbursements for treating low-income patients in fiscal years 1987 through 1994 due to its use of faulty data. However, these claims were not filed until seven or more years after the final notice was issued by HHS regarding payment determinations for each year in question. The court held that while there is an exception allowing late appeals based on "extraordinary circumstances," this does not apply when providers simply failed to identify errors within the statutory time limit.
In the dissenting opinion for the case between Kathleen Sebelius and Auburn Regional Medical Center, Justice Scalia argued that Medicare providers should not be limited by a strict 180-day deadline to appeal reimbursement decisions. He believed that this rigid timeframe was unfair and potentially harmful to healthcare providers who may need more time to gather necessary information or evidence. Furthermore, he disagreed with the majority's interpretation of the statutory language as imposing an absolute limit on appeals. Instead, he suggested that Congress intended for there to be some flexibility in these deadlines, particularly when it comes to cases involving government mistakes or oversights. Thus, according to Justice Scalia’s dissenting view, hospitals like Auburn Regional Medical Center should have been allowed additional time beyond 180 days if they could show good cause why their claims were delayed.