Medicare payments
Azar, Secretary of Health and Human Services v Allina Health Services, et al11
This case drew interest—and many amicus briefs—from health care providers, including the AMA and the AHA.12,13 There was good reason for their interest: First, the case involved more than $3 billion in reimbursements; second, it represented a potentially important precedent about the rights of providers and patients to comment on Medicare reimbursement changes. The question involved the technical calculation of additional payments made to institutions that serve a disproportionate number of low-income patients (known as Medicare Fractions).
At stake. The issue was a statutory requirement for a 60-day public notice and comment period for rules that “change a substantive legal standard” governing the scope of benefits, eligibility, or payment for services.14 In 2014, the Secretary of the Department of Health and Human Services (HHS) in the Obama administration posted a spreadsheet announcing Medicare fractions rates for hospitals (for 2012)—without formal notice or comment regarding the formula used. (The spreadsheet listed what each qualifying institution would receive, but it was based on a formula that, as noted, had not been subject to public notice and comment.) The AMA and AHA briefs emphasized the importance of a notice and comment period, especially when Medicare reimbursement is involved.
Final ruling. The Court held that the HHS process violated the notice and comment provision, thereby invalidating the policy underlying the so-called spreadsheet reimbursement. The decision was significant: This was a careful statutory interpretation of the 60-day notice and comment period, not the reimbursement policy itself. Presumably, had the HHS Secretary provided for sufficient notice and comment, the formula used would have met the requirements for issuing reimbursement formulas.
Key points. Hospitals will collectively receive $3 or $4 billion as a consequence of the ruling. Perhaps more importantly, the decision signals that HHS is going to have to take seriously the requirement that it publish Medicare-related reimbursement policies for the 60-day period.
Other important cases of the most recent term
A number of diverse cases ruled on by the Supreme Court are worth mentioning. The Court:
- allowed the President to move various funds from the US Department of Defense into accounts from which the money could be used to build a portion of a wall along the southern US border.1
- essentially killed the "citizenship question" on the census form. Technically, the Court sent the issue back to the Commerce Department for better justification for including the question (the announced reasons appeared to be pretextual).2
- changed, perhaps substantially, the deference that courts give to federal agencies in interpreting regulations.3
- upheld, in 2 cases, treaty rights of Native Americans to special treatment on Indian Lands4,5; the Court held that treaties ordinarily should be interpreted as the tribe understood them at the time they were signed. (These were 5 to 4 decisions; the split in the Court leaves many unanswered questions.)
- made it easier for landowners to file suit in federal court when they claim that the state has "taken" their property without just compensation.6
- held that a refusal of the US Patent and Trademark Office to register "immoral" or "scandalous" trademarks infringes on the First Amendment. (The petitioner sought to register "FUCT" as a trademark for a line of clothing.)7
- allowed an antitrust case by iPhone users against Apple to go forward. At issue: the claim that Apple monopolizes the retail market for apps by requiring buyers to obtain apps from Apple.8
- held that, if a drunk-driving suspect who has been taken into custody is, or becomes, unconscious, the "reasonable search" provision of the Fourth Amendment generally does not prevent a state from taking a blood specimen without a warrant. (Wisconsin had a specific "implied consent" law, by which someone receiving a driving license consents to a blood draw.9)
- decided numerous capital punishment cases. In many ways, this term seemed to be a "capital term." Issues involved in these cases have split the Court; it is reasonable to expect that the divide will endure through upcoming terms.
References
- Donald J. Trump, President of the United States, et al. v Sierra Club, et al. 588 US 19A60 (2019).
- Department of Commerce et al. v New York et al. 18 996 (2018).
- Kisor v Wilkie, Secretary of Veterans Affairs. 18 15 (2018).
- Washington State Department of Licensing v Cougar Den, Inc. 16 1498 (2018).
- Herrera v Wyoming. 17 532 (2018).
- Knick v Township of Scott, Pennsylvania, et al. 17 647 (2018).
- Iancu, Under Secretary of Commerce for Intellectual Property and Director, Patent and Trademark Office v Brunetti. 18 302 (2018).
- Apple Inc. v Pepper et al. 17 204 (2018).
- Mitchell v Wisconsin. 18 6210 (2018).
Liability under the False Claims Act
The False Claims Act (FCA) protects the federal government from fraudulent claims for payment and for shoddy goods and services. It incentivizes (by a percentage of recovery) private parties to bring cases to enforce the law.15 (Of course, the federal government also enforces the Act.)
At stake. The FCA has been of considerable concern to the AHA, the Association of American Medical Colleges, and other health care organizations—understandably so.16 As the AHA informed the Court in an amicus brief, “The prevalence of [FCA] cases has ballooned over the past three decades.... These suits disproportionately target healthcare entities.... Of the 767 new FCA cases filed in 2018, for example, 506 involved healthcare defendants.”17
Final ruling. The Court considered an ambiguity in the statute of limitations for these actions and the Court unanimously ruled to permit an extended time in which qui tam actions (private actions under the law) can be filed.18
Key points. As long a period as 10 years can pass between the time an FCA violation occurs and an action is brought. This decision is likely to increase the number of FCA actions against health care providers because the case can be filed many years after the conduct that gave rise to the complaint.
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