Connect with us

International Circuit

US SC to hear lawsuit by 200 hospitals over funding shortchange

The U.S. Supreme Court has agreed to hear a lawsuit by more than 200 hospitals that serve low-income populations accusing the federal government of shortchanging them on Medicare funding by about $1.5 billion per year.

The hospitals, located in 32 states, are asking the court to overturn a decision by the U.S. Court of Appeals for the D.C. Circuit upholding the current method of determining funding used by the U.S. Department of Health and Human Services (HHS).

The hospitals have argued that the underfunding has contributed to the closure of rural hospitals.

“The neediest patients pay the price, traveling farther and waiting longer for care, if they can obtain it at all,” they said in their petition.

The Supreme Court, following its usual practice, did not give a reason for deciding to take the case on Monday.

“We look forward to presenting our case to the court,” said Hyland Hunt of Deutsch Hunt, a lawyer for the hospitals. A spokesperson for HHS declined to comment.

The hospitals’ 2017 lawsuit centers on how HHS should calculate so-called disproportionate share hospital (DSH) funding, which under federal law provides additional Medicare reimbursement to hospitals that serve disproportionately low-income populations.

One of the factors used to determine hospitals’ DSH funding is how many of their Medicare patients also qualify for supplemental security income (SSI), a federal assistance program. The law states that HHS must divide the number of Medicare patients who qualify for SSI by the total number of Medicare patients, adjusted for how many days they spend in the hospital.

The hospitals claim that HHS is breaking the law by counting only patients who actually receive SSI benefits while they are in the hospital, regardless of whether they are eligible for SSI.
SSI benefits are determined on a monthly basis, and may be zero for a particular month even while a patient remains “eligible” for the program, the hospitals said.

The hospitals argue that failing to count some SSI-eligible patients is inconsistent with HHS’s practice, upheld by the Supreme Court in 2022, of counting all Medicare-eligible patients, regardless of whether Medicare actually pays for their hospital stays, when calculating DSH funding.

“Left standing, the agency’s cake-and-eat-it-too position threatens the financial viability of safety net hospitals and impairs their ability to treat low-income elderly and disabled patients and serve their broader communities,” they said in their petition.

In a response brief HHS said that Medicare eligibility, which is permanent for senior citizens, is fundamentally different from SSI benefits that fluctuate month to month. It said that patients’ monthly eligibility reflects their actual financial need. Reuters

Copyright © 2024 Medical Buyer

error: Content is protected !!