• Federal Courts Stop HHS from Recovering Payments in Excess of Hospice Cap
  • September 1, 2010 | Author: Thomas H. Hawk
  • Law Firm: King & Spalding LLP - Atlanta Office
  • A pair of recent federal court decisions have given hospice providers at least temporary relief from attempts by the U.S. Department of Health and Human Services (HHS) to collect monies that HHS says is owed to it pursuant to the hospice cap regulation, 42 C.F.R. §418.309(b)(1).  The hospice cap regulation sets forth a formula for calculating the cap.  The dispute relates to how patients new to the hospice provider are accounted for in the calculation.

    An Arkansas federal district court temporarily restrained HHS from attempting to collect monies paid to Southeast Arkansas Hospice, Inc. in excess of the annual cap.  The court held that allowing HHS to collect the amounts demanded would irreparably harm the hospice provider.  That, coupled with a number of cases nationwide holding HHS’s calculation of the cap invalid, constituted sufficient grounds for a temporary injunction.  The Arkansas case is Southeast Arkansas Hospice, Inc. v Sebelius, No. 4:  10-CV-00721 BSM, and is available by clicking here. 

    A New Mexico court reached a similar result, but on procedural grounds.  In Zia Hospice, Inc. v Sebelius, D.N.M., No. 1:  09-CV-00055-CG-LFG, the federal district court refused to lift an earlier granted stay of enforcement of the hospice cap because HHS missed a deadline for filing a motion.  The court held that it lacked jurisdiction in the matter.