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  • United States Court of Appeals, Fourth Circuit

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    This case involves a reimbursement dispute under the Medicare program between the University of North Carolina Memorial Hospital and the Secretary of Health and Human Services. The hospital sought reimbursement for costs related to services provided by interns and residents at affiliated medical clinics for 1980-1983, but the claim was denied on grounds that the clinics were operated by the university's school of medicine rather than the hospital. Both an intermediary and an administrative review board upheld the denial. However, the district court reversed, finding the decision was not supported by substantial evidence. Upon appeal, the Fourth Circuit affirmed the district court's ruling, agreeing the language of the operating agreement, organizational structure, licensing, rules and patient records all indicated the clinics were part of the hospital

    Исходное описание:

    Filed: 1989-09-28 Precedential Status: Non-Precedential Citations: 887 F.2d 1082 Docket: 88-2894

    Оригинальное название

    University of North Carolina, D/B/A the North Carolina Memorial Hospital v. Louis W. Sullivan, Secretary of Health and Human Services, 887 F.2d 1082, 4th Cir. (1989)

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    This case involves a reimbursement dispute under the Medicare program between the University of North Carolina Memorial Hospital and the Secretary of Health and Human Services. The hospital sought reimbursement for costs related to services provided by interns and residents at affiliated medical clinics for 1980-1983, but the claim was denied on grounds that the clinics were operated by the university's school of medicine rather than the hospital. Both an intermediary and an administrative review board upheld the denial. However, the district court reversed, finding the decision was not supported by substantial evidence. Upon appeal, the Fourth Circuit affirmed the district court's ruling, agreeing the language of the operating agreement, organizational structure, licensing, rules and patient records all indicated the clinics were part of the hospital

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    14 просмотров2 страницы

    United States Court of Appeals, Fourth Circuit

    Загружено:

    Scribd Government Docs
    This case involves a reimbursement dispute under the Medicare program between the University of North Carolina Memorial Hospital and the Secretary of Health and Human Services. The hospital sought reimbursement for costs related to services provided by interns and residents at affiliated medical clinics for 1980-1983, but the claim was denied on grounds that the clinics were operated by the university's school of medicine rather than the hospital. Both an intermediary and an administrative review board upheld the denial. However, the district court reversed, finding the decision was not supported by substantial evidence. Upon appeal, the Fourth Circuit affirmed the district court's ruling, agreeing the language of the operating agreement, organizational structure, licensing, rules and patient records all indicated the clinics were part of the hospital

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    из 2

    887 F.

    2d 1082
    Unpublished Disposition

    NOTICE: Fourth Circuit I.O.P. 36.6 states that citation of


    unpublished dispositions is disfavored except for establishing
    res judicata, estoppel, or the law of the case and requires
    service of copies of cited unpublished dispositions of the Fourth
    Circuit.
    UNIVERSITY OF NORTH CAROLINA, d/b/a the North
    Carolina
    Memorial Hospital, Plaintiff-Appellee,
    v.
    Louis W. SULLIVAN, Secretary of Health and Human
    Services,
    Defendant-Appellant.
    No. 88-2894.

    United States Court of Appeals, Fourth Circuit.


    Argued: Feb. 6, 1989.
    Decided: Sept. 28, 1989.

    Dana Joseph Petti, Assistant Regional Counsel (Robert H. Edmunds, Jr.,


    United States Attorney, Harry L. Hodgood, Assistant United States
    Attorney, Bruce R. Granger, Chief Counsel, Region IV, Department of
    Health & Human Services, on brief), for appellant.
    Carel Theilgard Hedlund (Leonard C. Homer, Ober, Kaler, Grimes &
    Shriver, Lacy H. Thornburg, Attorney General, J. Charles Waldrup,
    Assistant Attorney General, on brief), for appellee.
    Before CHAPMAN and WILKINS, Circuit Judges, and N. CARLTON
    TILLEY, Jr., United States District Judge for the Middle District of North
    Carolina, sitting by designation.
    PER CURIAM:

    This case involves a reimbursement dispute under the federally funded


    Medicare program which provides for reimbursement of medical services
    provided the aged and disabled, 42 U.S.C. Sec. 1395c et seq.

    North Carolina Memorial Hospital's claim for reimbursement for costs related
    to services provided by its interns and residents while working at the Medical
    Faculty Practice Plan Clinics for the years 1980-1983 was denied when the
    Medicare Intermediary, Blue Cross/Blue Shield of North Carolina, determined
    that the Clinics were operated and controlled by the School of Medicine of the
    University and were not part of the Hospital.

    The Provider Reimbursement Review Board upheld the disallowance, finding


    the Clinics were not a part of the Hospital. Upon appeal, the District Court
    reversed the decision of the Secretary, holding that the decision was not
    supported by substantial evidence.

    For the reasons stated in the opinion of the District Court, we affirm. The
    language of the agreement setting up the Clinics makes both the Hospital and
    the School of Medicine responsible for the management and the operation of
    the Clinics, the Clinics are organizationally and physically part of the Hospital,
    they are licensed and accredited as part of the Hospital, School of Medicine
    physicians rendering treatment there must abide by the rules of the Hospital,
    and patient records belong to the Hospital. The Board's finding that the Clinics
    were not part of the Hospital was not supported by substantial evidence.

    AFFIRMED.

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