Hospital can’t challenge HHS data on DSH payments, court rules
Tampa General Hospital has lost the latest battle in a court fight against HHS on the data used to determine Disproportionate Share Hospital (DSH) payments for serving low-income patients.
The hospital first sued HHS over what data it would use to calculate DSH payments after the Affordable Care Act (ACA) changed the formula to be based largely on uncompensated care. A quarter of payments would be based on what a hospital received before the change, with the remaining 75 percent based in part on HHS’s estimate of the hospital’s portion of uncompensated care provided nationwide.
The estimate would be based off Medicare data hospitals provided in their 2010 and 2011 reports, with HHS setting a deadline that March 2013 updates to the reports would be the most recent data used in the calculation. Tampa General tried to submit data after the deadline in April 2013, arguing it would show it should receive $3 million in additional DSH payments. When HHS refused to use the data, the hospital sued, arguing the agency was basing the payments on “obsolete” data.
While the ACA specifically states DHS estimates themselves can’t be challenged in court, attorneys for Tampa General argued the underlying data could. The opinion from Judge Thomas Griffith of the U.S. Circuit Court of Appeals for the District of Columbia said the ACA doesn’t allow for such a distinction.
“By asking us to review the appropriateness of the data the Secretary used to calculate Tampa General’s DSH payment, Tampa General urges us to engage in the kind of ‘case-by-case review of the reasonableness or procedural propriety of the Secretary’s individual applications’ that Congress intended to bar,” Griffith wrote.
The district court ruling came to a similar conclusion, arguing the hospital was attempting “an end run” around the bar on a judicial review.
A report from the Florida State Senate released in March projected Tampa General would receive more than $5.6 million in DSH payments for the state’s current fiscal year.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.