NJ’s New Amendment to Tax Foreclosure Law: More Harm Than Good? Banner Image

NJ’s New Amendment to Tax Foreclosure Law: More Harm Than Good?

NJ’s New Amendment to Tax Foreclosure Law: More Harm Than Good?

On September 24, 2021, Governor Murphy signed a law amending N.J.S.A. § 54:5-89.1, with the amendment preventing investors who purchase homes subject to a tax foreclosure for below fair market value from intervening in foreclosure actions to redeem those properties. The statute at issue addresses the rights of people with unrecorded interests in properties that are in foreclosure for unpaid taxes or municipal liens. Under the statute, anyone with such an interest in the property is bound by the foreclosure judgment; however, once the person records the interest, they may apply to intervene in the action. Under the prior version of the law, “[n]o person, however, shall be admitted as a party to such action, nor shall he have the right to redeem the lands from the tax sale whenever it shall appear that he has acquired such interest in the lands for a nominal consideration after the filing of the complaint,” with exceptions for relatives or those who purchased the property at a judicial sale. (Emphasis added). According to the Assembly members who sponsored the amendment, under this prior version of the law, “[h]omeowners who are in the process of foreclosure are being approached and convinced that their property value has dropped significantly and is worth much less than they know. They are being told the best option is to get what they can get for their home now before the value declines anymore. Some of these elaborate schemes weave in false appraisals and lawyers backing up the buyers’ deception. For the many who believe these so-called real estate investors or 'title raiders' that you may find through 1-800 number posters, flyers, or online ads on Craigslist, they watch their homes being re-sold for more than they were offered for it.”

Under the amendment, the law now states that no person can intervene in an action or exercise the right of redemption if they “acquired such interest in the lands for less than fair market value after the filing of the complaint[.]” (Emphasis added). Thus, those who pay more than nominal consideration but less than fair market value are now barred from intervening or redeeming. According to the sponsors, “New Jersey has some of the highest foreclosure rates in the nation. Homeownership and equity equate to wealth for many families in the state. To know they are being deceived out of their homes in the middle of a fight against foreclosure is unacceptable. This new law marks the beginning of an ongoing effort to address the concerns homeowners have with the foreclosure process, lending and predatory practices that are taking homes away from families.”

The amendment, however, could cause more harm than good. If a property owner does not have sufficient funds to redeem a tax sale certificate, the property is lost to the tax sale certificate holder and the property owner receives nothing. Under the prior scheme, the investor has to intervene in the foreclosure and demonstrate that the property owner received more than nominal consideration, as adjudicated by the Court. See, e.g., Simon v. Cronecker, 189 N.J. 304 (2007). If approved by the Court, the investor usually would have redeemed the tax sale certificate and the homeowners would receive cash and often an extended (albeit short) time to stay in the property, often rent-free, before the property would turned over to the investor. While not perfect, and there are more than enough examples of unscrupulous investors taking advantage of a homeowner’s plight, the homeowner would receive consideration for his property, and the Court had a say in protecting the homeowner from outrageously low offers. If investors now have to pay fair market value for properties, one can anticipate that there will be less bidding for properties pre-foreclosure and more homes foreclosed on and lost with the homeowners receiving nothing. Time will tell if this noble amendment works for those unfortunate homeowners or it will be a case of the best intentions leading to wrong results.

For copy of the statute, please contact Michael O’Donnell at modonnell@riker.com, Desiree McDonald at dmcdonald@riker.com, or Kevin Hakansson at khakansson@riker.com.

Get Ready for Round Four of the Provider Relief Fund

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Connor Breza.

Additional $25.5 Billion in COVID-19 Provider Funding

The Department of Health and Human Services (“HHS”) announced that an additional $25.5 billion in new funding will be available for healthcare providers affected by the COVID‑19 pandemic. $8.5 billion of the funding will be allocated to the American Rescue Plan (“ARP”) for providers who serve rural Medicaid, Children’s Health Insurance Program, or Medicare patients, and $17 billion will be available for Provider Relief Fund (“PRF”) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.

Applications for funding open on September 29, 2021. For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments, visit the Health Resources and Services Administration website.

Environmental Justice Comes Early to New Jersey

New Jersey is no longer waiting to implement environmental justice requirements following surprise action by the New Jersey Department of Environmental Protection.

Since September 2020, the Garden State has been waiting for the Department to complete the gargantuan task of implementing the first of its kind Environmental Justice Law. The New Jersey law authorizes the Department to deny or condition certain permits for facilities that would have a disproportionate impact on an overburdened community. However, the substantive provisions of the law do not go into effect until the Department adopts regulations to implement the Environmental Justice Law. While the Department has gone to great lengths, including through a substantial stakeholder process, to develop implementing regulations, the regulations have not yet been proposed or adopted. (The regulations are expected to be proposed in late 2021 and adopted in late 2022.)

With the issuance of Administrative Order 2021-25 on September 22, 2021, certain aspects of the Environmental Justice Law are now in effect. The terms of the Administrative Order apply to:

  • All facilities subject to the Environmental Justice Law, including:

- major sources of air pollution (i.e., facilities with Title V air permits, such as power plants);
- solid waste facilities;
- landfills;
- incinerators;
- sewage treatment facilities that process more than 50 million gallons per day;
- scrap metal recycling facilities; and
- other recycling facilities that process more than 100 tons per day.

  • That seek covered permits in overburdened communities, which are mapped by the Department (these areas encompass 4.5 million people in 3,168 census block groups and 331 municipalities).

For these facilities, the Administrative Order:

  • Extends the public comment period for relevant permits applications to at least 60 days, with a potential extension for an additional 30-day period upon the written request of a member(s) of the overburdened community;
  • Requires a mandatory public hearing in a manner intended to maximize participation of individuals within the overburdened community;
  • Encourages individuals to provide the facilities and the Department with information regarding existing conditions within the overburdened community and potential facility-wide environmental and public health stressors that could result in adverse impacts in the event of an approval;
  • Requires the facility to respond to and address the concerns raised by individuals in the overburdened community and to conduct any additional analysis that the Department deems necessary for its review;
  • Strongly encourages each facility to engage directly with individuals in the overburdened community in advance of, and in addition to, formal public comment, including providing relevant information related to facility-wide impacts; and
  • Authorizes the Department to apply special permit conditions as may be necessary to avoid or minimize environmental or public health stressors.

The Order takes effect immediately and applies to all existing permit applications with open and unexpired public comment periods. The Order also reserves the Department’s authority to apply the terms of the Order to permit applications with closed or expired public comment periods.

In essence, the Administrative Order creates a process to implement the key components of New Jersey’s Environmental Justice Law—without rulemaking—but leaves many questions unanswered, especially given the significant complexity of the Environmental Justice Law and its implementation.

  • The terms of the Administrative Order are only effective to the extent allowable by existing law; how will this limitation impact the terms of the Order and how aggressive will the Department be its implementation of the Order?
  • Does the Order apply to the renewal of a Title V air permit?
  • How will the Department apply the requirements of the Order to permit applications already submitted, including Title V air permit renewal applications, which can remain pending for a very long time?
  • How will the Department use its claimed authority to require additional analyses and to impose permit conditions under the Order?
  • When will the formal regulations be proposed and adopted to provide structure and certainty to this process?

If you own or operate a facility in an overburdened community or are considering development or acquisition of a facility in an overburdened community, you would be well advised to carefully consider the impact of this Administrative Order.

For more information, please contact any attorney in our Environmental Practice Group.

New York Court Holds Title Insurer Did Not Need to Inform Agent of Title Claim or Seek Agent’s Consent to Settle

The Supreme Court of the State of New York, New York County recently granted a title insurance company’s motion to dismiss its policy-issuing agent’s counterclaim, finding that the title insurer had no obligation to inform the agent of a title claim arising from a policy the agent issued, nor did the insurer have to seek the agent’s consent before settling.  See Fidelity National Title Insurance Co. v. Rockwell Abstract, et al., 652588-2021 (N.Y. Sup. Ct. Sept. 1, 2021).  In 2006, the non-party property owner (“Ada”) executed a mortgage on her property.  The lender obtained a title insurance policy underwritten by plaintiff and that was issued by defendant, plaintiff’s policy-issuing agent.  In 2015, the children of Ada’s deceased husband, who had passed away in 2001, brought a lawsuit claiming they were 50% owners of the property and that Ada did not have the right to mortgage the property in 2006.  The lender submitted a claim to plaintiff, who eventually settled the case.  Plaintiff then brought this indemnification action against defendant, claiming defendant failed to properly identify the children’s interest in the property.  Defendant filed a counterclaim that plaintiff breached the duty of good faith and fair dealing because plaintiff did not inform defendant of the claim or seek defendant’s consent to settle.  Plaintiff moved to dismiss the counterclaim.

The Court granted plaintiff’s motion to dismiss the good faith and fair dealing counterclaim.  Under the parties’ agency agreement, “Agent agrees that Company shall be fully authorized and empowered, in its absolute discretion, to control, defend, prosecute, settle, compromise, and/or dispose of any claim, litigation or proceeding for which: (i) Company may be liable; and/or (ii) an insured under a Title Assurance may be liable.”  Based on this provision, the Court found that the agent “contracted away [its] right to have input in a potential settlement” and that “plaintiff was entitled to settle the title litigation ‘in its absolute discretion’ and did not need to inform defendant[].”  Accordingly, the Court dismissed the agent’s counterclaim.

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Desiree McDonald at dmcdonald@riker.com, or Kevin Hakansson at khakansson@riker.com.

More Stark Law Changes

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Connor Breza.

Final Changes Regarding Distribution of Profits

The Centers for Medicare & Medicaid Services (“CMS”) and Department of Health and Human Services (“HHS”) announced a Final Rule, effective January 1, 2022, modifying the requirements under the Stark Law with respect to distribution of profits among physicians in a group practice.

Under the new rule, § 411.352(i) will be modified to clarify the permissible methods for distributing profit shares derived from the referral of designated health services (“DHS”) among the physicians of a group practice (as defined under the Stark Law). Of note, this regulation would modify references to “profits” and “revenues” to more accurately be reflected by the term “overall profits,” which is defined under the rule as “the profits derived from all the designated health services.”

In doing so, this change will require that group practices utilize the same methodology for distributing such income across the group, whereas in the past it was not uncommon for profits derived from different types of DHS to be distributed differently. Specifically, the proposed final rule states that “a physician practice that wishes to qualify as a group practice may not distribute profits from designated health services on a service-by-service basis.” As an example, the rule proceeds to elaborate that, “[i]f the practice wishes to qualify as a group practice, it may not distribute the profits from clinical laboratory services to one subset of its physicians and distribute the profits from diagnostic imaging to a different subset of its physicians.”

This change will have a wide-reaching effect on the ways group practices can allocate and distribute profits derived from DHS, most significantly as it pertains to ancillary services provided throughout the group. In anticipation of potential disruptions to group practices, and potential difficulty with becoming compliant with the modified regulations, CMS delayed the effective date beyond that of the remainder of the Final Rule’s changes to provide group practices with ample time to adjust.

Changes to Indirect Compensation Arrangement

CMS released a proposed rule amending the federal Stark law’s definition of “indirect compensation arrangement.” The federal Stark Law, also known as the Physician Self-Referral Law, (1) prohibits a physician from making referrals for certain designated health services payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless an exception applies, and (2) prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third party payer) for those referred services.

This prohibition applies to direct as well as indirect compensation arrangements. CMS’s proposed rule seeks to revise the regulation at § 411.354(c)(2) that sets forth the conditions for the existence of an indirect compensation arrangement. As the regulations now stand under § 411.354(c)(2)(ii)(A), an indirect compensation arrangement is identified when there is an unbroken chain of financial relationships between an entity and a physician, and the physician (or immediate family member of the physician) receives aggregate compensation from the person or entity in the chain, with which the physician (or immediate family member) has a direct financial relationship, that varies with the volume or value of referrals or other business generated by the physician for the entity furnishing the designated health services, and one of the following criteria is implicated:

  1. The individual unit of compensation received by the physician (or immediate family member) is not fair market value for items or services actually provided;
  2. The individual unit of compensation received by the physician (or immediate family member) is calculated using a formula that includes the physician's referrals to the entity furnishing designated health services as a variable, resulting in an increase or decrease in the physician's (or immediate family member's) compensation that positively correlates with the number or value of the physician's referrals to the entity; or
  3. The individual unit of compensation received by the physician (or immediate family member) is calculated using a formula that includes other business generated by the physician for the entity furnishing designated health services as a variable, resulting in an increase or decrease in the physician's (or immediate family member's) compensation that positively correlates with the physician's generation of other business for the entity.

The new regulation proposed by CMS would modify the definition for an indirect compensation arrangement to require that the unit of compensation received by the physician (or immediate family member) be identified as payment for anything other than services personally performed by the physician (or immediate family member). Furthermore, the proposed rule seeks to expressly identify the units to consider under § 411.354(c)(2)(ii)(A) and to determine whether an indirect compensation arrangement satisfies the requirements of an applicable exception under a new regulation at § 411.354(c)(2)(ii)(B)(2).

Under the proposed regulation, CMS specifies that the specific units will be:

  1. Time, where the compensation paid to the physician (or immediate family member) is based solely on the period of time during which the services are provided;
  2. Service, where the compensation paid to the physician (or immediate family member) is based solely on the service provided; and
  3. Time, where the compensation paid to the physician (or immediate family member) is not based solely on the period of time during which a service is provided or based solely on the service provided.

CMS’s aim in proposing the change is to facilitate compliance with the federal Stark Law as it applies to indirect compensation arrangements. It is also intended to cover arrangements that were not previously included in the rule, such as payments for space, equipment and services performed by a family member, or company the family member has an ownership interest in.

Seventh Circuit Reverses and Remands FDCPA Claim for Lack of Standing

The United States Court of Appeals for the Seventh Circuit recently reversed and remanded a plaintiff’s successful summary judgment motion for violations of the Fair Debt Collection Practices Act (the “FDCPA”). See Wadsworth v. Kross, Lieberman & Stone, Inc., 2021 WL 3877930 (7th Cir. Aug. 31, 2021).  In the case, plaintiff Audrey Wadsworth had been hired by Pharmaceutical Research Associates, Inc. (“PRA”). The job offer included a signing bonus - $3,750 payable after 30 days of employment, followed by another $3,750 payable after 180 days of employment. But, if Wadsworth voluntarily ended her employment or PRA fired her for cause within 18 months of the second payment, she was obligated to repay the full bonus. In her employment agreement, Wadsworth agreed to promptly reimburse PRA for any amounts owed as of the final date of her employment. Wadsworth collected both signing payments, but in September 2017, after completing one year of employment, PRA fired her. PRA quickly hired Kross, Lieberman, & Stone (“Kross”), a debt-collection agency, to recoup the bonus payments. Kross mailed Wadsworth a collection letter shortly after her employment ended, and in the coming weeks, a Kross employee called Wadsworth by telephone four times. Wadsworth then sued Kross, claiming that its letter and phone calls violated the FDCPA because Kross failed to provide complete written notice of her statutory rights within five days of the initial communication, and because the Kross employee who called her never identified herself as a debt collector or stated that she was attempting to collect a debt. Both parties moved for summary judgment. Kross did not contest Wadsworth’s allegations about its conduct but argued instead that the FDCPA is inapplicable for two reasons: the signing bonus was not a “debt” within the meaning of the FDCPA and the firm was not acting as a “debt collector” under the FDCPA because Wadsworth’s debt was not in default at the time of the letter and phone call. The District Court rejected both arguments and entered summary judgment for Wadsworth. Kross timely appealed.

The Court granted Kross’s appeal, reversing the District Court’s decision and remanding for further proceedings. Instead of analyzing the meanings of “debt” and “debt collector” that the parties and lower court had focused on, the Court based its reversal on the fact that Wadsworth had not suffered a concrete injury traceable to Kross’s alleged FDCPA violations. The Court cited the U.S. Supreme Court’s decision in Spokeo that, to establish standing to sue in federal court, the plaintiff must have “suffered an injury in fact” among other requirements, and that injury is “real and not abstract.” See Spokeo, Inc. v. Robins, 136 S. Ct. 1540, 1547-48 (2016). The Court cited Seventh Circuit precedent applying Spokeo to FDCPA cases, saying that when a debt collector fails to inform a debtor of his statutory rights, the debtor has suffered a concrete injury “only if it impairs the [debtor’s] ‘ability to use [that information] for a substantive purpose that the statute envisioned.’” See Bazile v. Fin. Sys. of Green Bay, Inc., 983 F.3d 274, 280 (7th Cir. 2020) (quoting Robertson v. Allied Sols., LLC, 902 F.3d 690, 694 (7th Cir. 2018)). The Court held that Wadsworth’s injuries, which were not monetary in nature and instead consisted of “personal humiliation, embarrassment, mental anguish, and emotional distress,” were “quintessential abstract harms that are beyond our power to remedy.”

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Desiree McDonald at dmcdonald@riker.com, or Kevin Hakansson at khakansson@riker.com.

New York Court Grants Summary Judgment in Action to Void a Restrictive Covenant

The Supreme Court of New York, Suffolk County, recently granted a property owner’s motion for summary judgment and held that a purported restrictive covenant on the property was void.  See U & Me Homes, LLC v. Cty. of Suffolk, 148 N.Y.S.3d 682 (N.Y. Sup. Ct. July 16, 2021). In the case, the plaintiff purchased an undeveloped parcel of land that was split-zoned by the defendant Town of Southampton (the “Town”), with a portion permitting 2-acre residential development and a larger portion permitting 5-acre residential development. The deed and title search report, however, did not contain any reference to any development restrictions. The plaintiff immediately proceeded to obtain a Health Department permit and an engineering permit from the defendant County of Suffolk (the “County”) to build a one-family home on the property. Shortly thereafter, a neighbor complained to the Town that there was a developmental restriction on the property, which the Town sought to confirm with the County. Both the Town and the County agreed that the proposed home could not be built because the parcel contained a blazed section of a public trail. However, the County had issued a quitclaim deed in 2010 to a predecessor in title that did not include any restrictive language. Moreover, a bargain and sale deed dated March 21, 2000 did not include any restrictions, despite the County Director of Planning’s recommendation. The plaintiff brought this action alleging that the covenant failed to run with the land and bind grantees, successors or assigns, and that such a restriction is offensive to public policy. The parties cross-moved for summary judgment.

The Court granted the plaintiff’s motion and denied the Town and County’s motion. First, the Court found that there was no proof that the original grantor and grantee intended the covenant to run with the land, noting that “[w]hen the purpose and effect of a covenant is to substantially alter the legal rights which otherwise would flow from the ownership of land and which are connected with the land, such requires a clear showing that the original grantee and grantor intended the covenant to run with the land.” The Court also found that the faulty drafting of the March 21, 2000 deed by the County called into question whether a restrictive covenant was even created, and that the County offered no statutory authority to support its ability to enter into such a restriction. Moreover, the Court found that, even conceding that the County wanted to restrict the development of the property, as the drafter of the deed, it could have easily drafted a deed binding successors to the use restrictions, noting that “[t]his is not a case of exalting technical form over substance, but of a complete failure of substance, on the part of the County.” Lastly, the Court found that the County and the Town both overstepped their bounds and reversed the role of government in response to issues that implicate the Bill of Rights and the Constitution, noting that “[t]he combined actions of these two governmental bodies have deprived the plaintiff of a bedrock constitutional right and have brought about a per se taking of an important ‘stick’ in the ‘bundle of sticks,’ the power to exclude people from one’s real property.” Here, the County failed to adequately protect the initial deed and as such, that deed restriction did not run with the land. Thus, the Court determined that the plaintiff was free to pursue its long-delayed residential permit application.

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Desiree McDonald at dmcdonald@riker.com, or Kevin Hakansson at khakansson@riker.com.

CMS Clarifies Subsidiaries and Group Practices Under Stark Law

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Connor Breza.

Centers for Medicare and Medicaid Services (“CMS”) issued an Advisory Opinion clarifying the ability for wholly-owned subsidiary physician practices to meet the Group Practice requirement of the In-Office Ancillary Services Exception under the federal Stark Law. The Stark Law is a federal law that prohibits individuals from making referrals for certain designated health services ("DHS") payable by federal healthcare programs to entities in which they, or an immediate family member, possess a financial interest unless a statutory exception is met, such as the Group Practice exception. In the case being addressed by the Advisory Opinion, a physician practice that overall met the definition of a Group Practice sought to acquire two separate subsidiaries that would not independently meet the Group Practice definition and thus sought clarification as to whether the collective entities could meet the “single legal entity” requirement of the Group Practice definition under 42 C.F.R. § 411.352(a).

Specifically, CMS found that under the circumstances encompassing the Advisory Opinion, a physician group practice together with its wholly-owned subsidiaries could meet the definition of a “single legal entity” so long as the main entity remained a sole owner of the subsidiaries, and it primarily provided services of the type provided by a supplier that is enrolled in Medicare as a clinic/group practice and billed to Medicare in accordance with the claims processing instructions for physician services in the Medicare Claims Processing Manual.  For example, all clinical employees should be employed by or contracted with the physician group, and the revenue and expenses from the subsidiary should be treated as group practice revenue and expenses.

This Advisory Opinion sheds further light on the boundaries of the Group Practice definition and provides greater clarity as to how subsidiary relationships with medical practices can be structured to comply with the federal Stark Law and the Group Practice requirement.

New York Federal Court Holds Insured Not Entitled to Coverage Under Title Policy When Statute of Limitations for Potential Challenge to Title Had Run

The United States District Court for the Southern District of New York recently granted the defendant title insurance companies’ motion for summary judgment and found that the insured was not entitled to coverage when the action giving rise to the alleged title defect occurred in 1982 and the statute of limitations for a challenge to title had run.  See Morris Builders, L.P. et al. v. Fidelity National Title Insurance Company, et al., 2021 WL 4066725 (S.D.N.Y. Sept. 7, 2021).  The case involved the conveyance of parklands from the City of Yonkers to certain development agencies.  In 1985, the City of Yonkers, the insured, and three other parties entered into an agreement whereby Westchester Industrial Development Agency (the “Owner”) acquired certain parcels of land from the City, which the Owner simultaneously agreed to lease to the insured.  In 1989, the insured obtained title insurance policies covering the Owner’s interest in the property.  In 2011, upon learning that the Owner was planning to convey a neighboring lot, the insured began investigating the chain of title to the parkland properties.  As a result, the insured determined that a prior, 1982 transfer of the property was “unlawful under the public trust doctrine because it was not approved by an act of the State Legislature.”  The insured then wrote letters to the defendant title insurance companies claiming that there was a title defect and sought coverage under the policies.  Although the defendants agreed “to take curative measures pursuant to Condition 3(c)” of the policies, they included a reservation of rights in their letter to the insured.  Defendants also retained counsel to represent the insured, but the insured objected based on an alleged conflict.  In 2014, the insured brought an action against the other parties to the 1985 agreement and eventually reached a settlement whereby it obtained clear title to the property at issue, with the law firm retained by defendants involved “for the limited purpose of resolving the Defect.”  The insured then brought this action claiming defendants were required to indemnify it for certain additional losses incurred in litigating the 2014 action, as well as other damages arising from the alleged defect.  The parties cross-moved for summary judgment after conducting discovery.

The Court granted defendants’ motions and denied the insured’s.  Despite the extensive history, the Court found that the question of coverage under the policy hinged on the simple question whether there was a title defect as of the time the insured discovered the alleged defect or the time it filed the prior action in 2014.  The Court found that because the claim arose from an allegedly improper 1982 transfer of the property, any challenge would be subject to a six-year statute of limitations.  Accordingly, the Court found that the insured was not entitled to coverage under the policies.  “At the time [the insured] purported to discover the Defect in 2011, the applicable statute of limitations had long since barred any claim challenging [the owner’s] title to the Park Lots and, by extension, [the insured’s] leasehold.”

For a copy of the decision, please contact Michael O’Donnell at modonnell@riker.com, Desiree McDonald at dmcdonald@riker.com, or Kevin Hakansson at khakansson@riker.com.

Hospitals Lose Outlier Payment and S-10 Audit Litigations

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, or Connor Breza.

Appellate Division Dismisses Outlier Payment Case

Lee Memorial Hospital v. Becerra, No. 20-5085 (DC Cir. 2021)

In this case, eight years ago, a number of acute-care hospitals sued the Department of Health and Human Services (“HHS”), challenging the amount of so-called Medicare “outlier” payments they had received from the HHS for the years 2008-2011. Generally speaking, outlier payments are intended to protect healthcare facilities from unexpected losses by providing Medicare reimbursements in instances of rare and costly treatments.

At the commencement of the litigation, the hospitals first argued to the United States District Court for the District of Columbia (“District Court”) that the District Court had jurisdiction to consider their suit and urged the court to render a decision on the merits of the case. Accepting the hospitals’ jurisdictional argument, the District Court subsequently ruled against the hospitals on the merits. In an abrupt change of course, several of the hospitals then appealed that ruling, arguing for the first time that the District Court lacked jurisdiction to entertain their lawsuit after all.

On appeal, the U.S. Court of Appeals, D.C. Circuit declined to accept the hospitals’ about-face. Instead, the Appellate Division ruled that for the hospitals to prevail in showing that the now-final judgment against them was void because the District Court ostensibly lacked jurisdiction to enter it, they would need to show that there was not even an arguable basis for that District Court’s conclusion—at the urging of the hospitals themselves—that jurisdiction existed over their challenge. The hospitals failed to make that showing.

The full appellate opinion can be found here.

Appellate Division Rejects S-10 Audit Litigation

Ascension Borgess Hosp. v. Becerra, No. 20-139 (DC Cir. 2021)

In this case, 48 hospitals eligible to receive uncompensated care payments under 42 U.S.C. § 1395ww(r) sued HHS, claiming Worksheet S-10 audits conducted in 2015 unlawfully reduced or otherwise altered the amounts of payment made by Centers for Medicare and Medicaid Services. The hospitals first appealed those reimbursement decisions to the Provider Reimbursement Review Board (“PRRB”), arguing that HHS’s use of unpublished audit protocols to establish uncompensated care payments violated the notice-and-comment rulemaking requirements of the Administrative Procedure Act. The PRRB determined that administrative review of the uncompensated care payments was barred by 42 U.S.C. § 1395ww(r)'s preclusion provision and, consequently, concluded that it did not have jurisdiction over the issues in the appeals. The hospitals then appealed the PRRB’s final decisions to the U.S. Court of Appeals, D.C. Circuit, challenging the PRRB’s dismissal of their reimbursement appeals for lack of jurisdiction.

The parties filed cross-motions for summary judgment. Ultimately, the D.C. Circuit granted HHS’s motion for summary judgment, while denying the plaintiffs’, holding that the applicable preclusion provision of 42 U.S.C. § 1395ww(r)(3) bars administrative and judicial review of HHS’s decision to use audited worksheet data in calculating the amount of uncompensated care payments to which the hospitals were entitled.

The full appellate opinion can be found here.

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