Success in District Court on a Graduate Medical Education Issue
|May 19, 2021 |
GME Solutions would like to congratulate our hospital clients and counsels, Powers Pyles Sutter & Verville and Baker Donelson, on the recent favorable ruling by the U.S. District Court for the District of Columbia. The court agreed that a Medicare regulation is inconsistent with the law and under reimburses hospitals that train Graduate Medical Education (GME) fellows.
The Medicare statute sets a cap on the number of GME residents for which a hospital can be reimbursed. The term “cap” implies a consistent, static limit. Unfortunately the Direct GME cap does not adhere to that concept. Hospitals that train GME residents and fellows above the cap and train fellows, or residents outside their initial residency period are being penalized by the regulation, as the regulation is preventing the hospital from reaching the 1996 cap when they train fellows or residents outside their initial residency period.
The D.C. District Court agreed that the application of the cap is invalid because it is reducing the weighting factors for the residents and, subsequently, under reimbursing the hospital for training its residents and fellows.
The decision is Milton S. Hershey Medical Center v. Becerra, 1:19-cv-2680-TJK, and is available here.
If you have not contested this issue at your hospital, please contact us to discuss how you can preserve your rights to appeal.