Oklahoma Court Invalidates HHS Regulation for Calculating Hospice Provider Cap

On June 7, 2010, the U.S. District Court for the Western District of Oklahoma held that a Department of Health and Human Services (HHS) regulation, 42 C.F.R. § 418.309(b), implementing a statutory cap on Medicare payments for hospice care was invalid and must be set aside (Compassionate Care Hospice v. Sebelius, No. CIV-09-28-C (W.D. Okla. June 7, 2010).

The court found that the regulation conflicted with the congressional directive for calculating the annual provider cap and thus, enjoined HHS from enforcing overpayment determinations against plaintiff, Compassionate Care Hospice, calculated by using the invalid regulation, from further applying the regulation to calculate plaintiff’s payment cap, and remanded to the Provider Reimbursement Review Board for a determination of plaintiff’s overpayment liability, if any, as calculated under the statutory terms as opposed to the regulation.

For more information on hospice regulations, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510, visit the Hospice Providers specialty page, or the HLP website.