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From Health Law Daily, May 18, 2015

Participating hospitals limited to Medicare rate for ER treatment of federal prisoners

By Harold M. Bishop, J.D.

The U.S. Supreme Court has refused to hear a case by a hospital challenging the Medicare rate as full compensation for emergency medical services rendered to federal prisoners. Baker County Medical Services, d/b/a Ed Fraser Memorial Hospital (Baker), a small, rural hospital in Baker County, Florida challenged the compensation limit as an unconstitutional taking under the Fifth Amendment, even though it voluntarily participates in the Medicare program.

Facts. Besides voluntarily choosing to participate in the Medicare program, Baker also entered into a contract with a local federal detention facility to provide off-site emergency care to its prisoners. While these prisoners did not qualify as Medicare participants, the hospital nevertheless provided emergency services in keeping with its obligation to provide emergency medical treatment to all patients irrespective of their ability to pay under the Emergency Medical Treatment and Active Labor Act (EMTALA).

Rulings below. The district court dismissed Baker’s claim and the Eleventh Circuit affirmed because: (1) the federal government has a constitutional obligation to provide medical care to incarcerated individuals; and (2) 18 U.S.C. section 4006(b)(1) imposes the Medicare rate as full compensation for medical services rendered to federal detainees (see Voluntary participation in detainee care locks up hospital’s takings claim, August 15, 2014). Baker petitioned the U.S. Supreme Court for rehearing but the Supreme Court denied the petition.

In determining whether limiting Baker’s compensation to the Medicare payment resulted in an unconstitutional taking by the government, the Eleventh Circuit noted that “a long line of cases instructs that no taking occurs where a person or entity voluntarily participates in a regulated program or activity.” The Eleventh Circuit also acknowledged the financial difficulties that may exist due to Medicare reimbursements that fail to cover the hospital costs, but that a remedy must be sought within Congress, rather than the courts.

Petition for certiorari. In its petition to the U.S. Supreme Court, Baker asked the Court to consider the social and economic factors involved in its participation in the Medicare program, not just the mere fact of its participation. Baker questioned whether participation in Medicare is truly voluntary when Congress can take advantage of Medicare’s EMTALA mandate to create a separate statutory scheme that unilaterally limits the reimbursement amount CMS will pay for emergency services rendered to incarcerated individuals who are not Medicare eligible.

Companies: Baker County Medical Services, Inc.; Ed Fraser Memorial Hospital; U.S. Attorney General; Director of Office of Detention and Removal, U.S. Immigration and Customs Enforcement; U.S. Marshals Service, Prisoner & Operations Division, Programs and Assistance Branch

MainStory: TopStory SupremeCourtNews ReimbursementNews CoPNews CoverageNews CMSNews EMTALANews PartANews PaymentNews ProviderNews

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