Federal courts continue to invalidate hospice reimbursement caps ...

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Jury hands down $3.3 million verdict against CO nursing home in negligence case
Jury hands down $3.3 million verdict against CO nursing home in negligence case
A federal court has ruled against a Medicare regulation that caps reimbursements to hospice care providers. The decision in Oklahoma is the latest in a string of rulings invalidating the hospice caps.

The plaintiff in the case, Infinity Care of Tulsa, had received $5.2 million in payments from the Centers for Medicare & Medicaid Services for care provided during 2007. CMS, however, claimed that Infinity had been overpaid under the reimbursement cap regulation and tried to recoup roughly $2 million from the organization. On Feb. 28, the U.S. District Court for the Northern District of Oklahoma declared invalid the Medicare regulation, which limits the amount a hospice provider can be reimbursed per patient per year.

Several other U.S. District Courts have ruled against the Medicare hospice reimbursement cap recently, including courts in Texas and New Mexico. The U.S. District Court for the Northern District of Texas went so far as to call the hospice cap “arbitrary, capricious, an abuse of discretion, and unlawful.” (McKnight's, 3/4/10) In its own ruling, the Oklahoma court noted that, “every court that has considered the issue has held that [the regulation] is invalid.”