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Forsyth Medical Center files appeal against U.S. DHHS

Forsyth Medical Center

Forsyth Medical Center

WINSTON-SALEM, N.C. — Forsyth Medical Center has re-launched its lawsuit against Kathleen Sebelius, the former top health official in the Obama administration, repeating a claim that she failed to enforce regulations covering Medicare payment reimbursements.

The center filed the complaint earlier this month in the U.S. District Court for the District of Columbia. The hospital, along with other Novant Health Inc. affiliates, began their legal pursuit in June 2010. Forsyth is the only plaintiff listed in this complaint.

Sebelius is being sued in her role as secretary of the U.S. Department of Health and Human Services. She resigned from that position in April after four years. DHHS has not filed a response.

The hospital said the legal action is part of appealing a final decision by the Provider Reimbursement Review Board, which is a part of DHHS. The board made its ruling March 13.

Forsyth said it is dissatisfied with the determination “as to the amount of total program reimbursement due” for services provided to Medicare patients.

It is not clear which reimbursement years are covered, but the complaint appears to focus on a reimbursement calculation set in 1997 that was altered by DHHS. Forsyth said the change provides for calculations “that are not the most reliable data available to produce figures that can be considered sufficiently accurate.”

Because of the actions taken by DHHS, “the plaintiff will suffer economic harm because … adjustments will be lower than that to which the plaintiff is entitled under the law.”

The hospital did not specify the reimbursement amount it expects to receive other than saying it exceeds $10,000. Forsyth said it is part of a group appeal. Analysts say the amount Forsyth is pursuing could be several million dollars, depending on the number of years involved.

Forsyth also wants the court to retract a Centers for Medicaid and Medicare Services ruling, known as 1498-R, that was implemented in April 2010. The ruling covers in-patient reimbursement rates, in particularly for hospitals that serve a “disproportionate” base of low-income patients. Those hospitals typically receive a higher reimbursement rate.

It wants DHHS to disclose the “data necessary to compute the number of patient days used in calculating the disproportionate patient percentage” so that a proper calculation of the reimbursement can be done. The hospital said DHHS is not fulfilling data provisions established in rulings in other legal cases involving the calculations.

Leslie Alderman III, an attorney representing Forsyth, said Wednesday it is the policy of Alderman, Devorsetz & Hora PLLC to not comment to the media before the ending of a case.


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