Lexology May 23, 2024
In a recent decision, the D.C. District Court determined that a Medicare contractor erroneously computed the nursing and allied health pass-through reimbursement in violation of the regulation at 42 C.F.R 413.85(d)(2)(i). The regulation requires that the net cost of approved educational activities be determined by deducting the revenues that a provider receives from tuition and student fees from the provider’s total allowable educational costs that are directly related to approved educational activities. This decision, which was not appealed by the Centers for Medicare & Medicaid Services (“CMS”), is the latest in which the federal courts have reined in CMS for a reimbursement decision in conflict with its own regulations.
The hospitals challenged CMS Transmittal 12, issued on November 17, 2017,...
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