Shalala
Anaheim Memorial Hospital v. Shalala
Opinion
Lead Opinion
Tashima, J.
In French Hosp. Med. Ctr. v. Shalala, 89 F.3d 1411 (9th Cir.1996) (“French Hospital ”), we held that the reopening of a Medicare cost report entitles the provider to appeal only the “issue” on which the report had been reopened. On these consolidated appeals, we face the question which logically follows: How broad is the “issue” that was reopened?
I. BACKGROUND
A. The Statutoiy and Regulatory Framework
The Medicare statute, Title XVIII of the Social Security Act, Pub.L. No. 89-97, 79 Stat. 291 (1965) (codified as amended at 42 U.S.C. § 1395 to 1395eec (1991 & Supp. 1997)), creates a federally funded health insurance program for the elderly and disabled. The statute provides that the Secretary of Health and Human Services (the “Secretary”) will reimburse health care providers for services provided to Medicare patients. A hospital may participate in the Medicare program as a provider by entering into a provider agreement with the Secretary. 42 U.S.C. § 1395h; 42 C.F.R. § 421.103 (1996).
Reimbursement to a provider is normally handled by a “fiscal intermediary.” 42 U.S.C. § 1395h(a). A provider seeking reimbursement submits an annual cost report to the fiscal intermediary, 42…