Abbott-Northwestern Hospital, Inc. v. Richard S. Schweiker, Secretary of Health and Human ServicesAbbott-Northwestern Hospital, Inc. v. Richard S. Schweiker, Secretary of Health and Human Services
This appeal concerns the treatment, in the course of a retroactive adjustment, of interest earned on over-payments of social security taxes by providers of health services under the Medicare Act. The Secretary of Health and Human Services required that any interest received by the providers and attributable to Medicare payments be offset against the interest expense claimed by the providers under the Act. On appeal the district court concluded that such an offset was a violation of the Secretary’s own regulations concerning Medicare reimbursements. We reverse for the reasons stated below.
1.
A. The Refund
The facts giving rise to the interest award and the current dispute may be summarized as follows. Each of the plaintiff hospitals was formed by consolidating two or more constituent hospital corporations in 1969 or 1970. These predecessor hospitals had all waived their exemption from coverage under the Federal Insurance Contribution Act (FICA) as non-profit charitable institutions. Accordingly, they made FICA tax payments on wages paid.
See
*338 The intermediary’s payments would typically be the last act in a routine Medicare reimbursement — except for an end-of-the-year cost adjustment — but a complication arose. The Internal Revenue Service informed the providers in 1972 or 1973 that they had not automatically acceded to their predecessors’ FICA tax status and that their post-consolidation Social Security payments were therefore subject to refund with interest. 3 The providers retroactively waived this exemption, but under IRS regulations each employee was extended the option of adopting Social Security coverage for this period or receiving a refund of the taxes withheld on their behalf. A number of employees exercised the latter option. For each employee requesting a refund the hospital was reimbursed with interest the employer’s share of the previously paid tax. 4
B. Administrative Proceedings
In the course of its annual review of the provider’s costs in 1976 and 1977 the Secretary’s fiscal intermediary examined the status of these reimbursements.
5
In its Notice of Program Reimbursement to each of the plaintiffs the intermediary determined that (1) the portion of refunded FICA taxes previously reimbursed to the providers by the Medicare program must be offset against the providers’ reimbursable costs in the year the refund was received and (2) the interest earned on the Medicare portion of the refund constitutes “investment income” which must be offset against the providers’ reimbursable interest expense.
The providers challenged the intermediary’s determination before the Provider Reimbursement Review Board (PRRB).
See
The PRRB affirmed this second ruling while acknowledging that the intermediary was mistaken in characterizing the FICA interest as “investment income” subject to offset under
The Secretary of Health and Human Services declined to modify or reverse the PRRB’s ruling within 60 days; it therefore constitutes the agency’s final decision.
C. Judicial Proceedings
The providers sought review of the PRRB’s decision in federal district court.
See
The Magistrate concluded that the Board’s affirmance of the interest offset was contrary to Medicare regulations. Specifically the Magistrate pointed to
The district court adopted the recommendations of the Magistrate. The court stated that the accepted rules of statutory construction require that
II.
An administrative agency’s interpretation of its own regulation merits considerable respect by a reviewing court, and will be controlling absent a showing “that it is plainly erroneous or inconsistent with the regulation.”
Cheshire Hosp. v. N.H.-VT. Hosp. Service,
The district court acknowledged the substantial deference due the Board’s conclusion that its enabling statute and regulations warranted the interest income offset, but held the Board’s determination to be inconsistent with the language and policy of Medicare regulations. The disposition of this appeal turns on the same issue: is the reduction of the providers’ interest expense by the interest income earned on the FICA refund inconsistent with the terms or the underlying policy of the Medicare regulations.
The Secretary asserts that the regulations are simply silent as to the treatment of interest refunded in circumstances not a part of the ordinary course of business; and that, in such a case, the PRRB properly relied upon the basic principle that a Medicare provider should be reimbursed only its reasonable costs.
A.
The principal section relied on by the plaintiffs to establish a regulatory limit on the Board’s power to offset the refunded interest is
§ 405.419 Interest expense.
(a) Principle. Necessary and proper interest on both current and capital indebtedness is an allowable cost....
(b) Definitions
(2) Necessary. Necessary requires that the interest:
(i) Be incurred on a loan made to satisfy a financial need of the provider. Loans which result in excess funds or investments would not be considered necessary.
(ii) Be incurred on a loan made for purpose reasonably related to patient care.
(iii) Be reduced by investment income except where such income is from gifts and grants, whether restricted or unrestricted, and which are held separate and not commingled with other funds. Income from funded depreciation or provider’s qualified pension fund is not used to reduce interest expense. Interest received as a result of judicial review by a Federal court (as described in§ 405 .-454(1)) is not used to reduce interest expense.
(Emphasis in original.)
*341
Even ignoring the substantial deference due the Secretary’s own interpretation of its regulation, we are uncomfortable with the providers’ construction of
Nor is the language of this express offset any more restrictive when viewed in the context of the section as a whole.
The providers’ invocation of the Latin maxim
expressio unius est exclusio alterius
is equally unhelpful. The reliability of this maxim as a tool for statutory interpretation is open to question.
See
R. Dickerson,
supra,
at 234 (“it is simply not true, generally, that the mere express conferral of a right or privilege in one kind of situation implies the denial of the equivalent right or privilege in other kinds”). Whatever its general value, its specific application “is premised on the assumption that the legislature considered and rejected all factors not listed.”
Tri-State Terminals, Inc. v. Jesse,
The plaintiffs’ application of the rules of statutory construction to
B.
While we are satisfied that no Medicare regulation expressly prohibits the FICA interest offset, our inquiry is not at an end. There remains a question as to whether the Secretary’s treatment of the FICA interest is consistent with the policies inherent in its enabling statute and promulgated regulations.
There is no question that an agency is authorized to carry out its statutory duty through the adjudication of an individual dispute even in the absence of specific regulations.
Matter of Keokuk Steel Castings,
Nevertheless, PRRB’s
ad hoc
resolution of the current dispute was bound by the underlying policies of its governing statute and its own regulations.
Doraiswamy
v.
Secretary of Labor,
The reasonable cost of any services shall be the cost actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services, and shall be détermined in accordance with regulations establishing the method or methods to be used, and the items be included, in determining such costs....
This statute constrains the Secretary to reimburse a provider for only those costs actually incurred in providing services. The Secretary argues that since the interest refunded along with the FICA taxes was earned on monies originally paid by the Medicare program, it must be applied to reduce the costs of providing services to Medicare patients.
Absent any conflicting statutory or regulatory purposes, the Secretary’s conclusion does not strike us as arbitrary, capricious or in excess of statutory jurisdiction.
See Medical Center of Independence
v.
Harris,
(1)
Independent of the question of whether
*343 The plaintiffs assert in their brief that the interest income offset was promulgated for the single purpose of discouraging the diversion of Medicare funds to income producing activities unrelated to patient care. Since neither party asserts that such a diversion occurred here, they would argue that the purpose of the regulation would not be furthered by allowing any additional offsets.
This argument was recently rejected by the First Circuit.
Cheshire Hosp. v. N.H.-VT. Hosp. Service,
(2)
Under the Medicare Act, the fiscal intermediary advances a provider funds periodically to cover its estimated expenses. The intermediary makes retroactive adjustments of these payments at the end of a provider’s fiscal year to reflect actual costs.
See United States v. Gravette Manor Homes,
*344 Whatever merit this policy may have had, it has no obvious application to this dispute. This was not a case where the Secretary charged a provider for the theoretical time value of the money received on an overpayment; this dispute is over interest actually received on monies paid by the Medicare program. The interest was earned because the use of the money was enjoyed by someone else, not the provider. This is also not a case where the error in over-payment was resolved in the few months before the next annual fiscal review, or that was likely to be partially offset by an under-payment of some other expense over the same period; the FICA refund was a one time error that took nearly three years to be discovered. While we concede that the agency’s policy of ignoring the time value of money on short term under- or over-payments might have had some practical accounting advantage, we do not find the Secretary’s departure from the practice in the case of a one time wind-fall to be arbitrary or capricious.
III.
The plaintiffs finally contend that we should hesitate to sustain the agency’s retroactive determination of offset because a contractual relationship exists between the Secretary and a provider. We disagree. We have already concluded that the Secretary’s determination — to offset the FICA interest against the provider’s interest expense — was a reasonable result given the regulatory silence on the issue. The determination’s retroactive effect strikes us as no more unsettling than a court’s interpretation of an ambiguous clause in a contract. 13
The FICA interest offset merely recoups to the Secretary income earned on Medicare payments and insures that the providers receive reimbursement for no more than their reasonable costs. By contrast the plaintiffs here seek to benefit by a gap in the Secretary’s regulatory scheme. The FICA refund and its accompanying interest was an unforeseen result of their own mistaken over-payment; the plaintiffs can hardly claim that they relied upon any right to retain this wind-fall. In fact, the plaintiffs concede that they never doubted their obligation to offset the refunded principal against their reimbursable costs.
Under these circumstances, the judgment of the district court, invalidating the offset of interest income earned on the FICA tax refund against the providers’ interest expense, is reversed and the case remanded for the entry of judgment affirming the Secretary.
REVERSED AND REMANDED.
Notes
. The Health Insurance for the Aged Act,
. Medicare providers are commonly reimbursed for their services by private organizations acting as fiscal intermediaries pursuant to
*338
contract with the Secretary.
. In 1976 the Internal Revenue Code was amended to -provide that any exempt organization paying Social Security taxes for three calendar quarters is deemed to have waived its exemption.
. Three appellee hospitals (Metropolitan Medical Center, Inc., Abbott-Northwestern Hospitals, Inc., and Immanuel-St. Joseph’s Hospital of Mankato, Inc.) also received interest on Social Security payments made on behalf of employees who decided not to elect the refund option, though the principal was retained by the IRS. The parties appear to have agreed throughout this litigation that the interest earned on refunded or retained principal is indistinguishable for purposes of their treatment under the Secretary’s regulations, and is so treated on this appeal.
. At the end of the providers’ fiscal year a “cost report” is filed with the intermediary.
. The Board actually issued a separate decision for each of the hospitals. Any dissimilarity in the decisions has no bearing on this appeal; they are therefore referred to as though one opinion for ease in writing.
. The providers never disputed that the refund itself must be offset against Medicare reimbursements, but before the PRRB they did argue that the offset should be against costs in the year the original expense was incurred. In calculating the portion of the FICA tax refund attributable to Medicare use, the intermediary had multiplied the refund by the percentage of Medicare utilization in the year received. The PRRB sought a compromise between the two approaches by adjusting the refund by the Medicare utilization rate in the year the tax was paid; this adjustment limited the offset against present costs to an amount approximating that actually paid by Medicare. The providers do not challenge the PRRB’s treatment of the underlying refund in this appeal.
. At issue before the district court was that portion of interest earned on the FICA refund attributable to Medicare utilization actually offset against the plaintiff hospitals’ reimbursable interest expense — approximately $146,127.00. The proper treatment of this sum remains the only issue in this appeal.
. The providers’ brief makes allusions to a number of other canons of statutory construction we find unpersuasive in our context. First, they assert that the doctrine of
ejusdem generis
requires that an agency follow a specific statutory provision over a more general one. Although this maxim (literally meaning of the same kind, class, or nature) is applied to a phrase in which a catch-all item might be understood by reference to preceding, more specific terms,
see
R. Dickerson,
supra,
at 109 n. 18, 234, W. Hurst,
Statutes In Court
182 (1970), the principle that a specific provision prevails over a general provision is not without some basis.
See, e.g., F.T.C. v. Manager, Retail Credit Co., Miami Br. Off.,
. This is not to say that logic dictates the FICA interest refund be offset against the providers’ current interest expense. On the contrary, it is not clear to us why the Secretary, in the face of regulatory silence on the issue, did not simply offset the FICA interest against the providers’ total reimbursable costs in the year received as was done with the underlying principal; unless the analogy to investment income and the inertia of the fiscal intermediary’s original determination that it was investment income seemed to compel that method of offset. Since either offset strikes us as consistent with statutory and regulatory policy, however, we defer to the Secretary’s judgment.
. Congress prospectively altered this custom in § 117 of the Tax Equity and Fiscal Responsibility Act of 1982,
. While
.
Cf. Adams Nursing Home of Williamstown, Inc. v. Mathews,