University Medical Center v. SullivanUniversity Medical Center v. Sullivan
OPINION
This is an appeal by the Secretary of Health and Human Services from a ruling of the bankruptcy court in which the bankruptcy judge found that the Secretary violated the automatic stay provision of the bankruptcy code by acting post-petition to recover pre-petition overpayment made under the Medicare program to the University Medical Center. The Secretary also appeals the bankruptcy court’s award of attorneys fees and prejudgment interest. For the following reasons, I shall affirm the decision of the bankruptcy court as to the violation and reverse as to fees and interest.
BACKGROUND
The University Medical Center, (“UMC”), is a general care hospital that filed a voluntary petition in bankruptcy under Chapter 11 of the United States Code on January 1, 1988 and ceased to do business on March 31, 1988. While in business, UMC provided services to Medicare beneficiaries under an agreement with the United States Department of Health and Human Services, (“HHS”). This “Provider Agreement”, executed in 1966 between the Broad Street Hospital and the Secretary of Health, Education and Welfare — the predecessors in interest to UMC and HHS respectively — is similar to provider agreements entered into by hospitals and health care facilities across the country. The authority of the HHS to enter into agreements with health care providers is granted in 42 U.S.C. § 1395cc. By signing the Provider Agreement, Broad Street Hospital/UMC agreed to charge Medicare beneficiaries only as allowed by statute and to comply with civil rights laws in providing services, in exchange for eligibility to receive payment under Title XVIII of the Social Security Act for services provided to Medicare patients.
HHS reimburses Medicare providers through a fiscal intermediary on a periodic basis. The statute provides that payments be made at least once a month and otherwise at the discretion of HHS. 42 U.S.C. § 1395g(a). The usual method is for the intermediary to make periodic interim payments to providers upon application of the provider at the discharge of each Medicare patient. Payments made are estimates of actual expenditures. The intermediary conducts an annual audit of the actual expenditures of each provider to determine whether the provider has been overpaid or underpaid across the year. HHS is authorized to adjust current payments to account for the prior overpayment or underpayment. 42 U.S.C. § 1395g(a).
On January 8, 1988, one week after UMC’s bankruptcy filing, Blue Cross of Greater Philadelphia (“Blue Cross”), UMC’s fiscal intermediary, informed UMC by letter that UMC had been overpaid by $276,042.00 for Medicare services provided in 1985. The letter stated that Blue Cross would begin 100% withholding of interim payments that became due unless UMC made repayment or agreed to a long-term repayment schedule. UMC did not respond. On February 8, 1988, Blue Cross sent a second letter, again stating that 100% withholding of interim payments would begin unless other arrangements for return of the overpayment were made. On February 18, Blue Cross withheld a $58,000 payment.
In response to the withholding, officials of UMC met with a Blue Cross representative and orally agreed to provide Blue Cross with documentation demonstrating UMC’s need. for an extended repayment schedule, and, in the interim, to repay the 1985 overpayment at a rate of $15,000 per month over a period of 18 months. UMC officials apparently consented to this arrangement to keep Medicare revenues flowing, which the hospital needed to meet its payroll obligations. On March 4, 1988, UMC issued a $15,000 check to Blue Cross, after which Blue Cross released the $58,-000 it had withheld. However, UMC then failed to provide Blue Cross with the documentation of need, and on March 28, 1988, Blue Cross announced that it would resume 100% withholding.
PRIOR PROCEEDINGS
UMC brought an adversary proceeding against HHS in bankruptcy court on June 17, 1988, alleging that HHS’s actions, in demanding payment for previous overpayment, and in withholding current payments to recover the amounts overpaid, violated the automatic stay provision of the bankruptcy code, 11 U.S.C. § 362. Defendant answered by claiming the affirmative defense of contractual recoupment, as well as by filing a separate motion for relief from the automatic stay.
The bankruptcy judge resolved this dispute by finding that HHS’s demand for return of overpayment in exchange for continued Medicare payments violated the anti-discrimination provision of the bankruptcy statute, 11 U.S.C. § 525(a).
1
In doing so, the bankruptcy judge relied heavily on his opinion in an unrelated case,
In re St. Mary Hospital,
On December 7, 1988, the bankruptcy court followed
St. Mary Hospital
and ruled in the case at bar that HHS's withholding of Medicare payments from UMC violated the automatic stay provision.
In re University Medical Center,
On appeal to this court, Judge Ditter vacated the bankruptcy judge’s order in St. Mary Hospital, disposing of the action by approving a settlement agreement between the parties and without reaching the merits of the case. I now reach the merits of the withholding controversy in the confines of the UMC appeal, and I find that HHS’s withholding there was improper.
DISCUSSION
The district court has jurisdiction to hear appeals from final decisions of the bankruptcy court under 28 U.S.C.A. § 158(a). On review, the court accepts the factual findings of the bankruptcy court unless the findings are clearly erroneous.
In re Jersey City Medical Center,
With these standards of review in mind, I turn to the precise question presented: did
Resolution of this issue depends upon how one characterizes legally the right of HHS to recover overpayment under the Provider Agreement. UMC argues that the overpayment created a discrete, distinct debt, which HHS acted unlawfully to recover by withholding funds owed to UMC under a separate obligation. HHS counters that obligations to repay overpayment and to reimburse are not distinct, and that it did not withhold the funds in order to offset a debt, but rather to determine under the contract the amount that was due to UMC. Before deciding which characterization is accurate, it is necessary to address why a characterization of the debt is critical.
I. Decision of Bankruptcy Court
The bankruptcy court avoided the issue of characterization by determining HHS’s withholding to be unlawful under § 525(a).
See
The bankruptcy court relied on an analogy between Medicare recoupment cases and cases where government units were found to be in violation of § 525(a) for denying debtors the right to bid on government contracts and for evicting debtors from public housing units.
See e.g. In re Son-Shine Grading, Inc.,
This analogy is probably overdrawn. It may be true in the government-contract and public-housing cases that the government did not treat the bankrupt debtors differently from debtors who had not filed in bankruptcy, but were in similar financial trouble. Yet the government did treat the bankruptcy debtors differently from contractors and tenants who were not in bankruptcy and not eligible to file. It is this type of dissimilar treatment that § 525(a) was designed to prohibit, and this type of dissimilar treatment that appears to be missing in the case at bar. Medicare provider agreements give HHS the authority to adjust interim payments to account for previous overpayment in all cases, whether or not the provider is in bankruptcy or insolvent. It is, no doubt, an interesting coincidence that HHS happened to have waited until after UMC filed for bankruptcy in 1988 before attempting to exercise its right to recover a debt that arose in 1985. But there are no allegations or findings in the record that the present withholding was motivated by discrimination. Such a finding would appear to be necessary to make out a § 525(a) violation in this case. Nevertheless, I need not remand for fact-finding on this issue, as I find the withholding to be unlawful on other grounds.
A. Automatic Stay and Recoupment Exception
The automatic stay provision of the bankruptcy code becomes effective upon a debtor’s filing of a bankruptcy petition. 11 U.S.C. § 362(a). The stay prohibits creditors from taking any actions, judicial or extra-judicial, outside of the bankruptcy proceeding to recover amounts owed by the debtor. 11 U.S.C. § 362(a). This purpose of the stay is to give the debtor breathing room and allow for the equitable and organized hearing of all creditors.
See Penn Terra Ltd. v. Department of Environmental Resources,
The stay applies to actions by creditors to set off post-petition obligations against pre-petition claims. Although the code allows the set-off of mutual debts where both arose pre-petition, 11 U.S.C. § 553(a), it does not allow set-off where the creditor’s debt to the debtor arises after the debtor filed for bankruptcy.
Lee v. Schweiker,
However, HHS does seek the protection of a common law exception; it argues that the reason why the stay is inapplicable in this case is that the withholding is not a setoff, but rather is based on a contractual right to recoupment. The Third Circuit has recognized the existence of an equitable recoupment doctrine distinct from the setoff doctrine provided by § 553(a) of the bankruptcy code.
See Lee,
UMC argues that this court should not recognize an exception to the automatic stay that is not provided in the statute. In
Lee,
the Third Circuit explained the origin of recoupment, noted that the doctrine was “adopted in bankruptcy ... by decision”,
However, even if I were to accept the argument that
Lee
leaves this court free to reject recoupment, I cannot accept the claim that this position is the better-reasoned view. UMC argues that the re-coupment exception provides certain creditors with a self-help remedy that is inconsistent with the general purposes of the automatic stay in providing temporary relief to the debtor and equal treatment of creditors.
See
Appellees Brief at 18-23 (citing
Penn Terra Ltd. v. Department of Environmental Resources,
B. Contractual v. Statutory Recoupment
In the bankruptcy court proceedings, the judge refused to hold that HHS was in fact pursuing a contractual right to recoupment.
University Medical Center,
If HHS’s right to recoupment were based on the statute and not the Provider Agreement, the automatic stay would prevent withholding under the Third Circuit’s holding in
Lee,
The present case is distinguishable. Although HHS’s authority to reimburse Medicare providers and to recover overpayment is granted by statute, 29 U.S.C. § 1395g(a), UMC qualifies as a Medicare provider not by the statute but by the Provider Agreement. The statutory payment provisions are incorporated into the Provider Agreement through the clause that promises payment in accord with the provisions of the Social Security Act. The relationship between UMC and HHS is thus properly regarded as contractual. Having determined that HHS has a contractual right to withholding, and that the law recognizes a re-coupment exception to the automatic stay, I must still determine whether the contractual right to withholding was applicable in the post-petition context, and whether the recoupment exception was properly asserted on these facts.
C. Impact of Provider Agreement
UMC argues that the Secretary’s withholding is subject to the stay even if the Provider Agreement allows for recoupment, because this agreement was not assumed by UMC under 11 U.S.C. § 365, and thus does not govern the post-petition relationship between the parties. Section 365 of the bankruptcy code gives a trustee in bankruptcy the power to assume or reject any executory contract to which the debtor is a party. 11 U.S.C. § 365. An executory contract is “a contract ‘on which performance remains due to some extent on both sides.’ ”
See N.L.R.B. v. Bildisco & Bildisco,
If UMC had assumed its Provider Agreement, the automatic stay would not be applicable to withholding undertaken
UMC continued as a provider after filing in bankruptcy and negotiated with HHS for a long-term repayment schedule to settle the overpayment debt. Both actions are consistent with an intent to assume the Provider Agreement. Yet UMC never took formal steps to assume this contract, and HHS never filed a motion to force UMC to do so. Section 365 provides that the power to accept or reject exec-utory contracts is “subject to court approval”. 11 U.S.C. § 365(a). Although some courts have suggested that parties can assume a Medicare provider agreement through their actions without court approval,
see In re Advanced Professional Home Health Care, Inc.,
The significance of this nonas-sumption, however, is subject to debate. UMC argues that absent assumption of the Provider Agreement, HHS cannot effect a recoupment without violating the stay. At least one court has so held.
See Memorial Hospital,
I respectfully disagree. To hold that a contract must be assumed before a creditor can affect a right to recoupment would substantially negate the purpose of the re-coupment doctrine. The right to recoupment is not dependent on the reservation of such in a contract clause.
See Inre B & L Oil Co.,
Since the Supreme Court’s ruling in
Bildisco,
it has been clear that debtors in bankruptcy are not bound to all the obligations of executory contracts before these contracts are assumed. The Court in
Bildisco
specifically held that an employer who filed under chapter 11 was not re
The recoupment context is factually different from that addressed in
Bildisco.
In
Bildisco
a debtor was held to be liable for the reasonable value of services that it continued to accept under a contract it had not assumed.
The majority of courts to address the issue of recoupment in the Medicare context have held that recoupment applies regardless of whether the provider has assumed the provider agreement.
See Advanced Professional,
To the extent that these cases hold that the recoupment exception to the automatic stay applies in the period between bankruptcy filing and assumption of an executory contract, I concur. However, to the extent that they hold that withholding of interim payments under Medicare provider agreements falls within common law recoupment, I must dissent. None of these cases acknowledge a distinction between common law recoupment and the contractual right to recover overpayment under Medicare provider agreements, and thus do not specifically address whether common law recoupment should apply. Upon an examination of the nature of the overpayment debt under Medicare provider agreements, I find that the recoupment doctrine is inapplicable in the Medicare context.
E. Characterization of Claim
The defining feature of a recoupment, as explained above, is that the creditor’s claim is essentially a defense to the debtor’s claim. More than mutuality of obligation is required. That a debtor owes money to a creditor on a pre-petition obligation is not a defense to the debtor moving against the creditor on a post-petition claim.
Lee,
Two prototypical cases are
In re Midwest Service and Supply Co., Inc.,
Waldschmidt
involved a royalties agreement between a recording company and a recording artist. The recording company made advance payments under the agreement before the release of the artist’s album and before the artist’s bankruptcy filing. After the musician filed in bankruptcy, the recording company withheld royalties from actual record sales to recoup the amount of the advancements. The court allowed this withholding, finding that the advancement and the claim for royalties arose out of the same transaction.
The present case is distinguishable. Here the pre-petition overpayments were made with respect to transactions separate from those on which the debtor sought post-petition payment. It would be a distortion of the record to conclude that overpayment for Medicare services performed in 1985 are a defense to a claim for reimbursement for unrelated services provided in 1988. HHS does not contend as much. HHS does assert, however, that the focus should not be on the separate transactions, but on the contract as a whole, and the fact that all transactions were made under the one Provider Agreement. The Third Circuit in
Lee
recognized that the recoupment doctrine in bankruptcy has been applied primarily where the offsetting claims of creditor and debtor “arise out of the same contract”,
In support of its position, HHS offers the Tenth Circuit’s opinion in
B & L Oil.
I decline to follow B & L Oil, for two reasons. First, the court’s holding stretches the doctrine of recoupment beyond its equitable foundation. The court allowed recoupment despite finding that the creditor’s claim to its overpayment was “not ‘essentially a defense’ ” to the debt- or’s claim to be paid on post-petition deliveries. If a creditor’s claim is not a defense but rather a separate debt, the rationale for allowing recoupment does not exist.
Second, the
B & L Oil
court’s reasoning for stretching the recoupment doctrine is unpersuasive. The court simply states that other cases have allowed recoupment in similar situations, citing
Waldschmidt,
Further, even if
B & L Oil
were controlling, it is distinguishable. The Tenth Circuit explained that
B & L Oil
was not a case where the creditor "consciously made a loan, extended credit, or
made payment required by a contract,
as did’ the bankrupt’s ordinary creditors,” but rather the creditor made the overpayment by “mistake”.
The Provider Agreement is a unique type of contract. It does not provide for a defined transaction or even a series of transactions. It simply establishes a relationship between the parties: if UMC treats eligible patients, HHS will reimburse them for their costs. Under the agreement, the parties established an arrangement for payment, with HHS providing reimbursement with respect to each patient treated. The arrangement called for the payments to be estimates and thus contemplated that over time an overpayment or underpayment might result, creating a debt in one or the other party. The arrangement called for this debt to be calculated on an annual basis. The result is that the overpayment debt presently owed by UMC is distinct from and bears no direct relation to the particular claims for reimbursement for services performed post-petition. The Provider Agreement authorizes the adjustment of interim payments to account for an overpayment debt, yet the Provider Agreement was not assumed. Absent an assumption of the contract’s terms, HHS is left to rely on common law recoupment, which simply does not apply in this case. It must be remembered that the question is not whether a debt is owed, but whether HHS should be given preferred status with respect to that debt. I hold that they should not, and thus will affirm the bankruptcy court’s order requiring HHS to release the amount of reimbursement owed UMC for services provided post-petition.
III. Post-Petition Agreement
HHS contends that it is entitled to retain the $15,000 received from UMC under their post-petition agreement. Given UMC’s failure to provide necessary documentation and HHS’s later abandonment of the repayment contract, HHS does not argue that the parties reached a binding long-term repayment agreement. Yet HHS does argue that the release of the $58,000 in exchange for the $15,000 payment, binds the parties to this particular transaction. HHS relies on the provision of the bankruptcy code that allows debtors to continue business operations after bankruptcy filing. See 11 U.S.C. § 363(c). This section states that when the debtor is otherwise authorized under the code to continue in operation, the trustee may “enter into transactions ... in the ordinary course of business, without notice or hearing”. Id.
Section 363(c) cannot support HHS’s claim. Since UMC could not agree to a long-term repayment agreement without in effect assuming the Provider Agreement, it would appear that court approval of the agreement was necessary under the specific terms of § 365(a), despite the general language in § 363(c) to the contrary. Further, even assuming § 363(c) controlled, the agreement between the parties cannot be upheld in the face of this court’s conclusion, above, that HHS had no authority to withhold interim payments. Since HHS could not lawfully withhold the $58,000, UMC received no consideration for its $15,-000 payment. The bankruptcy court thus properly held that the $15,000 must be returned.
Section 362(h) of the bankruptcy code provides that an “individual injured by any willful violation” of the automatic stay “shall recover actual damages, including costs and attorneys' fees, and, in appropriate circumstances, may receive punitive damages”. 11 U.S.C. § 362(h). The bankruptcy court awarded attorneys’ fees to UMC, yet only for the period between the decision in
St. Mary Hospital
and judgment in this case. The court reasoned that before
St. Mary Hospital,
there was authority in this district and other jurisdictions to support the legality of withholding, yet after
St. Mary Hospital,
HHS “should have gracefully accepted that Opinion as setting forth the applicable law”.
University Medical Center,
HHS argues that any awards under § 362(h) are inappropriate because that section only authorizes damage awards to individuals, while UMC is a partnership.
See
2 Collier on Bankruptcy § 362.12 at 362-79. Most courts have rejected this narrow reading and have held that § 362(h) allows damage awards against corporations and other business entities.
See e.g. Budget Service Co. v. Better Homes of Virginia, Inc.,
In order for the damage awards to be upheld under § 362(h), HHS’s violation of the stay must have been willful. UMC relies on a series of bankruptcy court opinions holding that a party willfully violates the stay under § 362(h) whenever the party (1) has knowledge of the bankruptcy filing and (2) intentionally performs an act found to be in violation of the stay.
See In re Littke,
HHS in turn relies on an opinion by the Third Circuit holding that a party cannot be found in contempt for violating the automatic stay where the law regarding the application of the stay is ambiguous.
See I.R.S. v. Norton,
Norton
was decided before the enactment of § 362(h),
see
Bankruptcy Amendments and Federal Judgeship Act of 1984, Pub.L. No. 98-353, when civil contempt was the typical remedy sought by parties damaged by violation of the automatic stay.
See Wagner,
UMC would have this court go an additional step and hold that § 362(h) imposes a lesser state of mind requirement than that imposed in civil contempt proceedings.
See McLaughlin,
In the present case, the bankruptcy court recognized that the law regarding HHS’s right to withhold interim Medicare payments was not settled at the time of the initial withholding. Indeed, other courts had upheld the right to recoupment under Medicare provider agreements,
see Yonkers,
The bankruptcy court’s award of prejudgment interest must be overturned on the same ground. While the bankruptcy court did not tie the interest award to
Notes
. That provision reads, in pertinent part, that:
... a governmental unit may not deny, revoke, suspend, or refuse to renew a license, permit, charter, franchise, or other similar grant to, condition such a grant to, discriminate with respect to such a grant against, deny employment to, terminate the employment of, or discriminate with respect to employment against, a person that is or has been a debtor under this title or a bankrupt or a debtor under the Bankruptcy Act ... solely because such bankrupt of debtor is or has been a debt- or under this title or a bankrupt or debtor under the Bankruptcy Act ...
11 U.S.C. § 525(a) (emphasis added).