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EASTERN MAINE MEDICAL )

CENTER,  )  
)  
Plaintiff,  )  
)  
v.  )  Civil No. 05-7-B-H  
)  

HEALTH AND HUMAN SERVICES, )
SECRETARY, )
)
Defendant. )

RECOMMENDED DECISION ON CROSS-MOTION S FOR JUDGMENT ON THE ADMINISTRATIVE RECORD
Plaintiff Eastern Maine Medical Center (EMMC) cares for patients having End Stage Renal Disease (ESRD) by providing them with, primarily, dialysis treatments that are reimbursed through the Medicare program administered by the Department of Health and Human Services.  In August 2000, EMMC submitted a "Composite Rate Payment Exception Request" in which it sought to be compensated for dialysis treatments at a rate substantially above the "composite " national (or default) rate that Medicare pays health care providers for each dialysis treatment they provide. The Department denied the request over successive administrative appeals, asserting that the request was not supported by adequate documentation. EMMC contends in this action that the administrative denial of its request was arbitrary and capricious.  EMMC also claims that the Provider Re imbursement Review Board (PRRB), which conducted a hearing on the request, violated EMMC's due process rights by denying EMMC's request that the PRRB issue subpoenas requiring that the individuals who performed the first and second stage administrative review of the request appear at the hearing to give testimony and produce their the administrative record. I conclude that the existing record does not reflect an administrative determination that was arbitrary and capricious and that the "due process" theory advanced by EMMC does not require a remand.
BACKGROUND
"Pursuant to Title XVIII of the Social Security Act, 42 U.S.C.

Download MJK_10272005_1-05cv7_EMMC_v_HHS_AFFIRMED_12052005.pdf

Maine Law