Medicare Funds Require Clinic to Serve Inmates

     (CN) - A Florida hospital that cares for federal detainees as a condition of its voluntary Medicare participation cannot challenge its reimbursement rate, the 11th Circuit ruled.
     The U.S. Constitution requires the federal government to provide medical care for inmates in federal prison. Congress decided to impose the Medicare rate as full compensation to medical providers for services provided to federal prisoners.
     Ed Fraser Memorial Hospital, a small rural hospital in Baker County, Fla., challenged this determination, claiming that it is unconstitutionally forced to give emergency medical care to federal prisoners at the Medicare rate, an amount less than its actual costs.
     In affirming dismissal of the challenge Thursday, however, the 11th Circuit noted that "a long line of cases instructs that no taking occurs where a person or entity voluntarily participates in a regulated program or activity."
     As a voluntary participant in the Medicare program, a hospital cannot receive federal funds without opting into the Emergency Medical Treatment & Labor Act, requiring it to provide emergency medical care regardless of a patient's ability to pay, and obliging it to treat federal detainees, according to the ruling.
     By volunteering to treat Medicare beneficiaries, the hospital is precluded from challenging the rate at which it is reimbursed for treating federal prisoners, the Atlanta, Ga.-based federal appeals court found.
     "We recognize the financial difficulties and perceived inequity that may come with shortfalls in a rural hospital's reimbursement for costs associated with providing emergency treatment to federal detainees, but conclude that the Takings Clause of the Fifth Amendment is not the proper vehicle for altering this harsh reality," Judge Adalberto Jordan wrote for a three-member panel.
     The hospital notified the court that if it withdrew from Medicare, Baker County Medicare participants would be left without emergency care.
     "This grim prospect provides a sympathetic backdrop for the Hospital's takings challenge and, if it came to pass, would result in hardship to Medicare participants in Baker County," the 15-page opinion concludes. "Yet it does not diminish the underlying voluntariness of the Hospital's participation in Medicare."