MEMO: Elgin Nursing and Rehabilitation Center v. U.S. Department of Health and Human Services
August 1st, 2014 — Based both on communications to the AOPA offices and some recent traffic on the O&P List Serv, there seems to be a great deal of interest, at least by some AOPA members, in a May, 2013 Appeals Court decision, in the Fifth Circuit, Elgin Nursing and Rehabilitation Center v. U.S. Department of Health and Human Services.
The case is valuable in that it explores the deference which Courts usually provide to CMS to interpret its own rules. Recognizing that most Court decisions are limited to their own facts and are not automatically accorded value as precedent for any other cases, particularly outside the Circuit where the case is heard, AOPA requested a review and summary of the Elgin case from Winston & Strawn, the law firm that is handling AOPA’s lawsuit against CMS about audits and ALJ matters. A copy of that memo can be viewed below and unfortunately, concludes that realistically if there is any precedential value of the Elgin case to RACs, pre-payment audits and the like, it is indirect and limited.
The Winston & Strawn legal summary is concise and is in pretty straightforward language; you can access it via this link to the AOPA website:
https://www.aopanet.org/wp-content/uploads/2014/08/AOPA-Memo-Elgin-v.-HHS.pdf