Dt. court holds claim for Medicaid refund barred by 11th Am.

Although the district court dismissed the University of Pittsburgh Medical Center’s request for a refund from the state of West Virginia as barred by the Eleventh Amendment, the Medicaid provider’s claim for declaratory and injunctive relief will go forward. The Medical Center alleges that West Virginia is violating the Commerce Clause in its application of a Medicaid payment cap for transplant procedures. The Medical Center alleges that the state does not apply the cap to medical providers physically located in West Virginia, and this unfair application of the cap violates the Commerce Clause of the Constitution. Univ. of Pittsburgh Medical Center v. Walker, 2007 WL 1575060, No. 2:06-0890 (S.D. W.Va. May 30, 2007).

The complaint alleges that there was a dispute between the provider and the state regarding whether the provider was overpaid by several hundred thousand dollars for transplant services.  The Medical Center refunded over $600,000 to the state “under protest.”  A Medicaid Program instruction caps Medicaid payments for transplant procedures at a maximum of $75,000, regardless of other procedures performed in conjunction with the transplant.  The provider alleges that this cap is not enforced with respect to medical providers physically located in West Virginia, in order to shift the cost burden of performing transplants to non-resident healthcare providers.  The complaint alleges that this application of the cap violates the Commerce Clause of the Constitution, Art. 1, Section 8.

 

The court’s sovereign immunity discussion is rather brief.  The court notes that under the exception to Eleventh Amendment immunity under Ex Parte Young, 209 U.S. 123 (1908), only prospective relief is permitted.  Awards of retroactive monetary relief are barred by the Eleventh Amendment.  The court dismissed as insignificant the plaintiff’s payment of the funds “under protest,” since the money was presently in the hands of the state.

 

Additionally, the court dismissed four of the six named public officials, sued in their official capacities.  The court held that four defendants did not have a sufficient link to the challenged conflict.  That leaves as defendants the Secretary of the West Virginia Department of Health and Human Resources and the Commissioner of the West Virginia Department of Health and Human Resources Bureau for Medical Services.