Dist. Ct. erred in affirming defendant’s decision, which denied plaintiff’s request for Medicare reimbursement for costs associated with financing construction of new medical facilities, where basis of denial was fact that it was unclear whether instant $15.7 million loan was used to refinance original $15.3 loan that did not qualify for said reimbursement. Dist. Ct.'s decision was based on decision made by defendant’s Acting Principal Deputy Administrator, and Administrator failed to cite any rule that forbids refinancing to replace disqualified loan with proper one. As such, Administrator’s decision must be rejected under Chenery Corp., 318 US 80, for failure to provide sufficient reason to support instant denial. Also, Administrator failed to identify what documentation Administrator deemed to be missing in plaintiff’s application for reimbursement, so as to support finding that new loan did not replace original loan. On remand to agency, defendant may ask plaintiff for better documentation and explore any significance regarding difference in principal amounts between original and new loans.
Federal 7th Circuit Court
Civil Court
Medicare