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Limiting Successor Liability Under Assigned Medicare Provider Agreements

BY William P. Smith, James W. Kapp, III
July 02, 2015

Recent years have seen an uptick in distressed health-care mergers and acquisitions as providers and systems struggle to adjust to a changing economic climate. Significant changes have taken place in health care service delivery as a result of the enactment of the Patient Protection & Affordable Care Act (“Obamacare”) in 2010. Expenditures have increased due to the cost to implement reforms, including capital investments in information technology systems and new patient care and integration models. At the same time, revenues have decreased due to the availability of fewer government funds and the government's efforts to reduce Medicare-related costs. As a result, more and more health care providers have turned to reorganization and consolidation as a means of remaining viable. This article aims to inform readers of the risks associated with accepting assignment of a distressed health care provider's Medicare provider agreement, as well as providing suggestions for managing those risks.

Medicare Provider Agreements and the Prospective Payment System

One source of a health care provider's value is its Medicare provider agreement. This agreement between a health care provider and the Secretary of the United States Department of Health and Human Services enables the provider to receive payment from the federal government for services provided to Medicare beneficiaries pursuant to Title XVIII of the Social Security Act, also known as the “Medicare Statute.” Pursuant to the Medicare provider agreement, the health care provider agrees to provide services and comply with the Medicare Statute, and the government agrees to reimburse the provider for Medicare-eligible expenses. In connection with entry into the Medicare provider agreement, each health care provider is issued a provider billing number under which it may submit claims for reimbursement of covered goods and services.

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