Moody Nursing Home, Inc. v. United States

We are presented in this case with the question of how much reimbursement, if any, plaintiff, a skilled nursing facility, is due for physician fees incurred in operating a required utilization review program. For the reasons stated below, we affirm the decision of the Blue Cross Association Provider Appeals Committee and hold the apportionment of utilization review costs between Medicare and private patients proper.

Plaintiff, Moody Nursing Home, Inc., is a qualified skilled nursing facility under the Medicare program. 42 U.'S.C. § 1395x(j) (1976). In order to qualify as a skilled nursing home *583…