The crush and complexity of Medicare regulation make it increasingly difficult for providers and the government to understand and comply with applicable law. And so the Tenth Circuit recently mused “[w]hat happens if we reach the point where even these legislating agencies don’t know what their own ‘law’ is?”
The Caring Hearts Personal Home Service Inc. v. Burwell decision reminds us of the mind-numbing complexity of the Medicare program and importance of independent judicial review beyond the administrative agency appeal process, which increasingly has that "rubber stamp" feel. Observing early on its opinion that there are “about 37,000 separate guidance documents” on the Centers for Medicare & Medicaid Services website, “and even that doesn’t purport to be a complete inventory,”[2] the Caring Hearts decision also serves as an important reminder that health care providers, even when trying in earnest to comply with complex and frequently changing rules, face a daunting task.