(United States First Circuit) – In a dispute between the Secretary of Health and Human Services and eight Maine hospitals, involving the ‘often surreal’ Medicare reimbursement regime and the system through which the federal government reimburses hospitals for charity care, so-called disproportionate share payments (DSH payments), 42 U.S.C. section 1395ww(d)(5)(F)(i)(I), the district court’s judgment is: 1) reversed in part as to the cost reports for which the Board and the district court found that the notices provided to specific plaintiffs were inadequate and as to the cost reports for providers and years covered by written settlement agreements entered into by individual providers and the intermediary; and 2) affirmed in part as to judgment to the Board for all other plaintiffs and cost years.