Today I tried to think about the worst things that have ever happened in history. I came up with the Holocaust and the Civil War.  The Civil War because more Americans died in that one war than all other wars in which America has been involved combined (until the Vietnam War).  Roughly 1,264,000 American soldiers have died all America’s wars over history, in aggregate (620,000 in the Civil War and 644,000 in all other conflicts).  It was only as recently as the Vietnam War that the amount of American deaths in foreign wars eclipsed the number who died in the Civil War.  So, maybe my second horrible thing is war, in general.

Regardless, why was I trying to think of the worst things in history?

Because NCTracks has got to be one of the worst things to happen in North Carolina history to Medicaid providers.  Obviously, I am not insinuating that NCTracks is comparable to the Holocaust or wars, in general. But to the Medicaid providers in NC, NCTracks may be as awful as the Holocaust or a war, in general (to those individual providers).

NCTracks’ defectiveness has adversely affected ALL PROVIDERS.  It has hit big providers, such as hospitals.  (WakeMed recently announced a loss of 2.5 million due to NCTracks), and small providers (I receive 2-5 phone calls daily from small providers who have not received either (a) payment; or (b) correct payment). 

A while ago I wrote the blog “Why There is Not a Lawsuit Against NCTracks” (paraphrasing my own title).  Well, as humans sometimes do, I am recanting my prior opinion as to one factor.  I wrote in my prior blog that if providers sued NCTracks, then NCTracks paid the providers, that the lawsuit would no longer have merit…as in, if NCTracks actually paid providers that providers would have no damages (because damages is a criterion for a lawsuit).

I am officially recanting that statement.

People sue manufacturers every day in products liability for defective design.

What are examples of a defective design?

• A defective nail gun that shot through a wall, paralyzing a man in another room;
• A lock-up of a poorly designed braking system that led to the death of a mother and her four children;
• Machines at work — such as saws, presses, packaging machines, come-along chain hoists and other tools — with defective safety features that have blinded or caused hand or arm amputations to users;
• Retractable dog leashes that led to finger amputations;

These examples are courtesy of a law firm in Boston.

My example?

A computer system implemented to provide payments to Medicaid providers, but upon implementation, actually causes Medicaid providers to not receive Medicaid reimbursements…  Obviously, the very reason NCTracks for which NCTracks was created is defeated.

It would be like me hiring a painter to paint my house.  But, instead of painting my house, the painter eggs it.

Issues I have heard of regarding NCTracks:

1.  NCTracks fails to correctly reimburse Medicare/Medicaid crossover claims;

2.  NCTracks fails to correctly reimburse office visits, assuming that the Medicaid recipients are giving a $5 co-pay, not a $3 co-pay;

3.  NCTracks fails to reimburse for immunizations and a well-child visit;

4.  NCTracks fails to reimburse for injections and an adult office visit;

5.  NCTracks incorrectly determines that a provider’s license has expired and does not reimburse;

6.  NCTracks fails to comprehend its own taxonomy codes;

7.  NCTracks fails to recognize secondary claims;

8.  NCTracks incorrectly suspends provider numbers;

9.  NCTracks incorrectly denies claims with multiple NSTs during the same inpatient encounter;

10.  NCTracks fails to reimburse for ambulance services.

Design defect?  Probably.  Holocaust? Probably not (although I am sure it feels like it to all individual providers).  War? Probably not (although I am sure it feels like it is to all individual providers).

Regardless, the damages are not just the non-payment of Medicaid reimbursements.  Now it may be damages for a design defect…

Now THAT may be a tort!!!