Happy New Year, everyone!!! Hope your New Year’s celebrations were safe and surrounded by friends and family! According to a journalist, the new year did not ring in the Medicaid reimbursements owed by NCTracks. (Obviously I cannot comment on NCTracks’ current status due to the lawsuit we filed on behalf of all physicians in NC).
Here is the following article by Mike Voorheis…
A year after a Wilmington doctor filed a lawsuit, the state still owes his practice more than $100,000 in unpaid or underpaid Medicaid and Medicare services, he says.
Dr. S. Albert Abrons, a family physician, is the first of seven plaintiffs listed in Abrons vs. N.C. Department of Health and Human Services, a class-action suit, (filed by Williams Mullen), that seeks unspecified damages from the state and three other defendants responsible for the development and implementation of NC Tracks, the software that disburses Medicare and Medicaid payments to health care providers.
Problems with the software began immediately in January 2013 and continued for about 14 months, Abrons said. During that time, Abrons and his staff treated thousands of Medicaid patients. Instead of being reimbursed at the higher Medicare rate for primary care services – a provision of the Affordable Care Act – Abrons was reimbursed at the lower Medicaid rate.
That amounted to about $20 per visit, his office manager said, eventually leading to a six-figure deficit.
Abrons said that meant he had to take out loans and couldn’t give raises to his employees when he wanted to.
“The state still owes me and every provider, I presume, enhanced payments for 2013,” Abrons said.
Abrons fought the state to correct numerous errors beyond the reimbursement rates, he said. The harder he pushed, the less receptive DHHS became.
“There was a complete lack of courtesy,” Abrons said. “Those people have no humanity.”
N.C. Rep. Susi Hamilton, D-New Hanover, was also very critical of DHHS’ response.
“The problem clearly starts at the top,” Hamilton said, referring to DHHS Secretary Aldona Wos.
“There is an unwillingness to admit that there are problems. We’ve left several messages and were unable to get a response.”
The state filed a motion to dismiss the lawsuit in July and did not wish to comment further, spokesman Kevin Howell said.
Some organizations have had success in receiving their backlogged reimbursements. Wilmington Health CEO Jeff James said the state does not have extraordinary unpaid bills with his organization.
Elderhaus PACE’s Rick Richards said the state owes the Wilmington organization about $350,000. A plan is in place, he said, to have the debt cleared in the next 90 days.
The lawsuit argues that more than 70,000 providers in North Carolina may have had a claim against the state.
“It’s systemic,” Hamilton said. “It’s not about one physician’s profit margin or bottom line. The more we delay payment for services, the more reluctant the private sector is to provide services to Medicaid or Medicare patients. That’s not acceptable.”
Hamilton said that after 14 months of frustration that she’s grown more optimistic over the past 10 days, since speaker-elect Tim Moore has added his voice to the cause.
But even if Abrons recoups the money that is owed him, Hamilton said, his practice has still been a victim of the state’s mismanagement. Every paper that is resubmitted and every phone call that is made to the state costs money. And that doesn’t include the time and money invested in the lawsuit.
“Time is money,” Hamilton said. “They have experienced a tremendous loss even if they are reimbursed at 100 percent.”
Jason DeBruyn of the Triangle Business Journal wrote:
Computer Sciences Corporation, the company that designed, developed and is operating the Medicaid claims payment system in North Carolina, is facing a health care fraud lawsuit brought by the U.S. attorney’s office in New York.
That lawsuit has no immediate impact in North Carolina, though Computer Sciences Corp. (CSC) built the system in this state – called NCTracks – using 32 percent of the code used in New York City. Initially, CSC had hoped to duplicate as much as 73 percent of the New York City code in North Carolina.
NCTracks has been the target of several attacks from health care providers who say they have not been paid on time. The N.C. Department of Health and Human Services, where NCTracks is housed, faces a lawsuit that could incorporate 70,000 health care providers and end up with damages exceeding $100 million. NCTracks has been the target of at least three searing audits.
The New York lawsuit, brought by Preet Bharara, the U.S. Attorney for the Southern District of New York, alleges billing fraud schemes that used computer programs to automatically alter billing data, including the use of a defaulting program to systematically falsify diagnosis codes submitted to Medicaid.
“As alleged, CSC and the City created computer programs that systematically, and fraudulently, altered billing data in order to get paid by Medicaid as quickly as possible and as much as possible,” Bharara said through a statement. “Billing frauds like those alleged undermine the integrity of public healthcare programs like Medicaid.”
Although this lawsuit makes no mention of activity in North Carolina, Knicole Emanuel, an attorney with Williams Mullen in Raleigh who represents providers in the lawsuit against DHHS, says it “will almost certainly cause the federal government to peer a bit closer at all CSC’s billing software systems in other states (including North Carolina).”
Representatives from DHHS did not immediately comment on the New York lawsuit.
Remember the NCTracks lawsuit? NCTracks Derailed: Class Action Lawsuit Filed!! Computer Sciences Corporation (CSC) is one of the Defendants in that action here in NC.
Well, Monday CSC was hit with another enormous lawsuit. This one is filed in New York, and the Plaintiff is the U.S. Federal Government.
The feds are accusing CSC of a multi-million dollar Medicaid fraud scheme through its Medicaid billing software CSC implemented in NY.
Here is the press release.
From the complaint: “[T]hese fraud schemes were far from isolated events; instead, they were part and parcel of a general practice at CSC and the City to blatantly disregard their obligations to comply with Medicaid billing requirements.” (Compl. par. 8.)
The feds are seeking treble damages, which permits a court to triple the amount of the actual/compensatory damages to be awarded to a prevailing plaintiff.
According to the lawsuit, CSC has received millions of taxpayer dollars (budgeted for Medicaid) unlawfully and in direct violation of federal billing requirements.
If I were a taxpayer in NY, I would be incensed!!!! If I were a Medicaid recipient of parent of a child receiving Medicaid services, I would be furious!!
Now, take a step back…who is administering our Medicaid billing system here in NC?
This will almost certainly cause the federal government to peer a bit closer at all CSC’s billing software systems in other states…
Have you ever bought a used car only to find out it is a lemon? Or a house only to find it is a money pit? Well, I suspect that sinking feeling is much like how Secretary Aldona Wos feels after inheriting the NC Medicaid system.
There is no question that Secretary Wos inherited a lemon…or, even more apropos,…a Medicaid money pit.
Remember, in the January 2013 Medicaid Audit conducted by State Auditor Beth Wood, the audit found Medicaid to be a total of almost $1.2 billion over budget during the past three fiscal years. (FYI: The Fiscal Year begins July 1 and ends June 30. Hence, the need for a new budget now that this Fiscal Year is fast-ending.) The January Audit concluded that (not this year) but the last 3 years, Medicaid was over budget by a total of almost $1.2 billion. The past 3 Fiscal Years were, obviously, before Secretary Wos’ stent as NC Director of the Department of Health and Human Services (DHHS).
Secretary Wos did not only inherit a “money pit” Medicaid system as it pertains to the budget. Think about how expensive NCTracks is turning out to be. But NCTracks was not Secretary Wos’ “baby.” The past administration implemented the new NCTracks system, which is still not “live.” Originally NCTracks was set to go live August 2011 at a cost of $265 million. When the contract was put out for bid in 2008 (for the second time), Computer Sciences Company (CSC) hired former legislator and DHHS Deputy Secretary Lanier Cansler as its lobbyist. Shortly after CSC landed the contract, Perdue named Cansler as her DHHS secretary. (Hmmmm).
NCTracks now brags the hefty price tag of $484 million and is scheduled to go live July 1, 2013. The project is now the most expensive contract in state history.
A new audit released Wednesday says DHHS failed to fully test NCTracks. According to the N&O, “[o]f 834 “Critical Priority Test Cases” set to be performed on the new system, it failed 123. The audit says 285 of the “critical” tests, more than one quarter, were never performed.”
Now many people are criticizing Secretary Wos for the price tag of NCTracks. But prior to pointing fingers, remember from where NCTracks came. And the $1.2 over budget for the last 3 years.
Now this blog is NOT a “let’s all get to together and applaud the new Secretary; we all think she is the bee’s knees; all our Medicaid questions have been answered.”
I am merely pointing out that inheriting a money pit must be a burden. After only five months or so on the job, Secretary Wos has received much criticism; yet many critiques are aimed at “inherited bads.”
Believe me, the current MCO situation (which, although new and may or may not have been Sect. Wos’ doing…although I tend to think not since PBH has been our pilot for years prior) is as catastrophic for the behavioral health providers as a warm day is to Frosty the Snowman.
But at a recent, town-hall-style meeting in Durham, I asked my tugging question. My tugging question for so long has been, “How is the Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA) supervising the Managed Care Organizations (MCOs)?” Well, I asked the question. (Important legal disclaimer…I did NOT ask this question as an attorney. I asked this question as a quasi-journalist for this blog at a public forum. I was NOT representing any party, only my mere legal curiosity).
Sect. Wos’ answer? “Call me.” (These quotes may not be exact…but very close).
“If you have specific questions for specific providers, call me and I will see what I can do.”
Wow! Really? Someone who will actually listen? Well, I got the phone number of her assistant. A Ricky Diaz.
The next day I realized sadly that IF I DID contact Sect. Wos for a specific provider, that as an attorney, if I spoke to Sect. Wos about a specific provider, that I could be accused of ex parte communications with a represented party. And they would be right. So I was stuck between a rock and a hard place. (We’d all be fine if not for these dag on laws…)
So, here we are, a real possibility that going straight to the top could help my clients, but this legal, ethical dilemma overpowers. So I contacted the AG’s office and asked for a telephone conference with Emery Milliken, the general counsel of DHHS, any AG that would like to be involved, Sect. Wos and me. I also contacted Ricky Diaz and asked to schedule a telephone conference with Sect. Wos, me, and whatever counsel Sect. Wos wants.
That was over a week ago.
The lack of supervision over the MCOs has put many good providers out of business, has neglected to provide many Medicaid recipients of their medically necessary needs, has forced so many good providers to fire staff and not provide Medicaid services (due to the MCOs denying services of Medicaid recipients and refusing/terminating Medicaid contracts with good behavioral health care providers).
Call me naive, but I actually think if I spoke to Sect. Wos, she would care and try her best to remedy the catastrophic situation for behavioral health providers. Maybe not. But one can dream.