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Don’t Like the Reimbursement Rates? Maybe Litigation Is the Answer!

Jan 3

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The Medicare and Medicaid reimbursement rates are a disgrace to health care providers nationwide. The low reimbursement rates are the reason why so many providers refuse to accept Medicare and/or Medicaid patients. Yet, with the pandemic, it is estimated that 100 million people will be on Medicaid by next year. Having a Medicaid card to wave around is useless if providers refuse to accept it.

Hospitals in Nebraska are not putting up with it – and they should not put up with it! Not only can hospitals NOT turn away any person; thus being forced to accept Medicaid and Medicare … and uninsured patients, but the overhead for a hospital is astronomical.

Saying more than half of the state’s hospitals are operating in the red, the Nebraska Hospital Association is calling for a 9.6% increase to Medicaid reimbursement rates this year, and 7.7% next year, after seeing a 2% bump each of the last two years.

The Hospital Association has never demanded this high of a rate increase. Inflation has significantly impacted the costs for Nebraska hospitals. The association says drug costs are up 35%, labor costs are up 20%, supplies are up 15-20%, and food and utilities are up 10%. Overall, it says inflation is up more than 20% per patient compared to the pre-pandemic level. The cost of labor has spiked, especially during the pandemic when emergency room nurses were in such short supply and such demand. Some hospitals were forced to pay nurses $10k a week! Traveling nurses became a “thing,” which allowed nurses to jump around hospitals for the best pay. In no way, I am not campaigning for lower salaries for nurses. Nurses are essential. However, the reimbursement rates are supposed to reflect society’s needs.

The Nebraska Hospital Association is completely in the right to sue for higher reimbursement rates. I commend them. I beseech more association groups to do the same. The dental, pediatric, primary care, home health, long term care facilities, behavioral health care, and other associations across the country should follow suit.

The legal argument is clear. Under §1902(a)(30)(A) of the Social Security Act, State Medicaid programs must ensure that provider payments are “consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” to provide access to care and services comparable to those generally available. On November 2, 2015, CMS issued a regulation (42 CFR Part 447) under this authority requiring State Medicaid programs to demonstrate that their Medicaid fee-for-service (FFS) non-waiver payment rates ensure sufficient access to care. See blog.

Hospitals lose money on Medicare and Medicaid patients. Considering the legal requirement of reimbursement rates to be consistent with efficiency, economy, and quality of care, I am shocked that MORE associations haven’t litigated this issue. Perhaps the providers within these associations, who pay high yearly memberships, should demand that associations fund this type of litigation.

I have no doubt that the cost of litigation dissuades most associations from making the expensive decision to litigate for better rates. But isn’t litigating for higher reimbursement rates the job of the associations? The cost would be prohibitive for single provider facilities. And, aren’t we always more strong when we band together?

Posted in Access to Care, Associations, Budget, CMS, Federal Government, Federal Law, Health Care Providers and Services, Hospitals, Increase in Medicaid Spending, Knicole Emanuel, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Long Term Care Facilities, Medicaid, Medicaid Attorney, Medicaid Providers, Medicaid Reimbursements, Medicare, Medicare and Medicaid Provider Audits, Medicare Attorney, North Carolina Medicaid Rules, Regulations, Policies, and Statutes, Physicians, Primary Care, Provider Appeals of Adverse Decisions for Medicare and Medicaid

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Introducing: The Gordon & Rees Raleigh Health Care Team

Jul 15

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I am extremely excited to announce that our Gordon & Rees Raleigh health care team just keeps growing!! Remember, this is just the Raleigh health care team…firm wide, we are a health care team of 40-50 attorneys. Now that is a bench as deep as NCSU, UNC, and Duke’s basketball teams put together!

We have:

Me.

Obviously.

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Robin Vinson

Robin was a partner at Smith Anderson for over two decades. In 2011, Robin was named Managing Partner of the Raleigh office of Nexsen Pruet, where the oversaw the growth of that office from 5 to 23 lawyers in less than two years. In January of 2013, Robin joined forces with his life-long friend, Paul C. Creech, Esq., to form a boutique health care law and litigation firm until Paul retired in 2015 due to medical reasons. Robin now joins us with renewed entrepreneurial spirit and vigor to make this Raleigh office of Gordon Rees a very special place to practice law and service clients.

Robin began his practice in health care litigation and morphed into a health care transactional attorney. He has bought and sold more physicians’ practices than Imelda Marco had shoes. He has created affordable care organizations (ACOs), has written physician policy manuals, and dealt with antitrust issues and e-discovery issues, including electronic medical records issues. When it comes to health care law, he is the Christopher Michael Langan without the sub-par childhood.

Personally, I have never had a mentor in the health care industry, and I believe that he can learn me a thing or two.

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Robert Shaw

Robert transitioned to GR with me from Williams Mullen.  He is absolutely brilliant with an analytical mind, which probably stems from his tax law background.  Yes, he can answer tax questions for health care providers as well!

His expertise in numbers makes him exceptionally well-suited to argue against extrapolations, as he actually understands that independent variables are just variables that have become teenagers and want out of the house.

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DeeDee Murphy

DeeDee comes to us from Williams Mullen, as well.  Prior to WM, DeeDee worked as a senior consultant for more than six years at Ascendient Healthcare Advisors. DeeDee is also a smarty pants…she earned a Master of Public Health degree from the UNC School of Public Health as well as a J.D. from the UNC School of Law.  You can’t have too many acronyms, right?  She also has expertise in CON law.

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That is our Raleigh health care team.  Like I said, we have a wealth of knowledge nationwide with our healthcare team, and I would be remiss if I excluded a few of our super stars.

Our team is led by the brilliant Thomas Quinn out of the Denver office.

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We also have a partner who is a registered nurse (RN), Linda Mullany, from the San Diego office.

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And Joe DiCecco from the Houston office

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And Thomas Chairs from the Pittsburg office.

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And Josh Urquhart, also from the Denver office and the co-author of the Colorado Healthcare Law Blog.

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And these are only a few attorneys that comprise our nationwide, talented health care team So, as you can see, I joined a rock star law firm with almost 700 attorneys in 35 offices nationwide.  Gordon & Rees boasts the following statistics:

92% Trial Win Rate
10% Top Verdicts
Law360 California Powerhouse
Go-To Employment Law Firm
#71 Largest U.S. Law Firm
650 lawyers, 40 jurisdictions,
35 U.S. offices in 22 states
Top 10 Fastest-Growing Firm

We also ranked in the top 100 law firms for female attorneys, a ranking that I am especially proud of (sorry for ending a sentence with a preposition, but writing “of which I am especially proud” seemed way too pomp and circumstance).

I will make every effort going forward to NOT write blogs about how awesome my law firm is, but I had to just write one.  So, please forgive me on this unabashed, shameless, self-serving blog.  It will not happen again (I hope).

Look forward to my next blog…Administrative costs of the MCOs and our tax dollars hard at work.

And here is the legal disclaimer:

Legal Disclaimer and Note:   I welcome your feedback, thoughts, questions, and suggestions.  Just a reminder: These materials have been prepared by me for informational purposes only and are not legal advice. Internet followers and online readers should not act upon this information without seeking independent legal counsel.

This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Please note that an attorney-client relationship, and corresponding confidentiality of information, does not arise until Gordon & Rees has received an executed legal service agreement. Do not send us confidential information until you speak with one of our attorneys and get authorization to send that information to us. Gordon & Rees is pleased to receive inquiries from prospective clients regarding its services and its lawyers. However, an inquiry to Gordon & Rees should not disclose information about a particular matter prompting the inquiry.

While I try to update this site on a regular basis, I do not intend any information on this site to be treated or considered as the most current expression of the law on any given point, and certain legal positions expressed on this site, by passage of time or otherwise, may be superseded or incorrect. Readers should not consider the information provided to be an invitation for an attorney-client relationship, and should always seek the advice of independent legal counsel in the reader’s home jurisdiction.

The opinions expressed on this site are the opinions of the user, and do not necessarily reflect the opinions or positions of Gordon & Rees.

Posted in Accountable Care Organizations, Health Care Providers and Services, Lawsuit, Legal Analysis, Legal Remedies for Medicaid Providers, Managed Care, Medicaid, Medicaid Advocate, Medicaid Attorney, Medicare, Medicare Attorney, NC, North Carolina, Tax Dollars

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