8 Maine hospitals sue Sebelius over payments for low-income patients

Tools

Eight Maine hospitals have joined forces in a lawsuit against U.S. Department of Health & Human Services Secretary Kathleen Sebelius over a long-simmering dispute over payment calculations for dual eligibility patients, the Bangor Daily News reported.

The lawsuit, filed Friday in U.S. District Court in Portland, claims Sebelius arbitrarily and improperly ruled against them in a dispute over millions of dollars in payments to care for the elderly, poor and disabled.

The eight hospitals include:

  • Maine Medical Center, a 637-bed facility in Portland;
  • Central Maine Medical Center, a 250-bed tertiary care hospital and Level II trauma center in Lewiston;
  • Mid Coast Hospital in Brunswick;
  • Eastern Maine Medical Center, a 411-bed facility in Bangor;
  • Mercy Hospital, a Catholic, nonprofit system in Portland;
  • Northern Maine Medical Center, which includes a 49-bed hospital and 45-bed skilled nursing and rehab facility in Fort Kent;
  • Southern Maine Medical Center, a 150-bed, not-for-profit, full-service medical facility in Biddeford; and
  • MaineGeneral Medical Center, a 287-bed facility in Augusta.

At the center of the lawsuit are payment calculations for dual eligible patients, who qualify for both Medicaid and Medicare. According to the article, the eight hospitals were told by a private Medicare conractor in 1997 to claim new visits of dual eligible patients. The contractor later changed its position and in May 2005, it reduced some of the previous subsidies given to the hospitals and asked them to repay the difference.

The eight hospitals repaid tens of millions of dollars but appealed the decision to an independent Medicare review board. The board ruled in March that the hospitals weren't properly notified that the special payments they received would be reviewed and reduced.

The board determined the hospitals should receive back 80 percent to 90 percent of the money they repaid, the Bangor Daily News reported. However, Sebelius then weighed in on the review board's decision and reversed its decision about the improper notification.

The lawsuit asks a federal judge to review her decision and decide whether the hospitals are entitled to receive the money.

To learn more:
- here's the Bangor Daily News article
- read the lawsuit (subscription required)

Related Articles:
AMA addresses care for dual-eligibles, promotes med school innovation
Payers can thrive in dual-eligible market
Humana partners with Medicaid plan for dual-eligible coverage
Insurers vying for $300B dual-eligible market
Dual eligibles have higher healthcare utilization, costs