Community health centers sue state over shortchanged Medicaid payments

The West Virginia Department of Health and Human Resources is taking heat for allegedly shortchanging Medicaid reimbursements for eight community health centers over the past decade, the Charleston Gazette reports. The centers all filed a joint lawsuit this week demanding that the state begin paying the correct rate immediately on top of making yet-to-be-determined back payments. 

"None of us took this lightly," FamilyCare HealthCenter CEO Martha Carter told the Gazette. "But we need to be paid fairly and legally if we are to keep providing quality services." FamilyCare, based in Scott, W.Va., currently serves 24,000 patients in three counties, and claims to have been underpaid by $384,000 just for 2009. 

Valley Health Systems of Huntington, another one of the eight, estimates the state owes it about $1.3 million from last year. Scarbro-based New River Health Association had to borrow a line of credit to pay its employees at the end of the year last year, CEO Dave Sotak told the newspaper. 

"If this situation is not remedied immediately, the very viability of the health centers will be in serious jeopardy," the lawsuit contends. "[T]he ultimate harm [will] befall the vulnerable populations for whom they care." 

Overall, 550,000 patient visits were handled by those eight centers last year, with roughly 28 percent of those patients covered by Medicaid. Currently, more than 346,000 state residents are on the program, according to the Associated Press; in 2014, when coverage under healthcare reform kicks in, 125,000 more will be in the same boat, the Gazette points out. 

A similar lawsuit was filed against DHHR in December. Appalachian Regional Healthcare in Beckley sued the state, claiming it, too, was underpaid. The case is still ongoing. 

The University of Virginia Health System, in October, stopped taking West Virginia Medicaid patients due to low reimbursement payments, as well, the AP reports.

For more information:
- read this Charleston Gazette piece
- check out this Associated Press story

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.