Counties File Claim Seeking $2.4B in Backpay From Medicare
Five California counties last month filed a claim against HHS seeking to recover $2.4 billion in Medicare underpayments for health care providers nationwide over the past six years, the Sacramento Bee reports (Whitney, Sacramento Bee, 4/4). Of that amount, $281 million would go to the five California counties that brought the claim (Clark, San Diego Union-Tribune, 4/4).
According to the claim, the pay disparity, which occurred from 2001 to 2007, has forced physicians to stop accepting Medicare patients and has forced elderly and disabled beneficiaries to travel long distances to find a provider (Sacramento Bee, 4/4).
CMS incorrectly classifies the five counties as rural areas with lower costs of living than counties that are classified as urban, according to the claim.
As a result, San Diego County officials said the payment formula reimburses health providers in rural counties 12% to 24% less than urban counties.
The underpayments affect physicians, nurse practitioners and physician assistants paid under a physician fee schedule. The figures were calculated from federal databases by physicians in Santa Cruz County.
CMS officials have until April 16 to respond to the claim (San Diego Union-Tribune, 4/4).
Michael Reedy, a San Jose attorney involved in filing the claim, said he expects federal officials to reject the claim, prompting a class-action lawsuit filed in federal court.
The five counties that filed the claim were:
- Santa Barbara;
- Santa Cruz;
- San Diego;
- Marin; and
- Sonoma (Sacramento Bee, 4/4).
El Dorado, Monterey, Placer, Sacramento and San Luis Obispo counties also might join the lawsuit, according to San Diego Medical Society President Ted Mazer (San Diego Union-Tribune, 4/4). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.