NHC doctor’s office among lawsuit plaintiffs over state Medicaid payment system

by Michelle Saxton
Wednesday, January 22, 2014

A New Hanover County medical practice is among seven plaintiffs in a lawsuit alleging a North Carolina Department of Health and Human Services software system to reimburse Medicaid payments was full of errors leading to catastrophic losses for health care providers.

Abrons Family Practice in Wilmington is among plaintiffs listed in a Jan. 16 class action complaint filed in Wake County that claims flaws in the state’s NCTracks system that went live in July caused Medicaid payments to be unpaid, delayed or shorted. 

Payment failures, under one estimate, reached nearly $700 million during NCTracks’ first three months, the lawsuit alleged.

Abrons Family Practice referred questions to Raleigh attorney Camden Webb, who is among lawyers representing the plaintiffs. 

“The lawsuit intends to first seek compensation, and that would be for some of the things that aren’t paid yet but also the collateral effects of damage to the practices,” Webb said in a Monday, Jan. 20, phone interview, adding doctors also want the system fixed.

Webb said administrative headaches led to extra employees, overtime and lost clinical time, adding that stopped payments caused some doctors to take out loans to make up differences.

At some practices, half the patients were served by Medicaid, Webb said.

“Half your revenues are not coming in,” Webb said. “How do you deal with that?”

No specific monetary number had yet been determined for damages and reimbursement, Webb said.

The lawsuit alleges NCTracks was untested and that the defendants knew it was negligently designed before going live. 

North Carolina’s Medicaid system, which provides health insurance for low-income parents, children, seniors and disabled people, processes about $13 billion a year in reimbursement claims for more than 70,000 providers serving more than 1.5 million Medicaid patients, the lawsuit stated.

Some doctors have had to make a tough decision to no longer see Medicaid patients due to the reimbursement problems, Webb said.

Other plaintiffs include Nash OB-GYN Associates in Nash County, Highland Obstetrical- Gynecological Clinic in Cumberland County, Children’s Health of Carolina in Robeson County, Capital Nephrology Associates in Wake County, Hickory Allergy and Asthma Clinic in Catawba County and Halifax Medical Specialists in Halifax County.

When asked for comment, state officials released a statement from DHHS Chief Information Officer Joe Cooper. 

 “As with any implementation of an IT system of this size and complexity, the transition has not been without challenges,” Cooper said. “To date, the new system has processed more than 104 million claims and paid more than $5.5 billion to North Carolina healthcare providers, out-performing the 35-year-old system it replaced. DHHS continues to address provider issues as they arise, and will not rest until every provider is fully transitioned to the new system.”

DHHS officials added that most identified defects were resolved, the system was tested before it went live and delaying the project was not feasible.

Other defendants include Computer Sciences Corp. of Virginia, which designed, developed and operated NCTracks, and project vendors Maximus Consulting Services of Virginia and SLI Global Solutions of Colorado.

CSC released the following statement, “We believe the lawsuit against CSC is without merit, and CSC will defend it vigorously.”

Meanwhile, another state program, NC FAST, which determines eligibility for Medicaid and other cases, also has had reported issues.

The United States Department of Agriculture warned North Carolina’s DHHS in December 2013 it could lose funds due to delays with the Supplemental Nutrition Assistance Program, also known as Food and Nutrition Service. DHHS responded that it was taking corrective action.

USDA officials were still reviewing North Carolina’s response, the federal department said Jan. 17.

NC FAST is North Carolina’s new case management system for FNS, and it has been working to add Medicaid, Work First and Affordable Care Act cases, Christine McNamee, New Hanover County Social Services’ assistant director for economic services, said Tuesday, Jan. 21.

Overtime progress has helped improve the county’s backlog, which currently was at more than 250 FNS cases and 50 Medicaid cases, McNamee said. 

email michelle@luminanews.com

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