A West Virginia lawsuit settlement that "will alter how rural health clinics and larger health centers are reimbursed for treating low-income patients on Medicaid" could lead to big financial windfalls for larger health care centers, while smaller clinics could face back fees in the millions that could lead to the closure of dozens of rural facilities, Eric Eyre reports for The Charleston Gazette.
The settlement will lower Medicaid reimbursements for rural clinics, and "also requires some rural health clinics to reimburse the state and federal government for charges dating back to October 2012," Eyre writes. Dr. Mark Tomsho, who said Summersville Regional Medical Center (right) would lose $750,000 per year because of lower Medicaid reimbursements, estimated that under new rules he owes $1 million. He said the clinic runs on an operating budget of $3 million a year.
State health officials said they wouldn’t know how many of the state's 40 rural clinics "must pay back money and face lower Medicaid reimbursement rates—an estimated 30 percent to 50 percent cut—until after the clinics file cost reports," Eyre writes. "The clinics must submit reports by June 30."
Medicaid reimbursement changes were prompted by a 2011 lawsuit filed in federal court by eight larger health-care facilities that "alleged that the state Bureau of Medical Services miscalculated Medicaid reimbursement rates for years," Eyre writes. "Under the settlement, seven of the eight large health-care centers, as well as some of the other 19 federally qualified facilities, will be reimbursed at higher rates. Some health centers also will get a windfall for being shortchanged in previous years. (Read more)
Meanwhile, "Legislative auditors said West Virginia is at risk of losing millions of dollars in federal Medicaid funding because state hasn't complied with a 2011 directive [that] requires states to suspend Medicaid payments to health care providers if fraud allegations are determined to be credible," WCHS-TV in Charleston reports. "A legislative audit says Medicaid has paid at least $17.9 million to providers whose cases were referred to the state's Medicaid Fraud Unit. The payments could be as a high as $211 million.
State health officials said they wouldn’t know how many of the state's 40 rural clinics "must pay back money and face lower Medicaid reimbursement rates—an estimated 30 percent to 50 percent cut—until after the clinics file cost reports," Eyre writes. "The clinics must submit reports by June 30."
Medicaid reimbursement changes were prompted by a 2011 lawsuit filed in federal court by eight larger health-care facilities that "alleged that the state Bureau of Medical Services miscalculated Medicaid reimbursement rates for years," Eyre writes. "Under the settlement, seven of the eight large health-care centers, as well as some of the other 19 federally qualified facilities, will be reimbursed at higher rates. Some health centers also will get a windfall for being shortchanged in previous years. (Read more)
Meanwhile, "Legislative auditors said West Virginia is at risk of losing millions of dollars in federal Medicaid funding because state hasn't complied with a 2011 directive [that] requires states to suspend Medicaid payments to health care providers if fraud allegations are determined to be credible," WCHS-TV in Charleston reports. "A legislative audit says Medicaid has paid at least $17.9 million to providers whose cases were referred to the state's Medicaid Fraud Unit. The payments could be as a high as $211 million.
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