A trial court dismissed the claims in June 2015 because the doctors had not first appealed their improperly-processed Medicaid claims to NCDHHS or the NC Office of Administrative Hearings (OAH). On appeal, the doctors argued that they were prevented from appealing to NCDHHS or OAH because neither the State nor CSRA had rendered or communicated a final decision or denial as to each claim.
Writing for a 2-1 majority, Judge Valerie Zachary agreed with these arguments, and sent the case back to the trial court for additional proceedings. “We conclude that plaintiffs’ arguments on this issue have merit and that the trial court erred in its analysis[,]” she wrote.
It is not yet known whether the latest ruling will be appealed to the North Carolina Supreme Court or will resume at the trial court level as ordered. Stay tuned to the NCMS Bulletin for updates on this case.
Review the Court of Appeals Opinion here.