Doctors’ NCTracks Lawsuit Gives Voice to Others Plagued by New Medicaid Claims System

Last week, most media outlets carried the story about seven doctors who, fed up with lack of proper reimbursement and continuing technical difficulties with the new NCTracks Medicaid claims system, filed a class action lawsuit against the system’s vendor, CSC, subcontractors and the state. The North Carolina Medical Society (NCMS) Executive Vice President and CEO Robert Seligson, was widely quoted as being supportive of the doctors, based on the NCMS’s labor-intensive efforts to help our members with their on-going NCTracks problems. For a list of links to some of the media coverage click here. To read the NCMS’ statement in response to the lawsuit, click here.

Since the lawsuit was filed last Thursday, at least one reporter has sought to put it in larger context. Scott Mooneyham, who writes for the Insider, a subscription newsletter circulated primarily to those at the General Assembly, lobbyists, journalists and other interested parties, wrote the following:

“What has been difficult for the press to reconcile are claims by Wos and other officials in the Department of Health and Human Services that the system is getting better against vague and whispered portrayals from others that they are not,” Mooneyham wrote in a piece that ran Monday. “While a few medical administrators have spoken up during legislative hearings, most have allowed the public criticism to come from politicians and auditors. When you depend on people for money, shouting and fussing about those same people can be a dangerous exercise. That all changed with the filing of a lawsuit, led by seven medical practices, against the state and the contractors who were hired to put the Medicaid claims system together.”

Watch the Bulletin for future stories on this lawsuit.

 
 

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3 Comments

  • We are now mid April 2014, the issues are still going on, without resolve. Doctors and hospitals in mid NC are not being paid, patients are still left out in the cold, and I can assure you, a copy of the lawsuit will be placed on one of those Doctors desk in our area, with a name and phone number of the attorneys who filed the suit, with a smile and encouraged to pick up the phone and make the call, when more Doctors go on-board against these absolute refusals to straighten out the problem.. Heads should roll, and people need to be voted out of office. While others thrown out. This is a political issue I can assure you, there is no software program that would take this long to fix.. This is intentional. The Health and Social services computer cannot show that people are active on the medicaid rolls, and the the other server showing they aren’t. And this is what people are being told. “Your account is showing you are inactive”.. So, someone on the hill in Raleigh is LYING. And maybe someone needs to start an audit on the files and records to see where the money for medicaid is really going, they claim its being spent, yet accounts are not being paid.. Someone is!!

  • On July 1, 2014, NC Tracks implemented a completely different payment calculation for processing secondary Medicaid claims than was previously used by HP Enterprise. This has resulted in lower reimbursement, which is placing a financial hardship on the very doctors that have contracted to serve these patients. In southeastern NC, our physicians treat a large population of Medicaid patients within 6 surrounding counties.
    We are still unable to resolve the issue of transmitting the prior authorizations for medications within the system. Because of the numerous unresolved issues and the negative impact of the decreased payments from NC Tracks, we feel we are being forced to seriously consider not seeing Medicaid patients at all. Thank you for being an advocate for the NC physicians.

  • Jennifer Coble

    Kudos to the practices stepping forward and putting action to their justified complaints. Not only have providers suffered tremendously from the extreme negative impact of what the system has provided, but patients have suffered as well. I know of several providers that have refused to see Medicaid patients and in a small area as we are that leaves very few opportunities for healthcare. I will be watching this action closely as this may very well be the beginning of more to come especially since we all have similar horror stories about the system.