Victory In Vaccine Administration Fees Lawsuit

A lawsuit brought by the North Carolina Pediatric Society and the North Carolina Academy of Family Physicians (NCAFP) to rectify a significant underpayment on approximately half of vaccine administration payments paid by Medicaid under the Affordable Care Act during 2013 and 2014 was decided in their favor last week. Superior Court Judge Beecher R. Gray ruled that the NC Division of Medical Assistance (DMA/Medicaid) will reprocess those payments for an extra $6.74 per affected vaccine within 120 days.  DMA has 30 days to appeal the decision.

The North Carolina Medical Society (NCMS) congratulates the NC Pediatric Society and the NCAFP for this important legal victory on an issue that has plagued all of our members for several years. The NCMS and the other organizations diligently advocated on behalf of all our members to correct the underpayment of administration fees for immunizations provided to Medicaid patients under the Vaccines For Children (VFC) program prior to the NC Pediatric Society, the NCAFP and eight member practices decided to take legal action.

During 2013 and 2014, all vaccines given under the VFC Program should have received the higher administration fee.  However, approximately half the administration fees were paid at a lower rate.  Under the ruling, the amount any one practice is due will be based on how many vaccines were administered and paid at the lower level during the two years impacted by this case.

Read the NCAFP’s article on the decision for more background on the case.


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