N.C. Doctors File Class Action Lawsuit Over Medicaid Billing System

Several doctors’ offices and other healthcare professionals in North Carolina have filed a class action lawsuit against the state’s Department of Health and Human Services, alleging it contracted with three separate companies to create a flawed computer system that botched Medicaid reimbursements to to the tune of millions of dollars following its July 2013 roll-out.

The class action lawsuit claims that the the system, known as “NCTracks,” does not comply with federal law. The plaintiffs are seeking damages on behalf of all 70,000 practitioners who bill Medicaid patients for services, alleging that the NCTracks system reportedly had 3,200 defects in just four months, and that more than 600 had been unresolved. Defendant Computer Sciences Corp. reportedly has still been unable to apply updates to the system required by the Patient Protection and Affordable Care Act.

The doctors further allege in the NCTracks class action lawsuit that two other companies, Maximus and SLI Global Solutions, failed to properly test the system prior to its roll-out in July 2013. Had they done so, the class action alleges they would have known of flaws in Medicaid billing that affected co-pays, prior authorization and numerous other reported flaws. Instead, the state Department of Health and Human Services allegedly allowed Computer Sciences Corp. to set its own standards for approval.

There are several major billing issues for which the plaintiffs are seeking damages:

1) Incorrect co-pays as a result of miscalculated deductibles that cost primary care physicians $2 per visit.

2) For patients covered by Medicare and Medicaid, a further $10 was missing in payments made to providers.

3) Pregnant women’s coverage was not adequately coded into the system so gynecologists and obstetricians missed out on significant incentives. An additional problem existed for administration of vaccines and injections for at-risk pregnant women and children.

4) As noted above, payment schedules mandated by the Patient Protection and Affordable Care Act were not established in the system.

5) Issues confirming prior authorization led to missed payments for ultrasounds and those which required patient consent. Other doctors were simply not included in the system.

6) Patients in a similar program, “Carolina Access” were not assigned to the right doctors, so their physicians were unable to submit their claims.

The NCTracks class action lawsuit is seeking to establish whether or not the state HHS was negligent in allowing the launch of a system that does not comply with federal regulations, whether or not the three companies properly designed the system and tested it prior to launch and whether or not the state agency was in breach of contract in adequately providing Medicaid billing services for the healthcare professionals in North Carolina

The providers are represented by class action lawyers Knicole Emanuel and Camden Webb of Williams Mullen.

The North Carolina NCTracks Medicaid Billing Class Action Lawsuit is Abrons Family Practice Urgent Care PA, et al. v. North Carolina Department of Health and Human Services, et al., Wake County Court, North Carolina.