Louisiana hospitals that accept Medicaid patients cannot bill those patients for more than the reimbursements received from the Centers for Medicare and Medicaid Services, a Baton Rouge federal judge ruled this week.
Chief U.S. District Judge Brian A. Jackson signed a final judgment in the case of a Calcasieu Parish man for whom Medicaid paid $1,574 for treatments he received in late 2008 at University Medical Center in Lafayette.
After his treatments, the patient, Joseph Taylor Jr., became the target of a lien for an additional $1,005 billed by the Lafayette hospital.
Taylor had received $10,000 in a settlement with the driver of a vehicle that had struck him, causing the injuries for which he was treated in Lafayette.
Jackson, however, ruled this week that federal Medicaid laws do not permit health-care providers to seek additional payments in such situations.
Earlier, the judge ruled the state Department of Health and Hospitals, or DHH, which administers the Medicaid program and money in this state, adopted a rule in 2008 that conflicts with federal law. That rule permits health care providers to seek additional money from Medicaid patients who, like Taylor, receive compensation for injuries caused by others.
“Congress did not intend for providers to receive Medicaid reimbursement for patient care and then intercept funds that the patient would otherwise receive,” Jackson ruled. “Once a health care provider has received Medicaid coverage for a patient, it is precluded from recovering more than the program’s reimbursement rates for care.”
Added Jackson: “To the extent that any state law or regulation conflicts with the federal Medicaid statute or its regulations, it is void.”
Telephone and email requests for comment drew no response Friday from Weldon J. Hill II, DHH’s attorney in the case.
Christina Stephens, DHH’s director of media and communications, said: “We’re taking this ruling under advisement and looking at our options and next steps. We’ve not made a final decision on (a possible) appeal. Certainly, we expect that any decision in a case like this could have undetermined, long-term ramifications on the Medicaid program.”
Telephone and fax requests for comment from Lake Charles attorney J. Lee Hoffoss Jr., who represented Taylor, were not returned. And an email request was rejected as undeliverable.
LSU, which operated the Lafayette medical center in 2008, also was a defendant in Taylor’s suit, which was filed in December 2009.
But Taylor and LSU informed Jackson in April 2011 they had settled their dispute. The judge then dismissed LSU from the case. No details of the settlement are in the court record.