In a recent case in New York State Court, "23 residential health care facilities" (read: nursing homes) challenged the rates they were paid for rendering services to Medicaid patients. Collectively, they had previously filed over 160 rate appeals, the court said.
True it is that nursing homes are entitled by law to be reimbursed for the services they provide to Medicaid recipients. It is also true that under the Medicaid program, these providers of services covered by Medicaid are given an "administrative review procedure to review and challenge" the amount of Medicaid money they receive for their services.
During the current Sunshine Week, in which all things are made visible, it is a good thing to shine a light on rate appeals of Medicaid money. "Trust but verify," which I understand comes from a Russian proverb. A good proverb for cases like this recent case in New York State Court: Woodside Manor Nursing Home, Inc. v. Zucker, 223 A.D.3d 94, 204 N.Y.S.3d 256 (N.Y. App. Div. 3d Dep't 2024).
Significant features of the Medicaid Program like the rate appeals involved in the Zucker case in New York, are the subject of Chapter 18D, titled Medicaid and the Children's Health Insurance Program (CHIP), in Volume 2 of CATASTROPHE CLAIMS / INSURANCE COVERAGE FOR NATURAL AND MAN-MADE DISASTERS (Thomson Reuters Nov. 2023 edition, 2024 Supplement in process).
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