Brian Roark on Hospitals Suing Massachusetts over Medicaid, Medicare and Uninsured Reimbursements
Brian Roark, member at Bass, Berry & Sims PLC, is extensively quoted in three separate publications regarding a recent Massachusetts court case brought by six community hospitals against the Commonwealth over implementation of a state law requiring reimbursement to hospitals with a large population of Medicaid, Medicare and uninsured patients.
Click here to read the full article by Rick Valliere for BNA’s Health Care Daily Report and Health Law Reporter, titled “Six Massachusetts Hospitals Sue State To Increase Payments for Public Coverage.” [Reproduced with permission from BNA’s Health Law Reporter, 18 HLR 1560 (Dec. 2, 2009). Copyright 2009 by The Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com.]
The article by Sheri Qualters for the National Law Journal is titled “Six Community Hospitals Sue Massachusetts over Medicaid Reimbursement.” Click here to read the full article (subscription required).
From the article:
Although it's been relatively uncommon for hospitals to sue a governmental entity like a state, hospitals are being squeezed by having to treat more Medicaid patients as unemployment rolls grow, said Brian Roark, a health care partner at Nashville's Bass, Berry & Sims, who isn't involved in the case.
"The normal course is still going to be [that hospitals] take that up with the [state] legislature, but you're going to see more hospitals deciding that the funding levels need to be determined by a court, [as] these six Massachusetts hospitals have decided," Roark said.
The article by Nick Brown in Health Law360 is titled “Hospitals Say Mass. Skimped on Reimbursements.” Click here to read the full article (subscription required).
From the article:
As a result, health care litigation specialist Brian Roark said, hospitals find themselves “squeezed on two ends.”
“On one end, they're having to treat more patients covered by Medicaid, and at the same time, states are reducing Medicaid reimbursements as they face recession,” said Roark, a partner at Bass Berry & Sims PLC, which is not involved in the case. “Medicaid and Medicare are federal programs, but states manage them and decide how to implement them.”
While the Massachusetts case is unique to Massachusetts law, similar cases may sprout up across the country as more Americans become Medicaid-eligible amid widespread job loss, Roark said.
Some laws, including Massachusetts', do not provide hard numbers on just how far legislators can go when cutting reimbursements, a gray area that leaves plenty of room for debate.
“What they're saying in [the instant] case is that leaders have gone too far, that they've violated a statute that requires them to fund hospitals based on their actual costs,” Roark said. "But there's no specific figure they've allegedly failed to meet."
He added that the intrigue of the case “may have greater legs” because of its timing, rearing its head in the thick of the national conversation on federal health care reform.
“One of the things the federal government is talking about doing is cutting payments to disproportionate share hospitals like the ones in this case, the rationale being that if health care reform is passed, more patients will be covered by insurance,” Roark said.
“In the end, it all comes down to the idea that, when people show up in the ER, they have to be treated," he said. "How are we going to pay for it?”
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