Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

We obtained summary judgment on behalf of a group of 21 Tennessee physicians in federal litigation in Nashville challenging a regulation from Centers for Medicare & Medicaid Services (CMS). CMS attempted to significantly limit enhanced Medicaid reimbursements for primary care services provided to vulnerable populations for 2013 and 2014. The physicians argued, and the court agreed, that CMS’ regulation was contrary to the language of the Medicaid reimbursement statute. Therefore, the court struck down the regulation as unlawful and concluded that TennCare is not entitled to recoup the enhanced payments made to the physicians.

The case is Averett v. U.S. Department of Health and Human Services, No. 3:16-cv-02815, 2018 WL 558825 (M.D. Tenn. Jan 24, 2018).

For more information about the case, please read the official news release here.

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