Several media outlets published articles detailing the lawsuit filed by 21 primary care physicians challenging a request for Medicaid reimbursements. Bass, Berry & Sims is representing the group of doctors in the lawsuit. 

The lawsuit focuses on a federal statute passed by Congress to entice physicians to expand necessary healthcare services in underserved areas. The U.S. Centers for Medicare and Medicaid Services (CMS) then added an additional requirement to the law, requiring these physicians either to be board certified or to bill 60% or more of “the Medicaid codes he or she has billed” within certain specified billing code categories. CMS then required state Medicaid agencies to audit the physicians who received the payments to ensure they met this now-two-part test. 

The lawsuit is challenging CMS’ interpretation of the law because many of the plaintiff physicians began practicing medicine before board certification became common for licensing or hospital privileges. In addition, several of the plaintiff physicians fell short of the arbitrary 60 percent billing code threshold only because their offices provide ancillary services, such as lab tests, that increase convenience to patients.

The lawsuit was covered in several media outlets, including:

For more information about the lawsuit, please read the full release posted here.