NC Doctors file suit against NC, call Medicaid billing system 'disaster'

by Bruce Mildwurf, WRAL, January 16, 2014.

North Carolina’s Medicaid billing system was so dysfunctional it costs doctors time, money and patients, according to a class action lawsuit filed by a group of medical providers Thursday.

The suit alleges the state Department of Health and Human Services and some of its computer services providers were negligent in developing and implementing a new Medicaid claims tracking system, known as NCTracks. Doctors from Cumberland, Nash, New Hanover, Robeson and Wake counties are part of the suit and claim "NCTracks has been a disaster, inflicting millions of dollars in damages upon North Carolina’s Medicaid providers.”

They name DHHS, Computer Sciences Corporation, Maximus Consulting Services and SLI Global Solutions as defendants.

"NCTracks was a disaster, and the State was beyond the point of no return,” the plaintiffs write in their lawsuit.

The 48-page document outlines the many struggles that medical providers encountered, including:

• rejected claims,
• delayed or wrong payment amounts,
• non-compliance with federal law,
• and simple system downtime.

The Medicaid process, when it works, provides health insurance to low-income people and some with disabilities. They go to a certified medical provider who then bills the government and gets reimbursed. Doctors across the state have complained since the NCTracks rollout that delays or denials of expected reimbursements have put them behind, forcing some clinics to stop accepting Medicaid patients and even to close their doors.

"Prior to July 1, 2013, Medicaid providers routinely submitted bills and received weekly electronic payments for services rendered, and payments were made in accordance with Medicaid reimbursement rules," the plaintiffs wrote.

In the complaint, the doctors lay out the timeline of a project that took a decade to build and came in more than $200 million over budget.

The three vendors named in the suit contracted to deliver different elements of the project.

• Computer Services Corporation was to provide a claims system for health care providers, train them to use it and offer phone support.
• SLI was to test the system for usability.
• Maximus was to provide a second layer of testing and verification for the software.

The suit details alleged wrongdoing by each vendor, claiming each "failed to exercise a reasonable degree of care."

The North Carolina Medical Society issued a statement in support of the doctors Thursday morning, writing, "NCTracks has inflicted real damage on Medicaid patients and providers across the State for the last seven months. We understand, from our own tireless efforts to help our members overcome the system defects, that legal action may be the only remaining option to remedy the harm to the Medicaid system and get NCTracks to function as advertised."