MONROE — A Ouachita Parish home health agency is facing a $2.3 million billing dispute with the federal government over what the government claims is years' worth of Medicaid and Medicare overpayments.
Supreme Health Services filed a complaint on Oct. 19 for a temporary restraining order and preliminary injunction in U.S. District Court for the Western District of Louisiana Monroe Division.
The company is requesting that the courts hear a case involving the home health agency's dispute with the U.S. Department of Health and Human Services (HHS) and administrators for the Centers for Medicare and Medicaid Services.
Supreme Health filed the complaint in an effort to prevent the government from recouping $1.7 million in alleged overpayments and $653,725.47 in interest payments. The alleged overpayments total $2,372,553.20. Supreme argues that the repayment would force it to go out of business.
Supreme Health began operating in 1983 as a home health agency, according to its court filing: "The company provides skilled nursing care, restorative therapy and other medical social services to 175 patients in homes, assisted living facilities and retirement communities."
Supreme Health claims that the state's failure to allow it to have a position be heard by an Administrative Law Judge, as required by applicable statute, violates its due process rights.
The filing was submitted in civil court because, according to court documents, an administrative law judge does not have the authority to issue an injunction or stay. Citing a backlog in cases that could take some three to five years to resolve, Supreme is now asking the courts not to resolve the underlying billing dispute but instead to "maintain the status quo pending completion of the administrative appeals process."
Under the Medical Modernization Act of 2003, providers have the statutory right to contest post-payment denials through a four-level appeal process within HHS, followed by a fifth level consisting of judicial review, court documents state. Once the second level of review is complete, Centers for Medicare and Medicaid Services may begin to recoup alleged overpayments despite the fact that the provider has not completed the entire four-level appeal process, according to court documents.
According to the filing, the Centers for Medicare and Medicaid Services hired a firm to conduct a post-payment review. According to that review, which was conducted in August 2011, Supreme was found to have an overpayment involving some 318 claims from November 2008 to May 2011 that total $1,739,569. In October 2016, a demand for payment was sent.