A California court ruling on Friday determined that Humana will not be able to dodge a Medicare Advantage Plan breach of contract suit from Prime Healthcare claiming inadequate reimbursements–underpayments.
Prime Healthcare was an in-network provider for Humana between August 2012 to February 2016, during which it claims Humana allegedly underpaid for services and according to Law360, sometimes refused to pay at all.
Federal judge Virginia A. Phillips rejected Humana’s recommendation to dismiss the case based on an “overly broad” interpretation of the Medicare Act, a move payers have used in the past to steer clear of breach of contract suits. ModernHealthcare reports, the health system is seeking an unspecified amount of damages of no less than $75,000.
Damaris Medina of Buchalter, one of the attorneys forPrime Healthcare said in an article for Healthcare Finance News:
This is a significant victory for providers who are in-network with Medicare Advantage Plans. Humana and other Medicare Advantage payers have made several arguments to prevent providers from suing them for breach of contract.
Medina also added that with this court decision, Prime can finally get to the root of the issue of a two-year, ongoing litigation with millions of dollars at stake in disputed claims.
To read more about claims and disputes made on both sides, visit HealthcareFinance.
Click here to read the Law360 story.
Visit ModernHealthcare to check out their article on the ruling.