21 physicians sue CMS over attempt to recoup Medicaid payments

Twenty-one physicians in Tennessee filed a federal lawsuit Monday against CMS to stop the agency from recouping $2.3 million in Medicaid payments.

The payments were made in 2013 and 2014 to physicians serving in rural communities and disadvantaged populations to help them expand their practices and provide more services in areas with limited care. However, CMS required TennCare, the state's Medicaid program, to audit the physicians to ensure they are either board certified or bill 60 percent or more of their Medicaid codes within certain billing code categories. More than 100 physicians across the state did not meet these requirements, so TennCare is now seeking repayment.

According to a press release from Bass, Berry & Sims, the attorneys who filed the lawsuit, one of the plaintiffs reportedly used the funds to open an outreach clinic for bilingual uninsured patients, expanded hours and upgraded other services, and another plaintiff hired a bilingual nurse and an internal medicine specialist.

The lawsuit was filed in the U.S. District Court of the Middle District of Tennessee. Bass, Barry & Sims predicts physicians who received similar payments in other states may eventually face similar repayments, according to a press release.


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