The allegedly unpaid claims date back to 2001. For dual eligible patients, Medicare typically pays its share of the claim first. The claim then crosses over to MaineCare, the state’s Medicaid program, which takes on costs for Medicare coinsurance and deductible expenses.
In July 1999, MaineCare stopped paying such “crossover claims,” MMC said. Instead, MaineCare would send providers documentation that showed zero payment for the claims. Providers could then show this documentation to the federal government and receive payment through Medicare.
MMC claims it did not receive documentation for crossover claims from November 2001 through August 2003, which prevented it from receiving Medicare reimbursement, according to the report. The allegedly unpaid claims amounted to $1.1 million in fiscal year 2002 and $1.7 million in FY 2003.
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Specialty Hospitals of America Sues DC Over Medicaid Reimbursement
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