A state appeals court Wednesday sided with three Lee County hospitals in a payment dispute with the state stemming from emergency care provided to undocumented immigrants.
The ruling by the 1st District Court of Appeal was the latest in a series of legal battles about Medicaid payments to hospitals for providing care to undocumented immigrants.
A three-judge panel agreed with Gulf Coast Medical Center, Lee Memorial Hospital and Cape Coral Hospital, which argued that the state Agency for Health Care Administration was improperly seeking to require them to repay portions of money received in the past for treating undocumented immigrants.
The appeals court detailed the circumstances in a 14-page ruling in the Gulf Coast Medical Center case. It said the state in 2002 started using a “pre-authorization” system in which only Medicaid inpatient claims that had been approved in advance could be submitted to the state for payment.
Gulf Coast Medical Center billed the Agency for Health Care Administration in 2007 for claims that had been pre-authorized for providing emergency care to undocumented immigrants. After a federal review in 2009 found fault with the way the state was paying such claims, the Agency for Health Care Administration began auditing claims billed to Medicaid in 2007.
The Agency for Health Care Administration ultimately said it had overpaid Gulf Coast Medical Center by $46,901 for the 2007 claims related to undocumented immigrants and requested repayment. But the hospital challenged the request for repayment, and the appeals court agreed with its arguments.
“Gulf Coast argues the Agency (for Health Care Administration) was without authority to order reimbursement as it was barred from conducting retrospective audits on claims for emergency in-patient services that were pre-authorized and paid,” said Wednesday’s ruling, written by Judge M. Kemmerly Thomas and joined by Chief Judge Brad Thomas and Judge Harvey Jay. “We agree and reverse.”
