In North Carolina, state law provides Medicaid providers with a pathway to operate within the state, but the regulations providers face can be daunting enough to navigate and cost them their livelihood. State law provides little protection for providers once the state rules against them in a prepayment review. These audits take place when a provider has already provided services and submits a bill to the state for reimbursement. Providers are forced into review by the state when the state deems they have acted negligently, fraudulently, or places another claim against the provider.
We touched on the rights providers have in these cases in a previous blog, but Attorney Ralph Bryant Jr. recently secured a court ruling extending rights to appeal these rulings. Oftentimes, providers’ are denied payment during the review process for seemingly arbitrary reasons which can put them out of business entirely. Frankly, many of these decisions are discrimination but state law does not provide protections to providers from discrimination during audits.
The North Carolina statute for prepayment review explicitly prevents providers from appealing through the administrative process, but Attorney Ralph Bryant Jr. believed in the right to appeal prepayment review decisions that put providers at risk through the judicial process.
In Halikierra Cmty. Servs. LLC v. N.C. Dep’t of Health & Hum. Servs., the judge ruled in favor of this belief.
Our client Halikierra Community Services LLC was one of North Carolina’s largest providers of in-home Medicaid services until the NC Department of Health and Human Services audited and suspended their services. Halikierra knew their services were vital to families in the Tar Heel State, so they continued to provide services while under review to the tune of $700,000 in expenses per month. When payments from the state stopped in 2018, it forced Halikierra out of business because of the previous guidelines preventing them from appealing this unfair and unethical decision.
Thankfully Halikierra and our law firm stood our ground, going after the NCDHHS and its employees for targeting a major business in our state. These personal vendettas previously went unchecked but will no longer be permitted without consequence.
The state attempted to argue that statutes in place require Halikierra to pursue its claims against negligence allegations through the Industrial Commission. However, the judge points out that NCDHHS acknowledged these claims aren’t about negligence but about constitutional rights violations, thus taking jurisdiction to the courts.
The judge ruled that the “mere fact that an agency action is nonreviewable under the Administrative Procedure Act does not shield it from judicial review.” This means Medicaid providers whose hard work is put at risk by senseless and unfair practices by state officials can now result in major lawsuits and penalties for bad actors.
The Ralph Bryant Law Firm is committed to justice for Medicaid providers across the state. Attempts to get in the way of important and life-saving work because of personal vendettas will no longer stand in our state. If you’re a current or former Medicaid provider whose work was put at risk for unfair reasons and your rights are being violated, contact our offices and we’ll fight for you as we did for Halikierra.
Ralph Bryant Law Firm
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