In Montana, Medicaid recoups reimbursement for supplies

Saturday, September 30, 2006

HELENA, Mont. - Montana's Medicaid program has done an about-face on reimbursement for rental equipment supplies, and it could mean up to tens of thousands of dollars in recoupments from the state's HME providers.
The state's Medicaid program has reimbursed providers separately for supplies like masks for years. But in late July, Medicaid sent providers a "reminder" that reimbursement for rental equipment like CPAPs includes all supplies, maintenance and other services.
About the same time, Medicaid began auditing providers and asking them to repay anywhere from $500 to $65,000 for supplies, going back several years.
"They're trying to pull a fast one," said Michael Calcaterra, president of the Big Sky Association of Medical Equipment Suppliers and a branch manager for Norco Medical in Missoula, Mont. "Even if they're now saying they shouldn't have paid for the supplies, they shouldn't ask us for the money back. They should say they're not going to pay for them anymore.'"
Peggy Michalsky, vice president of Big Sky and general manager at Juro's Home Medical in Billings, Mont., added: "From what I understand, this is just the tip of the iceberg of what they're going to do."
Big Sky officials planned to meet with a legislator and a lawyer in early September to discuss their prospects for fighting the audits and changing the way Medicaid modifies reimbursement.
In the meantime, some providers have tried to appeal their audits. Others, knowing they'll spend more money on lawyer's fees than recoupment, have written checks to Medicaid.