RALEIGH, N.C. (Legal Newsline) - A group of North Carolina doctors has filed a class action lawsuit against the North Carolina Department of Health and Human Services over its allegedly flawed computer programs that severely delay Medicaid reimbursements.
Computer Sciences Corporation, Maximus Consulting Services Inc. and SLI Global Solutions Inc. were also named as defendants in the suit.
On July 1, North Carolina implemented a software system known as "NCTracks," which was intended to manage enrollments for providers of Medicaid-covered services and reimbursement payments to those providers who serve North Carolina Medicaid recipients, according to a complaint filed Jan. 16 in the North Carolina General Court of Justice-Superior Court Division.
Abrons Family Practice and Urgent Care P.A.; Nash OB-GYN Associates P.A.; Highland Obstetrical-Gynecological Clinic P.A.; Children's Health of Carolina P.A.; Capital Nephrology Associates P.A.; Hickory Allergy & Asthma Clinic P.A.; and Halifax Medical Specialists P.A. all claim NCTracks was supposed to be a model of healthcare information technology that would "seamlessly and efficiently process and pay billions of dollars of claims each year."
"Instead, NCTracks has been a disaster, inflicting millions of dollars in damages upon North Carolina's Medicaid providers," the complaint states.
The plaintiffs claim NCTracks was negligently developed and designed, the system was untested and it was "plainly not ready for implementation."
The $484 million computer system was intended to streamline the process of filing Medicaid claims and issuing payments, according to the suit.
When Medicaid providers began to use NCTracks, they were immediately confronted with a host of errors and the system would lock up and advise that maintenance was ongoing for significant periods of time, according to the suit.
The plaintiffs claim the system lost provider information and rejected reimbursement claims for services that were plainly authorized for payment and would pay the wrong amounts for others.
NCTracks was not prepared to handle the volume of users attempting to simultaneously access the provider portal, despite the fact that CSC knew how many providers would use NCTracks simultaneously, according to the suit.
The plaintiffs are seeking treble and actual damages with pre- and post-judgment interest. They are being represented by Camden R. Webb and Knicole C. Emanuel of Williams Mullen.
Emanuel said North Carolina Medicaid providers have been damaged by NCTracks.
"Since NCTracks went live on July 1, Medicaid providers haven't received reimbursements, or if they have, they haven't received the correct amount," Emanuel said. "They say they're fixing the problems with NCTracks, but they're still not fixed."
Emanuel said even if the Medicaid reimbursements were paid in full now, they have still caused the providers damages.
"They've caused North Carolina Medicaid providers to spend a lot of time and money since it has gone live," Emanuel said. "Some providers have had to even stop taking Medicaid because they aren't being reimbursed."
An audit was released in December that said the NCDHHS could have done more to get Medicaid providers paid more quickly.
NCDHHS Chief Information Officer Joe Cooper released a statement regarding the problems with NCTracks.
"NCTracks has processed 81 million claims and paid almost $4.5 billion to North Carolina healthcare providers, but it is clear that there is still work to do. While DHHS has a process in place for prioritizing and resolving issues with NCTracks and over 81% of all identified defects have been resolved, we thank the Auditor for her recommendations. It is important to note that the number of defects in NCTracks is significantly less than the industry average for a software system of its size and complexity, and do not affect the vast majority of providers. Our primary focus continues to be to make system improvements and to ensure that every provider is paid for the work they do. But if even one provider is impacted negatively, that's one too many."
North Carolina General Court of Justice-Superior Court Division case number: 14-cv-000635
From Legal Newsline: Kyla Asbury can be reached at email@example.com.