The Tennessee Medical Association and The Litigation Center of the American Medical Association and State Medical Societies are jointly providing financial assistance to help fund a legal action by Tennessee primary care physicians. The lawsuit challenges a federal rule that has led to what the organizations deem unfair payment recoupments.
A TennCare audit conducted in 2015, based on criteria set by the Centers for Medicare and Medicaid Services in 2012, led to the attempt to collect millions of dollars from Tennessee physicians, mostly in rural, underserved areas, who received enhanced Medicaid payments under the Affordable Care Act.
A provision in the Affordable Care Act created a rate bump that reimbursed primary care physicians at a rate of 100 percent of Medicare rates for select primary care Medicaid services in 2013 and 2014.
This fall, TMA collaborated with attorneys to jointly represent some of the providers appealing the recoupment.
In October, the plaintiffs filed a joint complaint in the federal district court for Middle Tennessee arguing that the federal regulation CMS passed to implement the enhanced Medicaid PCP payment program was arbitrary and unfairly impacted certain primary care providers.