LAS VEGAS (KSNV MyNews3) -- Nevada’s Medicaid program is recovering money from doctors across the state, saying the doctors were improperly paid for medical services provided as long as six years ago.
However, many doctors say they were not overcharging the system -- and now the system is taking away money they earned.
As a result of News 3's involvement in this story, Medicaid officials say they launched specific ways to help doctors navigate what has been a troubled communication process.
Clark County obstetricians say the problem began when Medicaid started recouping money for overpayments issued to local obstetricians.
Medicaid conducts routine audits that comb for incorrect billing and coding, and that's what they say was recently discovered during a random review. But obstetricians such as Dr. Eric Grant say the audit was wrong.
Responding to
Medicaid's statement, Dr. Luis Lopez says he can't speak for all doctors, but he knows he did not try to work the Medicaid system to his financial advantage. But Medicaid docked the cash anyway, impacting the doctors' bottom line to the tune of thousands of dollars for payments issued since 2006.
Lopez participates in a program called Babies Are Beautiful, which allows non-insured women, citizens or not, pregnancy care paid for upfront. But Lopez says, in his case, the problem may have started when Medicaid issued retroactive coverage to patients who may have been undocumented immigrants.
Lopez already collected payment in full from these patients in 2010, but with Medicaid's green light, he submitted an insurance claim for reimbursement for the pregnancy-related services and returned the program's prepayments to the new moms.
Today, Dr. Lopez says Nevada Medicaid should have handled this differently and informed doctors of the mishap months after the delivery, not years later.
Medicaid says it has enhanced its website to make it more user friendly, highlighting urgent messages.
It also has a hot line for doctors to appeal decisions.
Also Friday, Medicaid sent instruction letters to the doctors on how to resubmit billing if they feel money was docked unfairly.
Nevada Medicaid says it did not do a good job of communicating the intentions of their financial review, or efficiently deal with the audit aftermath. And that "there is always an opportunity to do more."
