Georgia's Trusted Healthcare
& Medical Provider Attorneys

Former DCH Attorney Joins Jeyaram & Associates

Screen shot 2015-06-26 at 2.55.32 PMMr. Harrison Kohler joins Jeyaram & Associates as counsel. Mr. Kohler brings extensive criminal defense and administrative hearing experience to the firm. He represented the Department of Community Health (DCH) for nine years in both administrative hearings and negotiations with attorneys for Medicaid providers.

Prior to joining DCH, Mr. Kohler served as an Assistant Attorney General, which included 10 years as a prosecutor in the Medicaid Fraud Control Unit. During that time, he had 90 jury trials, including both criminal and civil, in 15 different superior courts and two federal districts in Georgia.

Further, Mr. Kohler has orally argued approximately 50 appellate cases. He successfully argued Georgia v. McCollum, 505 U.S. 42 (1992), in the United States Supreme Court. In 1996 the Supreme Court Historical Society named Georgia v. McCollum as one of the most significant oral arguments heard by the United States Supreme Court between the years 1955 and 1993.

Prior to pursuing a legal career, Mr. Kohler  served three years in the United States Army, including a year in Vietnam. He was awarded the combat medical badge and the Army Commendation Medal with Oak Leaf Cluster. Mr. Kohler has also been recognized by his peers as he’s earned the AV Peer Review Rating, which identifies a lawyer with “very high to preeminent legal ability, is a reflection of the firm’s expertise, experience, integrity and overall professional excellence.”

Please help us welcome Harrison to the firm!

Supreme Court Rules Medicaid Providers Cannot Sue To Enforce Their Rights

US Supreme CourtOn March 31, 2015, in a 5-4 decision, the United States Supreme Court issued its opinion in Armstrong v. Exceptional Child Center, Inc.[1] This decision essentially precludes all Medicaid providers from bringing a private cause of action to enforce their rights under the Medicaid Act.

Through Medicaid, the federal government subsidizes the States’ providing of medical services to qualified people. To get the federal monies, a state must adopt, and the federal government must approve, its Medicaid plan. Section 30(A) of the Medicaid Act requires that a state Medicaid plan must contain procedures to ensure that reimbursement rates for healthcare providers “are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” to meet the need for care and services in the geographic area.

In Armstrong, a group of providers filed suit under the Supremacy Clause to enforce the provisions of Section 30(A) and to enjoin the Idaho Health and Welfare Department officials from continuing to reimburse the providers at rates lower than rates set forth in a provider cost study that had recommended increasing reimbursement rates. The 9th Circuit ruled that the Supremacy Clause gave the providers an implied right of action to bring suit. The Supreme Court disagreed.

The majority of the Supreme Court reasoned that while the Supremacy Clause instructs the courts to give federal law priority when there is a clash between a federal law and a state law, it does not create a cause of action.

The Majority went on to hold that the providers could not proceed in equity because the power of the federal courts to enjoin unlawful state action must be set out expressly or implicitly in statute. Here, the court reasoned that the Medicaid Act set out an express provision of a single remedy for the State’s failure to comply with the Medicaid act. That remedy is found in 42 U.S.C. Section 1396(c) and stated that the Secretary of Health and Human Services may withhold Medicaid funds if the State is failing to comply with the Medicaid Act.

What are the real life implications of this suggested remedy? As pointed out in Justice Sotomayor’s dissent, the Majority’s suggested remedy-withholding state funds will lead to the very result the law was enacted to prevent: depriving the poor of essential medical assistance.

What is the potential impact of this decision? If low rates cannot be challenged, Medicaid recipients will have fewer choices of health care providers because lower reimbursement rates make it harder for healthcare providers to choose to provide care to Medicaid recipients.[2]

What remedies are left for a provider? In Georgia, a Medicaid provider’s relationship with the State is based in contract, so remedies under the contract may still exist. If you are a provider and have a question about your rights under the Medicaid Act, please contact Kimberly Sheridan at Jeyaram & Associates at 678-709-4703.

[1] For the full opinion, please go to http://www.supremecourt.gov/opinions/14pdf/14-15_d1oe.pdf

[2] http://harvardcrcl.org/supreme-court-threatens-medicaid-reimbursement-accountability/

 

Georgia Department of Community Health Conservative with Medicaid Changes

The Georgia Department of Community Health has decided not to move forward with an overhaul of Georgia’s Medicaid program.  There are two main reasons for the change:  (1) the Supreme Court’s decision to uphold the Affordable Care Act and (2) the upcoming election.  The Supreme Court left the decision of whether to expand Medicaid up to the individual states, and Georgia’s governor has not made a definite decision about whether or not the state will move forward with expansion of Medicaid under the Affordable Care Act.  In addition, some political leaders are voicing their intent to repeal the Affordable Care Act.  According to the DCH news release, “[T]he department concluded that the current health care environment is so volatile that acting now with a full redesign would not serve the best interests of all Georgians.”

DCH’s decision to implement only small changes based on information it received from the redesign process seems prudent in light of the current state of federal healthcare reform.  Implementing a complete overhaul of the entire Medicaid system in Georgia without definitive knowledge of whether Georgia will expand Medicaid under the Affordable Care Act or whether the Affordable Care Act will be overturned could create substantial problems for the state on many levels.  One impact is financial – the Medicaid budget is already facing a deficit, and DCH would be in an unfavorable position if it prematurely overhauled Medicaid at unnecessary expense to the State.

One final important point to note about the announcement is that DCH said that a Medicaid overhaul will not occur “at this time”, which means it could still happen after the political turmoil settles down. Any future changes to Georgia’s Medicaid program will be detailed here.