Neighborhood Health sues state, alleges $100 million in unpaid Medicare costs
Neighborhood Health Plan of Rhode Island is alleging the state owes it $100 million in unpaid Medicaid reimbursements, according to a complaint filed in Providence County Superior Court on Oct. 30. The 20-page complaint targets the Rhode Island Executive Office of Health and Human Services (EOHHS), arguing the state breached its contracts with Neighborhood and failed to meet its obligations to properly track Medicaid cases and cover cost increases, despite being aware of discrepancies, with the nonprofit health plan footing the bills for roughly a decade. "The State has acknowledged its reconciliation problems since at least 2018, and when it reconciled a limited sample of members, it found large underpayments," the lawsuit reads. "Yet it has refused to reconcile the rest, most recently rejecting an audit that would cover all members and all years under the contracts." The suit brings four charges and seeks a court order for the state to complete the payments subject to Neighborhood's review or that of a court-appointed independent auditor. It also seeks damages in an amount to be proven at trial that Neighborhood says stem from the state's failure to meet its obligations under the contracts, as well as reimbursement for its legal fees.
