News Brief: Court tells Medicaid it violated federal law
In what appears to be a step forward in the struggle by hospitals to get paid for their services, the Maryland State Court of Appeals ruled in late June that the state’s Medicaid program violated federal law by refusing to reimburse Baltimore’s Johns Hopkins Hospital for two liver transplants.
The state said the procedures were not "appropriate," but the court ruled that "medical necessity," not whether a procedure is "appropriate," is the federal standard, according to a report in the on-line news service AHA News Now.
The procedures cost $264,000. Denial in one stemmed from the case of a 10-year-old boy with end-stage liver disease who had two liver transplants — paid for by the state — in 1992. When the boy fell ill again in 1995, the state refused a third transplant after an evaluation showed "risk-taking behaviors" by the boy, including selling drugs and drinking alcohol. The second case involved an unknown cause for liver failure in a young girl. The boy is still alive, but the girl died one year after her transplant.
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