Firms representing nursing homes don’t have the authority to sue the state of Illinois and Medicaid managed care organizations for outstanding bills for beneficiaries, an appeals court has ruled.
The U.S. Court of Appeals for the Seventh Circuit handed down the ruling Tuesday against nursing home consulting and services firms Bria Health Services, LLC, Everest Care Group, LLC, Grand Lifestyles LLC and iCare Financial Services Inc., Bloomberg Law reported.
In a statement, Chad Bogar, managing partner with sb2 inc., which represented the firms, said they’re thankful the court provided “substantive guidance on the standing issue in these type of matters.”
“Both federal [and] state courts have come down on both sides over the last several years, which has caused delay and expense for everyone involved. Despite not reaching the merits, though, our clients have seen substantial improvement since the litigation was commenced and filing of the appeal with the court,” he added.
The firms were appointed by Medicaid beneficiaries who alleged that Aetna, Cigna, Humana and Molina Healthcare of Illinois Inc. haven’t “timely processed” claims for services.
The firms had argued that Medicaid regulations allow beneficiaries to appoint representatives to handle various matters with the agency, which includes filing a lawsuit, according to the report.
The court, however, found that the regulation only allows a representative to be designated only for the purposes of eligibility applications and determinations.