Recently, a Medicare Advantage (MA) plan began issuing settlement offers to hospitals for 340B MA Underpayments. Active pursuit of damages by multiple hospitals including demand letters and activation of arbitration clauses, and/or factors within the MA plan’s portfolio may have all contributed to this development.
Settlement offers from MA plans should be reconciled to the actual payment data. Do not get caught settling for less than the actual damages incurred from underpayments! MA settlement offers may be for much less than the underpayments that occurred. Any current or future offer for settlement could have a timeline to accept or decline the offer.
Hospitals who took early action and outsourced production of reports documenting damages to third parties or whom had third parties verify internal reports are in a strong position to evaluate settlement offers. Hospitals who chose to “wait and see” may be scrambling to produce valid reports or to find a qualified party such as GDS to quantify their damages.
Hospitals who "go it alone" should be prepared for their internal employees or report writers to be deposed under oath and to possibly testify in front of judges, magistrates, or at jury trial on the detailed and complicated outpatient payment profiles.
Most hospitals should have 340B MA Underpayment damages quantified and documented by a third party or at least have their internal reports reviewed.
Contact Adam Blackwell at
adamblackwell@govdataservices.com for further discussion or to schedule a complimentary initial consultation on the status of 340B MA Underpayment efforts.