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March 28, 2008 at 02:19 PM
The Employee Benefits Security Administration has issued an advisory opinion discussing when Medicaid plans can sue group health plans over unpaid bills.
Lisa Alexander, coverage division chief at EBSA, an arm of the U.S. Department of Labor, has written the opinion, 2008-03A, in response to a question from Ginni Hain, an eligibility division director at the federal Centers for Medicare & Medicaid Services.
Hain wrote to ask EBSA what Medicaid plans should do when beneficiaries who also belong to employer-sponsored group health plans fail to follow the group plan preauthorization rules.
If a state Medicaid plan pays a beneficiary’s bill because of a pre-authorization failure, can the Medicaid plan sue to be reimbursed by the group health plan? Hain asks.
