Does Medicaid Act provide a private right of action for Medicaid providers?

Medicaid Act

Under the Medicaid Act, Medicaid agencies must give consideration to provider costs when setting rates. However, is there any recourse for private health care providers in instances in which Medicaid rates are deemed to be too low? In other words, does the Medicaid Act provide a private right of action for Medicaid providers?  That right was recently tested in the case of Armstrong vs Exceptional Child Center Inc.


Medicaid is a federal health insurance program that is administered by the each state, and is aimed at low-income people. Medicaid reimburses costs for institutional care, but the federal government gives states some discretion when setting rates under the Medicaid program.

Armstrong vs Exceptional Child Center Inc.

Recently,medical providers in Idaho sued Medicaid in order to get them to comply with federal payment requirements. The suit was in relation to rates set for people with developmental disabilities.

They argued that low rates would deter new medical providers from agreeing to participate in Medicaid, and also cause existing providers to reconsider their participation. The overall result would be reduced access to health care for Medicaid patients. However, Idaho Medicaid officials argued that the private right of action was not authorized by Congress.

The US Supreme Court ruled in favor of the state of Idaho. Therefore the Medicaid Act does not provide a private right of action for Medicaid providers. This ruling means that health care providers have no recourse in cases where Medicaid rates are not in keeping with costs, as they can’t sue Medicaid to raise the rates (learn more).

Contact Nelson Hardiman, Los Angeles, CA, for more information on Medi-Cal and other matters. Call 310.203.2800 to speak to an attorney.

What are the major funding implications for Medi-Cal & Medicaid patients?

Medicaid reimbursement payments to health care providers under the Medicaid Act are required to be ‘consistent with efficiency, economy, and quality of care and services.’  The rate of Medicaid payments was recently challenged when health care providers in Idaho sued Medicaid over rates. What are the major funding implications for Medi-Cal and Medicaid patients, based on the ruling of Armstrong vs Exceptional Child Center Inc.?

Medicaid Reimbursement
Under Medicaid, states are given funds by the federal government to reimburse medical expenses for individuals that have dependent children, as well as individuals that are old and disabled.

The funds provided by Medicaid typically cover costs for institutional care. However, in instances where the cost of in-home care is either the same or less than the cost of institutional care, states may reimburse service providers for the cost of in-house care for individuals that are eligible for Medicaid.

The issue
Under section 30(A) of the Medicaid Act, state Medicaid agencies are required to take account of provider costs when setting reimbursement rates. In the case of Armstrong vs Exceptional Child Center Inc, the court was asked to consider whether under the Supremacy Clause, individual medical providers had a private right of action to enforce Section 30(A) of the Medicaid Act. This was in view of the fact that Congress did not clearly grant a private right of action.

Judgment and Implications
The US Supreme Court sided with the state of Idaho, and ruled that the Supremacy clause does not create a private right of action. Based on the ruling, hospitals and other health care providers cannot sue Medicaid over low reimbursement rates.  This means that health care providers are going to find it difficult to get better Medicaid funding rates.

For more information on Medi-Cal and Medicaid related matters, contact Nelson Hardiman, Los Angeles, CA. Call 310.203.2800 for an appointment.

Say “Good bye” to Love Handles and Fat with an Exilis body contouring treatment

does Laser Lipo work

If your love handles are making you feel unlovely, then maybe it’s time to do something about them. Perhaps you don’t know what to do, because you’ve tried everything to get rid of the stubborn belly fat on the sides without success. Don’t despair, because you can now say goodbye to love handles and fat with an Exilis body treatment.  But what is Exilis and how does it work?

Exilis Body Treatment

Exilis is a body contouring treatment that uses radiofrequency (RF) technology to shape and tighten the body. The laser energy targets and heats the fat cells in the deep layers of the skin. This action destroys the fat cells without harming the surrounding healthy cells. This makes it the ideal option for those localized areas of fat deposits like love handles, which are often difficult to trim.

Exilis also enhances the production of collagen and elastin. As a result, skin gets tighter and firmer over time. Exilis is a non-invasive treatment that works fast and has little downtime. This means that patients can quickly resume regular activities.

It generally takes 4 to 6 treatments with Exilis to achieve the desired fat reduction; however, many patients notice improvement after only one session. Exilis is a safe body contouring alternative that has been tested and cleared by the FDA. No significant side effects have been reported with Exilis (learn more).

Exilis treatment is available at Cobb Wellness and Aesthetics, Roswell, GA. So, if you are ready to say goodbye to love handles and fat, give us a call today at 770-649-0094. During your consultation Dr. Linda Kelley, will tell you more about the Exilis body treatment.

Why you should be as concerned about California’s Confidentiality of Medical Information Act (CMIA) as HIPAA

Under the federal Health Insurance Portability and Accountability Act (HIPAA), failure to secure protected medical information (PHI), can result in serious consequences. However there are some state privacy laws, like those in California, that also carry severe penalties.  This explains why you should be as concerned about California’s Confidentiality of Medical Information Act (CMIA), as you are with HIPAA (learn moer).

While many health providers are aware of the risks under HIPAA, they don’t’ realize that breaching CMIA’s data laws may be even riskier.  Under CMIA any private party can bring a lawsuit claiming monetary damages. However, under HIPAA investigations are carried out by the government.

CMIA strictly prohibits the disclosure of medical information, without prior approval of the patient.  A violation is considered so serious that if your medical records are compromised, you are entitled to $1,000 even if the disclosure does not adversely affect you in any way.

In the case of Sutter Health v. Superior Court (227 Cal.App.4th 1546 (July 21, 2014)), a class action suit was brought against Sutter Health Medical based on their violation CMIA. This arose because of the theft of Sutter Health’s desktop computer, which held medical records belonging to about 40mil patients. Although there was no evidence that the medical records were actually viewed by unauthorized persons, the suit was filed by a party of interest, alleging breach of confidentiality.

Although the Appeals Court held that Sutter Health should not be held accountable, the argument regarding strict liability has not been settled. This case underscores the reason why health care providers should be as concerned about CMIA, as they are about HIPAA. It is therefore vital that health data compliance policies are appropriately administered. Contact Nelson Hardiman, LLP, Los Angeles at 310-203-2800 for more information.