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Home Health Group’s Suit Against Medicare Advantage Plan Tossed

Nov. 19, 2019, 2:09 PM

A home health-care provider can’t sue a Medicare Advantage plan over its sporadic refusal to pay for pain management services because the provider didn’t exhaust its administrative remedies first, a federal court in Missouri said.

Physicians Home Health Infusions PC’s breach of contract and misrepresentation claims were “inextricably intertwined” with the Medicare Act, the court said. Thus, it had to appeal Unitedhealthcare of the Midwest Inc.'s payment denials through the Health and Human Services Department before going to court, the U.S. District Court for the Eastern District of Missouri said.

UHC is a private company that contracts with the Centers...

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