Appellate court affirms dismissal for Harmony Health Plan of Illinois Inc. and Amerigroup Illinois Inc.

June 17, 2008

On May 15, 2008, the Illinois Appellate Court found that reimbursements made by Medicaid Managed Care Organizations Harmony Health Plan of Illinois Inc., and Amerigroup Illinois Inc. to emergency medical service providers were in accordance with federal and state law, as well as the parties' agreements as Medicaid payers and providers.

The putative class action was brought by non-participating providers of emergency medical services seeking to be paid their significantly higher billed charges, rather than the Illinois Medicaid rate. The court affirmed the dismissal of the action, ruling that a contrary decision would risk the “extinguishment” of the managed care organizations. The decision is important for the managed care sector, because it addresses disputes that have arisen around the country between non-participating providers and managed care entities. In particular, the court held that to allow providers the right to receive their billed charges would negatively impact the Medicaid program.

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