Georgia doctors take on Medicaid HMOs over slow pay

The state medical association has asked the governor to delay statewide implementation of the Medicaid managed care program until problems are addressed.

By Amy Lynn Sorrel, AMNews staff. Sept. 11, 2006.

Georgia perinatologist Brad S. Bootstaylor, MD, says his Atlanta practice has not received Medicaid reimbursements for more than two months. He has had to lay off two employees, and his group is owed about $300,000 in outstanding claims since three private HMOs began to take over management of the state's Medicaid program in June.

"The transition to private insurers has made it difficult to provide the care that these patients need and deserve," said Dr. Bootstaylor, who practices at Atlanta Perinatal Associates. Between 30% and 40% of the group's patients are on Medicaid.

That is why Dr. Bootstaylor, along with about a dozen other doctors and medical groups, filed a lawsuit in August alleging that Peach State Health Plan, WellCare of Georgia and AMGP Georgia Managed Care Co. have violated the state's prompt-pay law.

The statute requires them to reimburse doctors within 15 business days of receipt of a clean claim.

The doctors, who are seeking class-action status, also allege that the managed care plans knew they were incapable of processing and paying claims on time when the Georgia Dept. of Community Health awarded them the $3 billion Medicaid contract last July.

"We have a contract ethically and morally to provide the best care to our patients, and they have a written contract to pay practitioners for doing that," Dr. Bootstaylor said.

Because of millions of dollars in late reimbursements, the doctors who filed suit claim they have had to lay off staff and scale back patient services.