Saint Luke’s Health System of Kansas City Files Suit Against Molina Healthcare
KANSAS CITY, Mo. — Saint Luke’s Health System has filed suit against Molina Healthcare, Inc., a Fortune 500 company that manages Medicaid plans for approximately 1.8 million members nationwide, for failing to pay multiple claims related to mental health services for Medicaid-eligible patients at Crittenton Children’s Center, Saint Luke’s child and adolescent behavioral treatment facility. The suit, which focuses on claims submitted between 2010 and 2011, also alleges Molina has violated Missouri’s "Prompt Pay" statute, which requires managed care providers to pay their obligations to health care providers in a timely fashion.
Saint Luke’s seeks damages, which include the unpaid claims together with penalties and interest under the Prompt Pay statute, in excess of $1,048,293.81.
"The issue of managed care providers and their obligation to responsibly process and pay claims is of vital importance to all Missouri health care providers who provide care to Medicaid patients," said Tim Van Zandt, Vice President of Public Affairs for Saint Luke’s Health System. "In this specific case, Molina’s actions deserve particular scrutiny as they impact the mental health coverage and care of one of our most vulnerable patient populations, our Medicaid-eligible children and their families."
Saint Luke’s Health System is a not-for-profit health care provider offering care in Missouri and Kansas. As a fundamental role of its service to the community, Saint Luke’s accepts reimbursement for health care services through the Medicaid program, which is designed to ensure access to needed care for patients with low incomes and who lack private health insurance. The lawsuit filed in Cole County, Mo., focuses on 127 unpaid claims by Crittenton Children’s Center for services it provided to minor patients, including patients who had been placed at the facility by the Children’s Division of the Missouri Department of Social Services in conjunction with the state’s foster care program.
"Our ability to receive reimbursement for treatment provided is critical to our ability to continue to care for these patients," said Janine Hron, CEO of Crittenton Children’s Center. "Crittenton is deeply committed to our not-for profit mission and while across the region we are seeing other psychiatric care providers eliminating or reducing services for children and adolescents due to shrinking reimbursements, Crittenton is continuing and expanding programs to serve these children and their families. For this to continue, we must be able to feel confident in our ability to receive reimbursement for the care and services we provide."
During the time of the alleged violations, Molina Healthcare had a contract with the State of Missouri to provide various services in connection with Missouri’s Medicaid managed care program. In 2012, Molina’s state contract came up for renewal and, at that time, the State of Missouri elected not to renew Molina’s contract and ordered Molina to pay all outstanding claims. The lawsuit alleges that not only did Molina not pay claims, the company also failed to provide any response to Saint Luke’s numerous written requests that Molina provide an explanation as to why the claims have gone unpaid.
"We are confident that our cause of action will be supported by the courts," said Van Zandt. "However, this case is larger than just this individual lawsuit. It highlights the importance of state contractor selection and the possible negative impact these managed care providers can have on healthcare in the State of Missouri if they don’t follow through on their responsibility to pay. They must be held accountable to paying the claims they have approved and legitimately owe to ensure quality care continues to be available to all."
Saint Luke’s Health System consists of 10 area hospitals and several primary and specialty care practices, and provides a range of inpatient, outpatient, and home care services. Founded as a faith-based, not-for-profit organization, our mission includes a commitment to the highest levels of excellence in health care and the advancement of medical research and education. The health system is an aligned organization in which the physicians and hospitals assume responsibility for enhancing the physical, mental, and spiritual health of people in the metropolitan Kansas City area and the surrounding region.