Today, Nossaman announced that the firm’s client Sutter Health received the final decision in a major Medi-Cal appeal case. The decision will be of major significance to all hospitals in the state that have Neonatal Intensive Care Units (NICUs) because it clarifies the reimbursement rate available through Medi-Cal based on nurse-to-patient ratios.
“We’re thrilled with the outcome of the case,” said Nossaman Partner and lead attorney in the case, John Wagner. “It was a long battle to reach this outcome for our client, which will recoup anywhere from $1.3 to $3 million. The case began in the administrative law court and we had to appeal it twice to Superior Court in order for our client to receive a fair hearing. In the end our client was victorious and we’re thrilled to have this decision not only for Sutter Health but for all hospitals throughout the state with Neonatal Intensive Care Units.”
Previously two significant courts of appeal decisions had held Medi-Cal was not obligated to reimburse hospitals at the special Neonatal Intensive Care Unit rate when nurse-staffing ratios were greater than one nurse to two patients (1:1-2). Arguing on behalf of Sutter Medical Center Sacramento, Mr. Wagner was able to demonstrate that the hospital had met requirements that entitled them to reimbursement at the special rate including on days when nurse-staffing ratios were at one nurse to three or four patients (1:3-4). All hospitals in the state with sophisticated Neonatal Intensive Care Units will benefit from the resultant clarification of case law.
