Spokane-area doctors and hospitals are turning up the heat in their campaign to obtain payment for health care they have provided to Medicaid patients from Idaho.


An alliance of the Spokane County Medical Society, Empire Health Services, and Providence Services Eastern Washington has asked the agency that oversees Idahos Medicaid program to review the issue, says Janet Monaco, executive director of the medical society. Depending on the outcome of that review, the alliance is prepared to take legal action and also ask for legislative relief to bring an end to nonpayments that they say cost them millions of dollars each year.


Through its partners, the alliance represents Spokanes four hospitals, plus the approximately 750 physicians who are members of the Spokane County Medical Society. Spokane hospitals and doctors have contended for months that Idaho Medicaid routinely denies their claims for reimbursement after theyve treated patients who are covered under Idahos Medicaid program. Medicaid is a federal- and state-funded health insurance program for low-income people and disabled children.


Its hard to gauge the extent of the problem here, but last year, Spokanes Sacred Heart Medical Center alone said it was owed $1.5 million for nearly 200 unreimbursed claims it had made to Idaho Medicaid. Hospitals bear the majority of the burden because much of the care given to patients covered by Idaho Medicaid is provided in hospital emergency rooms, says Dr. Rodney Trytko, past president of the county medical society.


As a first step in resolving the problem, the alliance has asked the state agency that oversees Idahos Medicaid program to review selected claims made by Washington health-care providers and tell the alliance why those claims were denied, Monaco says.


Weve gotten (the agency) to designate a person to review all the claims that have been unpaid, Monaco says.


In March, the alliance selected a variety of medical specialists and primary-care physicians to each submit five claims that had been denied by Idaho Medicaid, she says. We want to give them a chance to say, Well, this is why, and this is what we found, and hopefully we can learn something from it and wont have to go any further. Monaco says.


No response is expected for another month or so, she says.


However, if the alliance partners arent satisfied with the response they receive, theyre prepared to take action on several fronts, says Dr. Deborah Harper, a Spokane pediatrician who is serving as the medical societys president this year.


She says, We will go to our legislators and ask them and Gov. (Gary) Locke both to reinstate the (system) that theyd had previously, which called for Washingtons Medicaid program to reimburse health-care providers for treating Idaho Medicaid patients, and Idahos Medicaid program to reimburse providers in that state for care given to Washingtonians covered under Medicaid. The two Medicaid programs then settled up at the end of the year. That has fallen apart in the past several years, Harper says.


Trytko says that the joint-reimbursement arrangement was an agreement between the two states that was discontinued because Idaho was unwilling to live up to the bargain.


The hospital-physician alliance already has moved ahead on another front by identifying the person in Idahos Department of Health and Welfare who is responsible for holding up all these payments, Harper says. The medical society has been in contact with that person, and though the Idaho representative has been cooperative, no progress has been made, Harper says.


Im assuming she is under direction not to pay, Harper says.


Finally, the local alliance, with the help of the Washington State Medical Association, is prepared to hire one or more attorneys to take legal action against Idahos Medicaid system, she says.


Empire Health Services already has been pursuing legal avenues successfully in its own effort to be reimbursed by Idaho Medicaid, Harper points out.


Randall Stamper, a Spokane attorney, confirms that he has represented Empire Health Services in Medicaid-payment actions in North Idaho counties.


Weve worked at the county level to try to get relief, Stamper says, adding that his work has involved a significant number of cases on behalf of Empire.


We usually go before the county commissioners, because they control Medicaid money at the county level, Stamper says. Hes had mixed success in obtaining payment for Empires hospitals.


Theres a tendency in North Idaho counties to deny payment for Medicaid patients (who are) coming to Spokane hospitals, and argue about it later as to whether it was truly an emergency or whether care could have been provided in North Idaho, Stamper says. Our frustration is that that happens in clearly emergent cases.


He adds, Theres a tendency for (Idahos Medicaid program) to be very happy to obtain the service from us but to not want to pay for it.