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When the rule was promulgated, the Centers for Medicare & Medicaid Services published guidelines to help states and physicians interpret the law.

In one Q&A document, CMS stated that physicians board certified in non-eligible specialties who provide primary care and meet the 60 percent threshold could still be eligible for the enhanced payments.

Although a Hawaii obstetrician-gynecologist in a medically underserved area spent more than 60 percent of his time providing patients with primary care services, state officials say he cannot collect higher Medicaid payments allowed under a 2010 federal law designed to encourage physicians to provide this care.

On top of that, the state told the Hilo physician, Frederick Nitta, MD, that he must pay back the 5,000 he has already been paid for care he provided Medicaid patients and billed for at the higher rate.

If Hawaii courts allow the state’s “arbitrary and capricious” interpretation of the law’s provision to remain intact, physicians will be forced to deny vital medical services or risk closing their practices, the Hawaii Medical Assn.

If you decide you want to discontinue the service, you can cancel your subscription at any time.The law says eligible physicians must either “self-attest” as family physicians, general internists, pediatricians or a subspecialist in a specialty recognized by the American Board of Medical Specialties, American Board of Physician Specialties or the American Osteopathic Association.Also, at least 60 percent of Medicaid codes the physician bills must be primary care related codes that the law names.The HMA and Litigation Center say this approach skews the ratio. Nitta’s records, an auditor concluded that well over 60 percent of the physician’s time was spent providing primary care treatment and services to Medicaid patients, the brief says.The state is seeking repayment from at least one other physician in a shortage area and the HMA and Litigation Center told the court “it is inevitable that more local physicians will be notified that substantial amounts are owed to [the state] for alleged overpayment.” If that happens, “local physicians will be forced to make the difficult choice of denying medical services or risk closing their practices,” the amicus brief warns.

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