Tenet Healthcare Corp. and its seven Philadelphia-area hospitals are suing Medicaid HMO Keystone Mercy Health Plan for "regularly and aggressively reducing and/or denying the payment of legitimate claims." Since 1998, Keystone's denials and underpayments have cost Tenet approximately $15.9 million, and the health plan denies claims at twice the rate of other Medicaid HMOs, Tenet alleged. Keystone also routinely denies and rejects appeals, overturning its denials at one-tenth the rate of others, Tenet said. The lawsuit was filed in Common Pleas Court in Philadelphia on Oct. 29 and transferred to federal court last week. Keystone responded that Tenet's claims are baseless. "Our approach to medical management meets and exceeds all regulatory and (National Committee for Quality Assurance) quality standards," a spokesman said. -- by Cinda Becker
Tenet fights with Philadelphia-area HMO
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