A Colorado HMO has won a $9.8 million judgment in a lawsuit charging state officials with a systematic underpayment of Medicaid claims for indigent patients. Denver District Judge Larry Manzanares ruled last week that Community Health Plan of the Rockies is owed the money for a pattern of shortages that stretched from 1997 to 2001. Last November, another large Medicaid HMO -- Rocky Mountain Health Plan of Grand Junction -- won a $21.5 million judgment after charging the state with underpayments. The state also is facing lawsuits charging underpayments of a total of about $114 million from three other Medicaid HMOs -- Kaiser Permanente, Qual-Med and Colorado Access, the only Medicaid HMO offering managed care across Colorado. Jim Hertel, editor of Colorado Managed Care, a newsletter that tracks the industry, said the state may cover its 50% share of the judgments (the federal government is responsible for the other 50%) by cutting provider payments. "The ultimate outcome," Hertel said, "could well be less money for providers and fewer providers interested in serving the Medicaid population." -- by Michael Romano
HMO wins suit against Colo. Medicaid
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