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Providers’ Challenge to ‘Must-Bill’ Policy
For Dual Eligibles Remanded to Agency

April 3, 2012, 4:00 AM

A change in enforcement of the Department of Health and Human Services’ “must-bill” policy requiring providers to bill states for dual eligible beneficiaries was arbitrary and capricious if it did not take into account the providers’ legitimate reliance on prior interpretations, a federal trial court ruled March 26 (Cove Associates Joint Venture v. Sebelius, D.D.C., 1:10-cv-01316-BJR, 3/26/12).

The U.S. District Court for the District of Columbia remanded the case for a decision on whether Cove Associates Joint Venture d/b/a/Life Care Center of Scottsdale and Select Specialty Hospital of Denver Inc. were justified in relying on HHS’s prior ...