Vaccine Administrative Action Update
Good news! Practices who see Medicaid patients and had attested physicians/NPs in 2013 and 2014 should have received a check (likely substantial) earlier this month correcting an underpayment on vaccine administrative fees that occurred during the ACA years.
NCPeds, our Pediatric Council and the North Carolina Academy of Family Physicians (NCAFP) advocated together for the NC Division of Medicaid to correct a significant underpayment on administrative fees for immunizations provided to Medicaid recipients under the Vaccines for Children program in 2013 and 2014.
After discussions urging NC Medicaid to correct these underpayments proved unsuccessful, NCPeds and NCAFP joined eight private pediatric practices to retain a lawyer and began an official administrative action.
In October 2017, the judge ruled in our favor and instructed NC Medicaid to reprocess the payments with an extra $6.74 per affected vaccine without any additional work by providers.The court documents are available on the NCPeds member website (must be logged in as a member to view).
NCPeds would like to thank the people who made this undertaking possible.We are especially grateful to Graham Barden III, MD, FAAP at Coastal Children's Clinic, who identified the underpayment and related issues, and Christoph Diasio, MD, FAAP at Sandhills Pediatrics, who together dedicated countless hours to this effort which truly would not have happened without their involvement.
NCPeds would also like to thank our attorney, Joey Ponzi at Brooks Pierce who served as a spectacular advocate on our behalf. He is also, very deservedly, this year’s Good for Kids Awardee.
Significantly, this effort could not have proceeded without generous financial support from eight private pediatric practices who felt strongly enough about this issue to take the risk of funding the initial legal costs:
Blue Sky Pediatrics
Cary Pediatric Center
Coastal Children's Clinic
Haywood Pediatric and Adolescent Medicine Group
KidzCare Pediatrics PC
NCPeds would also like to thank to the practices that have donated since the ruling to help us retire our legal bills. And finally, we would like to thank our members because membership dues and donations keep NCPeds strong and helped make this work possible.
It was a great honor to represent North Carolina’s amazing pediatric community in this effort!
To support NCPeds work, donate on our secure NCPeds secure giving portal.