St. John”™s Riverside Hospital has sued MVP Health Care, claiming that the insurance company is making partial payments for Medicaid services.
The Yonkers hospital said MVP Health Care owes $428,277 for missed payments last year.
“Despite demand by the hospital that defendants pay the correct rate on all of its Medicaid claims,” the lawsuit, filed in Westchester Supreme Court states, “defendants have refused to do so.”
A spokeswoman for MVP said the Schenectady company does not comment on pending litigation.
The lawsuit also names Hudson Health Plan, the company that struck the Medicaid deal with St. John”™s in 2014. MVP acquired Hudson, the complaint states, and has assumed responsibility for Medicaid payments for the past two years.
St. John”™s sees patients at three locations: Andrus Pavilion in Yonkers; ParkCare Pavilion in Yonkers; and Dobbs Ferry Pavilion.
The Medicaid program covers inpatient services, such as coronary care, surgeries and medicines, and outpatient services such as rehabilitation.
St. John”™s said the agreement requires MVP to cover services for its Medicaid members at 100 percent of the state-established rate.
The rate is adjusted from time to time and applied retroactively to patients who were discharged before the new rate was published.
Last year, New York changed the Medicaid rates twice, but MVP, St. John”™s claims, arbitrarily paid some of the bills but not others.
MVP “has steadfastly refused to make any additional payments,” the complaint states.
The dispute comes at a time when St. John”™s is struggling financially. In 2015, for instance, it lost nearly $7.4 million on $242.6 million in revenue, according to its nonprofit tax form.
Recently, St. John”™s has been looking for a partnership with a larger health care network.
St. John’s is represented by attorneys Michael J. Keane and Colleen M. Tarpey, of the Garfunkel Wild law firm in Great Neck.
