Gov. Kathy Hochul wants to shut down a billing tactic she says lets specialists squeeze higher payments from Medicaid, according to the Times Union. Her budget proposal would block providers from using the state’s independent dispute resolution process to challenge Medicaid reimbursements.
State officials argue some out-of-network specialists exploit the system to secure rates that exceed standard Medicaid payments, driving up costs for taxpayers. A recent lawsuit by Fidelis Care claims one anesthesia provider used a billing switch to collect inflated reimbursements.
Critics, including some lawmakers and hospital leaders, warn the change could discourage specialists from serving low-income communities. Lawmakers will debate the measure as budget talks continue through March.
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