Hearing looks at lawsuit on school staff care plan

MASSENA — A hearing was scheduled for Tuesday in St. Lawrence Count Court, Canton, to discuss litigation between Massena Memorial Hospital and the St. Lawrence-Lewis Counties School District Employees Medical Plan.

Massena Memorial Hospital Interim Chief Executive Officer Patrick Facteau said the case boils down to the amount paid to the hospital for services.

“We lost money because we’re not getting paid appropriately,” he charged during Monday’s Board of Managers meeting.

He said, if the hospital had been paid appropriately, it would have received $210,000 more in revenue last month.

Mr. Facteau said according to a contract with BOCES, Massena Memorial is supposed to receive 92 percent reimbursement for all costs for outpatient services performed by the hospital on people covered by the plan. But, he alleged, the payment has fallen short.

“They were paying closer to 62 percent than they were to 92 percent,” he said. “They paid specifically the outpatient rates any way they wanted to. They did not follow the contract.”

St. Lawrence-Lewis BOCES Superintendent Thomas Burns has a different interpretation of the contract.

“While we do not want to offer details regarding active litigation, it is well known that MMH has had significant financial woes for many years, and their lack of financial stability has multiple causes including major reductions in Medicaid and Medicare revenue as dictated by policy makers. We obviously believe that their interpretation of the contract is erroneous and that will need to be borne out claim by claim and decided upon by the court,” he said in an emailed statement.

The ongoing legal battle between the hospital and the insurance plan, which is run out of the St. Lawrence-Lewis BOCES office and covers almost 10,000 teachers in 16 school districts, began in August 2017. The hospital claimed at the time the insurance plan had not paid almost $3.7 million for services under the 1997 agreement between the hospital and the insurance plan.

In March 2018, a judge ruled the suit could continue and the hospital could file an amended claim.

“The contract wasn’t followed. We met with them and said, ‘Why aren’t you paying? Do you have something different? Do you have something you can show us?’ We couldn’t get anywhere with them, so we brought suit,” Mr. Facteau said.

He said the hospital is the only organization bringing suit against BOCES, although others could.

“I know one was getting close to doing it, but they never did,” he said.

Starting Jan. 1, Excellus Blue Cross/Blue Shield will take over health insurance administration for the St. Lawrence-Lewis Counties School District Employees Medical Plan. That function has been handled by staff at St. Lawrence-Lewis Board of Cooperative Educational Services working in BOCES’ administrative offices for more than 30 years.

“We know that BOCES will no longer be processing claims for BOCES districts at the end of the year,” Mr. Facteau said.

The health consortium will remain intact after the administration change. It comprises 15 of the 18 school districts in the St. Lawrence-Lewis BOCES region plus BOCES employees.

Heuvelton and Madrid-Waddington central school districts are not in the consortium and Ogdensburg City School District plans to leave it June 30”

Johnson Newspapers 7.1

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