AUGUSTA, Maine — Maine Family Planning has sued the Department of Health and Human Services, seeking to overturn an agency order compelling the organization to repay $185,000 it billed to MaineCare for services provided to pregnant women considering abortions.
In t he suit, filed Oct. 2 in Kennebec County Superior Court, Maine Family Planning alleges that DHHS reinterpreted its own rules regarding what services should and shouldn’t be covered by MaineCare, which is Maine’s version of Medicaid, the federal low-income health care program.
DHHS made its ruling in August 2015, but it only came to light when the lawsuit was filed.
George Hill, chief executive of Maine Family Planning, said the services in question — such as blood typing, pregnancy dating and post-pregnancy contraception — were provided for more than a decade before DHHS opened an investigation five years ago.
“These are services that any pregnant woman would require, regardless of the outcome of her pregnancy, and in any other setting, would be eligible for MaineCare reimbursement,” said Hill in a written statement. “That Maine Family Planning received both verbal and written direction from the department to bill for these services is not in question, nor is there any evidence that Maine Family Planning disregarded guidance from DHHS at any time, billing or otherwise.”
DHHS spokesman David Sorensen said “the department has taken appropriate action to enforce the law, treating Maine Family Planning’s case as it would any other audit of a MaineCare provider.”
DHHS Commissioner Mary Mayhew said audits of Medicaid-funded service providers are routine.
“We are confident in our case and look forward to the opportunity to present it to the court,” said Mayhew in a written statement.
Hill said DHHS guidance on this issue was clear until the agency reinterpreted its rules.
“We are disappointed that the DHHS commissioner has discounted the guiding role that her own MaineCare staff played in establishing Maine Family Planning’s original billing practices,” said Hill.
“We believe our case has merit and that we will find in the Superior Court setting a more objective, more impartial setting in which to state our case,” he added.