Senior Care Centers claims MCOs are improperly holding $25.79 million

By Caroline Salls

Pittsburgh, May 31 – Senior Care Centers, LLC is asking the U.S. Bankruptcy Court for the Northern District of Texas to order several managed care organizations and the Texas Health and Human Services Commission (HHSC) to show why they should not be held in contempt of court and subjected to sanctions for failing to release Medicaid funds allegedly due to the Senior Care debtors, according to a motion filed Thursday.

Senior Care said the debtors receive revenue from third-party payors and/or patients, with the third-party payments being funded by Medicaid and Medicare reimbursements. HHSC administers the Texas Medicaid program.

Generally, the company said MCOs act as intermediaries between the states and health care providers. Through this relationship, the states disburse funds to the MCOs, which then reimburse health care providers in their networks for services rendered to enrollees.

According to the motion, the managed care organizations used by the Senior Care debtors are Amerigroup Texas, UnitedHealthcare, HealthSpring, Superior Health Plan, Molina Healthcare of Texas and Texas Medicaid & Healthcare Partnership.

In April, HHSC put a hold on specified funds, claiming “certain of the debtors have failed to refund resident credits intended under the IME Program to pay for dental services and certain durable medical equipment.”

However, Senior Care said the amount of funds held was allegedly miscalculated, meaning it is owed $25.79 million.

The company said in the motion that the court should impose sanctions of $100,000 per-day after the show-cause hearing is held until the funds are turned over by the MCOs and HHSC to the Senior Care debtors.

A June 5 hearing has been requested.

Senior Care Centers is a Dallas-based skilled nursing and long-term care industry leader in Texas and Louisiana. The company filed bankruptcy on Dec. 4, 2018 under Chapter 11 case number 18-33967.

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