Clinic Sues FamilyCare for $3 Million

June 9, 2010 -- FamilyCare, a Medicaid managed care plan, has been hit with a $3 million lawsuit over a contract dispute from one of its clinics.

 

Teri Bunker alleges that FamilyCare refused to abide by its capitation agreement – and did not give her the money withheld during 2008, 2009 and the first five months of 2010. During that time Bridge City Family Medical Clinic saw up to 3,000 FamilyCare members. Bunker, a licensed family nurse practitioner, owns the Multnomah County clinic.

 

FamilyCare “knowingly and intentionally” kept those government-paid dollars for “its own use and benefit,” according to the lawsuit filed in Multnomah County Circuit Court on June 4. There’s no state or federal law or regulation limiting such capitation payments, and the claim of illegality “was a pretext to cover up its unwillingness to comply with the parties’ agreements and a device to keep more money for itself.”

 

Bunker believes FamilyCare withheld money in 2008 to cause her “economic duress” in the hope that she would retroactively agree to a reduced capitated payment agreement,” the lawsuit contends.

 

Bunker, whose contract with FamilyCare ended on May 4, also contends that FamilyCare refused to help her patients remain under her care, “and intentionally misled the patients,” rather than transfer them to CareOregon, another Medicaid managed care plan.

 

“This is not a precipitous filing,” said Bunker’s attorney, Chris Kent. “The complaint speaks for itself, and we’ll proceed with the litigation process.” Mediation was attempted, but failed to resolve this dispute, he added.

 

In response, Jeff Heatherington, president of FamilyCare, said that Bunker had been paid “what we believe the federal law allows. We’re essentially not allowed to incentivize a provider with bonuses for more than 33 percent of the total amount that they’ve been paid.”

 

FamilyCare never interfered with Bunker’s relationship with her patients either, he said. “We tried to move all of her patients to CareOregon but DMAP (the state Medicaid agency) wouldn’t allow us to do that. The record will sustain that.”

 

Bunker began providing medical services to FamilyCare members in September 2003.