Sign In
Events
Newsletters
Search

Close

Close Search

Cancel

SEARCH
MY LAW.COMNEW

Toal v. DeKalb Med. Ctr. Inc.

Georgia's 1996 Medicaid reimbursement plan was invalid because the Georgia Department of Medical Assistance adopted the plan without make the findings necessary to insure that the plan provided for the reimbursement of health care providers at rates which are reasonable and adequate to meet the costs incurred by efficiently and economically operated facilities.

X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

The DeKalb Medical Center and various other hospitals sued the Georgia Department of Medical Assistance DMA, claiming, among other things, that DMA’s Medicaid reimbursements to the hospitals breached the terms of their respective provider agreements.1 The trial court granted summary judgment to the hospitals on certain issues and to DMA on others. Both sides appeal aspects of the trial court’s ruling.

Medicaid is a federal-state program under which the federal government provides financial assistance to states to enable them to provide medical care to needy individuals.2 To qualify for federal assistance, a state must formulate a plan and submit it for approval to the federal Health Care Financing Agency HCFA, an agency of the Department of Health and Human Services HHS.3 Among other things, the plan must contain a scheme for reimbursing health care providers who provide services to Medicaid patients.4 During the time period relevant in this case, a provision of the Medicaid Act known as the Boren Amendment required that state plans must provide for hospitals to be reimbursed at rates “which the State finds, and makes assurances satisfactory to the Secretary of HHS are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities.”5 The Boren Amendment has both a procedural and a substantive component—i.e., the State must make the requisite findings and assurances, and must also adopt rates that are in fact reasonable and adequate.6

Trending Stories

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

LEARN MORE

More From ALM

Premium Subscription
With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Team Accounts
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Bundle Subscriptions
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
Go to CLE Center
Southeastern Legal Awards 2025
May 01, 2025
Atlanta, GA

The Daily Report is honoring those attorneys and judges who have made a remarkable difference in the legal profession.


Learn More
GlobeSt. Healthcare Real Estate 2024
December 02, 2024 - December 03, 2024
Scottsdale, AZ

Join the industry's top owners, investors, developers, brokers and financiers for the real estate healthcare event of the year!


Learn More
ThinkAdvisor LUMINARIES Awards 2024
December 11, 2024
Las Vegas, NV

This event shines a spotlight on how individuals and firms are changing the investment advisory industry where it matters most.


Learn More
Go to Events Go to Webcasts
School Law Associate

We are seeking two attorneys with a minimum of two to three years of experience to join our prominent and thriving education law practice in...


Apply Now ›
Real Estate Litigation Associate - New York, NY

Description: Fox Rothschild has an opening in the New York office for a Real Estate Litigation Associate with three to six years of commerci...


Apply Now ›
Attorney - Insurance Defense

Downtown NY property and casualty defense law firm seeks a Litigation Associate with 3+ years' experience to become a part of our team! You ...


Apply Now ›
Go to Lawjobs