Mayo Clinic sues Sanford Health Plan over unpaid medical bill
Mayo alleges that Sanford in South Dakota is responsible for $739,956.20 in medical expenses incurred by a patient in 2022.
Photo: Constantine Johnny/Getty Images
The Mayo Clinic and Mayo Clinic Hospital in Rochester, Minn., is suing Sanford Health Plan over a patient's unpaid medical bill.
Mayo demands $750,000 in the civil complaint filed December 13 in Minnesota.
Mayo alleges that Sanford in South Dakota is responsible for $739,956.20 in medical expenses incurred by a patient in the Mayo facilities in 2022.
Mayo asked that the action be removed from the Third Judicial District Court in Olmsted County, Minnesota, to federal court in Minnesota.
Sanford wants a dismissal, saying it's not responsible for the medical expenses for a patient who is on a tribal plan. Mayo has until January 17 to respond.
A motion hearing on the lawsuit is scheduled for Feb. 11, according to keloland.
WHY THIS MATTERS
Mayo is reportedly not charging the patient with the expense.
Mayo alleges Sanford misrepresented its role as the patient's primary payer, leading to unpaid claims.
Sanford's dismissal request says Mayo failed to follow standard Medicaid procedure,
Sanford is the "payor of last resort" it said, and said the patient's secondary insurance, Blue Cross Blue Shield, should have been billed,
Sanford reportedly preauthorized care and made partial payment, but later claimed Blue Cross Blue Shield of North Dakota was the primary payer. Mayo reportedly refunded Sanford's payments, but was denied reimbursement by BCBSND due to lack of preauthorization.
However, the Twin Cities Pioneer Press reported that on April 15, 2022, two weeks after the patient left the hospital, Sanford told the Mayo Clinic that the actual payer was a tribal plan called the Three Affiliated Tribes Tribal Health Plan, which is administered by Sanford.
That tribal plan is a "payor of last resort," the complaint said, meaning it is an "entity that pays after all other programs have been pursued for enrollment and payment," the report said.
The patient's primary insurer was listed as Sanford Health Plan, with secondary coverage through Blue Cross Blue Shield North Dakota Medicaid.
THE LARGER TREND
In June, the U.S. Supreme Court ruled that the federal government had been underfunding Native American tribes that administer their own healthcare programs for 30 years and must pay potentially hundreds of millions more going forward, according to Reuters.
In its 5-4 ruling, the court found that federal law requires the U.S. Department of Health and Human Services to pay the overhead costs that tribes incur when spending money from Medicare, Medicaid and private insurers. The ruling was a victory for the San Carlos Apache Tribe in Arizona and the Northern Arapaho Tribe in Wyoming, each of which had sued over the funding.
Email the writer: SMorse@himss.org
