To All Healthcare Providers Who Treat Medicare Advantage Patients:

This is an update and reminder to please make sure you are timely pursuing all 340B rate adjustments disputes against your contracted Medicare Advantage Payors based on the Supreme Court’s recent 2023 ruling that the Medicare rates from 2018-2022 required adjustments in favor of providers.

In short, if you were ever paid between 2018-2022 for 340B qualified drugs – it is possible you have a recoverable dispute against your Medicare Advantage contracted payors who agreed to pay you at Medicare rates.

Why? Simple – when the Supreme Court ruled that the rates from 2018-2022 were too low and compelled Medicare to adjust rates higher for those dates of service, all applicable 340B claims, even ones paid correctly prior to 2023, became underpaid.

The result – you may now have a cause of action for these claims.

The catch – many of your Medicare Advantage payor contracts will have a statute of limitations of a year from when the “underpayment” occurred.  Because the Supreme Court made the ruling in December 2023 – you could likely have less than a month to get these claim disputes on file through legal action.

So, do whatever you can to preserve your right to this potential recoverable revenue and do not wait – the clock is ticking!

Should you have any questions about this recent, time-sensitive development, please let us know as we are here to help in any way we can.

Regards,
SAC Team