HILO — A Hilo obstetrician/gynecologist is fighting a state Department of Human Services finding that he had been overpaid more than $200,000 for services to Medicaid patients.
Honolulu attorney Eric Seitz filed an appeal Aug. 8 in Hilo Circuit Court on behalf of Dr. Frederick Nitta.
The suit, which names DHS and Pankaj Bhanot, the agency’s deputy director, as defendants, alleges DHS sent a letter to Nitta in July 2015 demanding that Nitta repay $205,220.86 in insurance reimbursements he received as a Medicaid primary care provider.
According to the filing, the DHS claims Nitta doesn’t qualify for the enhanced reimbursement rate given to primary care providers because less than 60 percent of his practice is devoted to primary care services.
Nitta disputed DHS’s letter demanding repayment and was granted an administrative hearing, which sided with the DHS. Nitta appealed the hearings officer’s conclusion to Bhanot, who upheld the decision.
“I’m appalled,” Seitz said Friday. “Dr. Nitta’s practice is over 90 percent Medicare and Medicaid patients. He’s the only doctor in … East Hawaii who considers to accept new Medicare (and) Medicaid patients. Most (doctors) treat the patients, but they don’t take new ones because the reimbursements aren’t large enough and they can’t afford to.”
This isn’t the first time a dispute concerning Medicaid reimbursements to Nitta has landed in court. In September 2014, DHS cut off Medicaid payments to Nitta, accusing him of fraud after a preliminary investigation found his office had been overpaid more than $1.2 million for urine drug screening tests between 2012 and 2014.
Nitta contested the decision, and in February 2015 a state hearings officer overturned Nitta’s payment suspension, finding there had not been a “credible allegation of fraud” against the doctor and that any overbilling resulted from insurance companies providing Nitta’s staff with an incorrect billing code to be used for the drug tests he administered to patients.
In March 2015, the state attorney general appealed to Hilo Circuit Court, arguing the hearing officer’s decision was “clearly erroneous.” Judge Greg Nakamura upheld the hearing officer’s ruling that overturned the payment suspension, finding there were mistakes made in the way Medicaid was billed but no intentional fraud.
The DHS investigator in both cases is Kurt Kresta. The Aug. 8 appeal claims Kresta, a former Dallas police detective, has “no training or background in medicine or any medical related field.” In that case, Kresta testified he determined Nitta was not a primary care provider from “internet reports, news articles, and other similar sources,” according to the appeal. The suit also states Kresta also cited records containing billing codes to help make his determination, but “the actual billing codes never were produced and could not be verified by Dr. Nitta’s counsel or the hearing officer.”
According to the document, a medical billing and coding expert hired by Nitta conducted a full audit of Nitta’s patient medical records and concluded “well over sixty percent of Dr. Nitta’s time and work was spent providing primary care treatment.”
The appeal claims the hearings officer relied “entirely upon the testimony of Kurt Kresta” and accuses Kresta of “obvious bias and incompetence.”
“Kresta’s basically looking for a way to put (Nitta) out of business because of, I think, probably, the extreme embarrassment the last time around. And that’s what’s fueling this,” Seitz said. “And for them to be going after him when there’s a horrible shortage of primary care physicians is, to me, absolutely hypocritical and dishonest.”
Nitta said Tuesday he takes Medicare and Medicaid patients because if he didn’t, most of his patients would be unable to find primary medical care.
“I don’t do it because I need the money. I don’t. I’m constantly busy; I can’t keep up,” he said. “The reason they’re doing this is because if they lose this case, all the other doctors they took money back for this enhanced payment — and they did, from all around the state — they’re going to get in big trouble now, because they’re going to have to give that money back.
“If I’m wrong, I’m just going to say I’m wrong and deal with it. The cost of me going to court with this is more than what they’re asking for. Why would I fight something if I felt guilty? I wouldn’t. I’d just pay it. The reason is, what the state is doing is wrong.”
A DHS spokeswoman said Tuesday the agency hasn’t been served with the appeal and can’t comment.