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July 3, 2024

Alice Peck Day Memorial Hospital et al v. Vermont Agency of Human Services, Secretary et al

In July 2021, four New Hampshire hospitals, participants in Vermont’s Medicaid program, filed a lawsuit against the program’s administrators. In their complaint, (Alice Peck Day Memorial Hospital et al v.  State of Vermont Agency of Human Services et al (2:21 – cv-00102)), Plaintiffs alleged that Vermont’s Medicaid program reimbursed them at materially lower rates than in-state hospitals for the same services. Econ One’s expert, Dr. Leslie Schafer, was retained by the Attorney General of Vermont as an expert witness.  

Dr. Schafer was asked to assess the validity of the alleged underpayment. With the assistance of Alina Marinova, Dr. Schafer developed a multi-state comparative approach that evaluated the similarities and differences between Plaintiffs and hospitals in other New England states and their Medicaid reimbursement rates using paid claims data and Medicare cost reports. Dr. Schafer drew on her extensive experience with prior healthcare reimbursement matters for this assignment.   

Dr. Schafer’s analysis was instrumental to the parties reaching a settlement in October 2023 prior to submission of an expert report. 

Industries: Healthcare, Insurance

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