Tuesday, June 6, 2023
Hawai'i Free Press

Current Articles | Archives

Saturday, November 5, 2022
Hawaii Supreme Court: Hawaii MDs Eligible for Enhanced Medicaid Payments
By Andrew Walden @ 9:00 PM :: 1938 Views :: Hawaii County , Health Care

by Andrew Walden

Hawaii is worst in the USA for pursuing Medicaid fraud, but the Hawaii Department of Human Services (DHS) and the Attorney General’s office did spend seven years litigating against an honest doctor in Hilo, Frederick Nitta, MD, who had the audacity to work as a General Practitioner.

In the end, DHS lost. 

Moreover, the unanimous 5-0 Hawaii Supreme Court decision in Nitta vs DHS, November 4, 2022, opens the door to increased Medicaid payments in chronically doctor-short rural Hawaii.

Here are some key excerpts from the State Supreme Court ruling:

More than ninety percent of Dr. Nitta’s patients … are eligible for Medicaid or Medicare and do not have other doctors. Thus, although he is a board-certified OB/GYN physician, Dr. Nitta provides Primary Care Physician (PCP) services for his patients, is recognized in the community as a PCP, and provides a broad range of services to his patients.

Hence, in 2013, at the suggestion of an AlohaCare representative, a staff member from Dr. Nitta’s office enrolled him in the Program via the DHS website. The parties do not dispute that Dr. Nitta was attested to have a specialty designation of family medicine, general internal medicine, or pediatric medicine.

It appears Dr. Nitta first learned he was participating in the Program when he received a letter from DHS dated July 7, 2015 telling him he was ineligible because he did not satisfy Rule requirements. Then, in a letter dated November 6, 2015, DHS demanded repayment of $205,940.13 in payments made to him via the Program….

The Hawaiʻi Medical Association (“HMA”) and the American Medical Association (“AMA”) (“amici”) filed an amicus brief. Amici highlighted the critical and worsening physician shortage in Hawaiʻi, noting that primary care has the greatest shortage, especially for Medicaid patients in East Hawaiʻi.  Amici posited that DHS’s continued recoupment efforts against physicians providing primary care services to Medicaid beneficiaries only worsens the shortage. Amici also urged that the payments to Dr. Nitta were consistent with the ACA’s purpose to “benefit physicians that provide primary care services to the Medicaid population.” ….

While the ICA appeal was pending, the Sixth Circuit issued its Averett opinion invalidating the Rule that set forth additional eligibility requirements for the Program.… In Averett, Tennessee’s Medicaid agency, TennCare, had sought to recoup an average of more than $100,000.00 per physician from twenty-one physicians practicing in family medicine in rural Tennessee….

On February 11, 2022, the ICA published an opinion ….  The ICA adopted the Sixth Circuit’s analysis in Averett and held the circuit court wrongly concluded that Dr. Nitta was ineligible by relying on the Rule….

On May 23, 2022, DHS filed its application for writ of certiorari, arguing (1) Dr. Nitta was still ineligible for enhanced payments….

DHS contends that Dr. Nitta was ineligible because his “primary specialty designation” was OB/GYN, not family medicine, general internal medicine, or pediatric medicine….  We disagree with DHS…a physician can have more than one specialty….

Congress clearly intended the enhanced payments as incentives for the provision of primary care services, regardless of a physician’s other practice areas.…

We agree with amici that:

“… These low Medicaid payment rates do not provide adequate incentives for physicians to participate in Medicaid, limiting access to physicians’ services by Medicaid beneficiaries. In addition, low Medicaid payment rates discourage young physicians and other health professionals from entering careers in primary care, undermining efforts to address the shortage of primary care practitioners in many areas of the country….”

PDF: Read Full Decision

HTH: Hilo doctor prevails in high court decision regarding reimbursements  

AMA: Ob-gyn can keep $205,000 in Medicaid pay that state tried to recoup


TEXT "follow HawaiiFreePress" to 40404

Register to Vote


808 Silent Majority

Aloha Pregnancy Care Center


Antonio Gramsci Reading List

A Place for Women in Waipio

Back da Blue Hawaii

Ballotpedia Hawaii

Broken Trust

Build More Hawaiian Homes Working Group

Christian Homeschoolers of Hawaii

Cliff Slater's Second Opinion

DVids Hawaii


Fix Oahu!

Frontline: The Fixers

Genetic Literacy Project

Grassroot Institute


Hawaii Aquarium Fish Report

Hawaii Aviation Preservation Society

Hawaii Catholic TV

Hawaii Christian Coalition

Hawaii Cigar Association

Hawaii ConCon Info

Hawaii Debt Clock

Hawaii Defense Foundation

Hawaii Family Forum

Hawaii Farmers and Ranchers United

Hawaii Farmer's Daughter

Hawaii Federalist Society

Hawaii Federation of Republican Women

Hawaii History Blog

Hawaii Homeschool Association

Hawaii Jihadi Trial

Hawaii Legal News

Hawaii Legal Short-Term Rental Alliance

Hawaii Matters

Hawaii's Partnership for Appropriate & Compassionate Care

Hawaii Public Charter School Network

Hawaii Rifle Association

Hawaii Shippers Council

Hawaii Smokers Alliance

Hawaii State Data Lab

Hawaii Together



Hiram Fong Papers

Homeschool Legal Defense Hawaii

Honolulu Navy League

Honolulu Traffic

House Minority Blog

Imua TMT

Inouye-Kwock, NYT 1992

Inside the Nature Conservancy

Inverse Condemnation

Investigative Project on Terrorism

July 4 in Hawaii

Kakaako Cares

Keep Hawaii's Heroes

Land and Power in Hawaii

Legislative Committee Analysis Tool

Lessons in Firearm Education

Lingle Years

Malulani Foundation

Managed Care Matters -- Hawaii

Malama Pregnancy Center of Maui


Military Home Educators' Network Oahu

Missile Defense Advocacy

MIS Veterans Hawaii

NAMI Hawaii


National Christian Foundation Hawaii

National Parents Org Hawaii

NFIB Hawaii News

No GMO Means No Aloha

Not Dead Yet, Hawaii

NRA-ILA Hawaii

Oahu Alternative Transport


OHA Lies

Opt Out Today


Patients Rights Council Hawaii

PEACE Hawaii

People vs Machine

Pritchett Cartoons

Pro-GMO Hawaii



Rental by Owner Awareness Assn

ReRoute the Rail

Research Institute for Hawaii USA

Rick Hamada Show

RJ Rummel

Robotics Organizing Committee

School Choice in Hawaii


Sink the Jones Act

Statehood for Guam

Talking Tax

Tax Foundation of Hawaii

The Real Hanabusa

Time Out Honolulu

Trustee Akina KWO Columns

UCC Truths

US Tax Foundation Hawaii Info

VAREP Honolulu


West Maui Taxpayers Association

What Natalie Thinks

Whole Life Hawaii