Neighborhood Health Plan Sues Rhode Island Over $100M in Unpaid Claims
Neighborhood Health Plan of Rhode Island, the state's largest Medicaid managed care organization, filed suit against the Rhode Island Executive Office of Health and Human Services and interim director Kristen Sousa, alleging $100 million in overdue Medicaid reimbursements dating back more than a decade. The complaint, filed Oct. 30 in Providence County Superior Court, claims the state failed to recalculate and reimburse higher costs tied to covering medically needy members, particularly those in long-term care and nursing facilities, under contracts spanning 2013 to 2025. Neighborhood attributes the underpayments to the botched rollout of the state's RIBridges (formerly UHIP) benefits system, which created years-long backlogs in processing and reconciling eligibility data. The insurer is asking a judge to order repayment plus damages, or to appoint a special master or independent auditor to determine amounts owed.