A judge’s decision to deny Prisma Health’s request for summary judgment and to dismiss a Medicaid overbilling lawsuit will allow a potential class action claim to advance, The State newspaper of Columbia reported.
In addition to denying Prisma’s requests, Judge Daniel Coble, of Richland County, also ruled that attorneys for plaintiff Dawn Darby, also of Richland County, can begin to conduct detailed discovery. The ruling requires Prisma’s defense team to provide Darby’s attorneys with thousands of more documents than those already turned over.
It also will fall to the judge to decide if the lawsuit should become a class action.
The hospital system declined to comment Monday.
“Prisma Health does not respond to active litigation,” it said in a statement to The State. “Because this matter is currently in litigation, we will not provide any comment at this time.”
The lawsuit came about after Darby received bills from Prisma for care provided to her child, J.D., who was injured at birth and is now a Medicaid beneficiary.
State rules require medical providers to count payments by Medicaid, a federal health insurance program for low-income residents, as completely satisfying a health care charge, the newspaper reported.
However, in December 2020, Prisma billed Darby for Medicaid-covered services for J.D. Despite having spoken with a hospital representative and thinking that she had resolved the matter, Darby was later contacted by Prisma about the balance and was told the matter could be sent to collections.
Documents in the case also say that she received numerous bills from 2018 to 2021.
Prisma’s attorneys have said in filings that Darby suffered no injury because she did not pay the December 2020 bill, and the matter was not sent to collections.
“At best, (Darby) received a medical bill that she was not supposed to receive and had to make a phone call to Prisma requesting that the bill be re-submitted to Medicaid,” The State quoted a filing as saying.
The hospital’s lawyers also have said that Darby has no specific legal authority to sue over this sort of billing dispute.