NCAFP, NC Pediatric Society Successful in Suit Against NC Medicaid Over Vaccine Administration Fees

After more than three years of advocating for NC’s Division of Medical Assistance (DMA) to correct an underpayment of administration fees for immunizations provided to Medicaid patients under the Vaccines for Children (VFC) program, the NCAFP and the NC Pediatric Society received final word last week that its legal action has proved successful. NC Superior Court Judge Beecher R. Gray ruled that DMA must reprocess payments to attested primary care physicians for an extra $6.74 per affected vaccine. He also ruled that payments must be made within 120 days. DMA has 30 days to file an appeal.

During 2013 and 2014, all vaccines given under the VFC Program should have received the higher administration fee. However, approximately half the administration fees were paid at a lower rate. The amount any one practice is due will be based on how many vaccines were administered and paid at the lower level during the two years impacted by this case. Both associations had advocated directly to Medicaid to correct the error and continued to partner on the legal case to force the issue.